Cardiopulmonary Resuscitation Education Research Articles

Abstract 22: When Laws Save Lives: Impact of Legislation Requiring Cardiopulmonary Resuscitation Education in High Schools on Survival After Sudden Cardiac Arrest

Introduction: Thirty eight states have laws requiring education of high school students on cardiopulmonary resuscitation (CPR) and the use of automated external defibrillators (AED). No study has measured the association of these laws and outcomes. Hypothesis: Out of hospital cardiac arrests (OHCAs) occurring in states with CPR high school education laws will have higher bystander CPR, survival, and favorable neurological survival than states without such laws. Methods: We conducted an analysis of the Cardiac Arrest Registry to Enhance Survival database and included all nontraumatic OHCAs with at least 50% population catchment from 1/2013-12/2017 in all ages. We excluded OHCAs witnessed by 911 responders, in healthcare facilities, or nursing homes. Outcomes were bystander CPR, survival to hospital discharge and neurologically favorable survival (Cerebral Performance Category score of 1 or 2 at hospital discharge). Chi-square tests were used to assess associations. Results: The 110,902 subjects with OHCA included Male, 64.0%; <18 yrs., 3.2%; <35 yrs., 10.7%; <50 yrs., 23.9%; White, 49.3%; Black, 19.1%; Hispanic, 2.3%; Other, 2.9%; Unknown, 26.5%. Most OHCAs occurred at home, 81.4%. 44.4% were witnessed by bystanders. 75.5% occurred in states with CPR high school education laws. A higher percent of OHCAs received bystander CPR prior to emergency medical services (EMS) arrival in states with CPR high school education laws (40.1%) compared to states without laws (37.0%) (p<0.001). Bystander CPR was less common in males (40.3% vs. 37.7% for females), those >50 yrs. (38.9% vs. 40.7% for ≤50 yrs.), Black and Hispanic subjects (25.7% and 34.9%, respectively, vs. 42.4% for Whites) (p<0.001 for all). Overall survival to hospital discharge was 10.4%; 8.8% had a favorable neurological outcome. A higher percent survived to hospital discharge in states with CPR high school education laws (11.0%) compared to states without laws (8.7%) (p<0.001). Neurologically favorable survival was more likely in states with CPR high school education laws, (9.3%) compared to states without laws (7.5%) (p<0.001). Conclusions: Bystander CPR, survival to hospital discharge, and neurologically favorable survival was higher in states that had CPR high school education laws.

Public knowledge, attitudes and willingness regarding bystander cardiopulmonary resuscitation: A nationwide survey in Taiwan

A low bystander cardiopulmonary resuscitation (CPR) rate is one of the factors associated with low cardiac arrest survival. This study aimed to assess knowledge, attitudes, and willingness towards performing CPR and the barriers for implementation of bystander-initiated CPR. Telephone interviews were conducted using an author-designed and validated structured questionnaire in Taiwan. After obtaining a stratified random sample from the census, the results were weighted to match population data. The factors affecting bystander-initiated CPR were analysed using logistic regression. Of the 1073 respondents, half of them stated that they knew how to perform CPR correctly, although 86.7% indicated a willingness to perform CPR on strangers. The barriers to CPR performance reported by the respondents included fear of legal consequences (44%) and concern about harming patients (36.5%). Most participants expressed a willingness to attend only an hour-long CPR course. Respondents who were less likely to indicate a willingness to perform CPR were female, healthcare providers, those who had no cohabiting family members older than 65 years, those who had a history of a stroke, and those who expressed a negative attitude toward CPR. The expressed willingness to perform bystander CPR was high if the respondents possessed the required skills. Attempts should be made to recruit potential bystanders for CPR courses or education, targeting those respondent subgroups less likely to express willingness to perform CPR. The reason for lower bystander CPR willingness among healthcare providers deserves further investigation.

Cardiopulmonary resuscitation education in the Russian Federation: A systematic analysis of the scientific evidence

Purpose of the study: To identify, summarize and appraise the available scientific evidence on education in cardiopulmonary resuscitation (CPR) in Russia.

Quality assessment of instructions for dispatcher-assisted telephone cardiopulmonary resuscitation (DATCPR) performed between emergency medical technicians (EMTs) and registered nurses (RNs)

Purpose: Quality of DATCPR instructions between EMT and RN are not well known. In vertical dispatch call-taker and CPR instructor would be the same EMT; in horizontal dispatch call-taker would be EMT while CPR instructor could be RN to takeover the calls of recognized OHCA. This study was to compare the quality of DATCPR instructions between EMTs and RNs.

Readiness of Hong Kong secondary school teachers for teaching cardiopulmonary resuscitation in schools: A questionnaire survey

Background: Bystander cardiopulmonary resuscitation can improve the survival rate of patients with out-of-hospital cardiac arrest. Teaching cardiopulmonary resuscitation in schools by teachers is one of the ways to increase the number of bystanders who can perform cardiopulmonary resuscitation. Nevertheless, there have been no studies on the readiness of teachers in Hong Kong to teach cardiopulmonary resuscitation in their schools. Objective: To assess whether secondary school teachers are prepared to teach their students cardiopulmonary resuscitation. Methods: This was a questionnaire survey. Teachers from 22 local secondary schools were recruited. The questionnaires were designed with questions covering their knowledge about cardiopulmonary resuscitation and attitudes towards teaching their students cardiopulmonary resuscitation. A knowledge score and attitude score were calculated. Result: 557 teachers completed the questionnaires. Most had never witnessed a cardiac arrest and over half of them had never been trained cardiopulmonary resuscitation or use of an automated defibrillator. About 25% of them answered all questions on knowledge wrong. Only 25% supported teaching cardiopulmonayr resuscitation in schools and 32% were willing to teach it. Legal liability was a major concern. Conclusion: Local teachers’ readiness for teaching students cardiopulmonary resuscitation in secondary schools is likely poor. More efforts are required to raise their knowledge level on cardiopulmonary resuscitation and instill a positive attitude towards cardiopulmonary resuscitation education in schools.

App-based learning as an alternative for instructors in teaching basic life support to school children: a randomized control trial

ABSTRACTBackground: The importance of early cardiopulmonary resuscitation (CPR) during an out-of-hospital cardiac arrest (OHCA) cannot be emphasized enough and has a major impact on survival. Unfortunately, CPR education in schools is often inadequate or non-existing due to lack of educators and financial resources. The introduction of application-based teaching could facilitate education as no instructor is needed. The aim of present study is to compare app-based self-teaching (intervention group) with a traditional instructor-led course (control group). This trial is in line with the endorsement of training school children by the World Health Organization (WHO).Methods: This randomized controlled trial contains 165 participants between 16 and 18 years. The control group followed an instructor-led course, while the intervention group used a tablet application to complete a self-education course.Both groups were taught in separated classes during 40 min and used manikins and automated external defibrillator (AED) trainer kits. Before and after training, both groups were evaluated in a practical test to examine their skills (an overall score and sub-scores on different sections were obtained, following ERC 2015 guidelines).Results: No significant difference (p = 0.304) in overall teaching effectiveness was found between both groups. Although, in a sub-analysis, we found significantly better results for the instructor group for checking airway (p = 0.018), asking for an AED (p < 0.01) and shocking the patient (p = 0.002).Conclusions: App-based teaching can be a valuable alternative for classic instructor-based education. Yet new apps have to be evaluated before being implemented in CPR education.

A Study on the Cardiopulmonary Resuscitation Education of the Medical Workers

A Study on the Cardiopulmonary Resuscitation Education of the Medical Workers

Effect of knee positions on cardiac compression variables in cardiopulmonary resuscitation of rescuer; Manikin study

The aim of the study was to analyze the effect of knee positions on cardiac compression variables in cardiopulmonary resuscitation (CPR) using the manikin. Adult with career of CPR instructor (n=9; mean age, 27.11±6.60 years; mean heights, 177.39±4.40 cm; mean weights, 69.45±14.85 kg) participated in the experiment, and each participant performed cardiac compression from two different knee positions. Cardiac compression was 30 times per minute for each position with order of position randomized. The results obtained from variables of cardiac compression force were composed of compression velocity, elapsed time, decay rate, and loading rate in maximum and minimum medial-lateral, anterior-posterior (AP), vertical direction respectively. The above variables in 20.3 cm of knee position showed effective result than that of 50 cm of knee position, while maximum AP compression force increased. Given the often predictable setting of sports and exercise rehabilitation related with cardiac arrest, CPR relative to change of knee position were significantly associated with more efficient cardiac compression variables. These data have significant implications for health services program in fields of sports and exercise rehabilitation.

Effect of quality management on the training effect of cardiopulmonary resuscitation

Objective The quality management method was introduced into the teaching of pediatric cardiopulmonary resuscitation(CPR), and to improve the quality of training and realize teaching objectives. Methods Quality management team analyzed the examination results of CPR by Plato method, and cleared the risk factors associated with quality problem.A standard operating procedure was used in teaching and assessment of the CPR, and doctors′ examination results of CPR would be analyzed by a statistical approach. Results Platonic analysis showed that heart compressions and artificial ventilation were risk factors associated with quality problem in CPR.In the total frequency of deductions, the proportion of the heart compressions was 36.8% and artificial ventilation was 15.7%.According to the standard operating procedure, the quality of heart compressions in CPR was improved.In the total frequency of deductions, the proportion was only 3.5%. Conclusion The quality management method can be applied in the teaching of cardiopulmonary resuscitation, which can improve the teaching quality. Key words: Cardiopulmonary resuscitation; Quality management; Standardized training of resident doctors; Teaching quality; Children; Skills

Current Status of Knowledge about Cardiopulmonary Resuscitation among the University Students in the Northern Region of Saudi Arabia.

Background Sudden cardiac arrest is a major public health problem in the world. Immediate initiation of high-quality cardiopulmonary resuscitation (CPR) significantly increased patient survival rate. Therefore, it is very important to train young people and increase public awareness of CPR for the long-term benefit of the community. Objective We aimed at estimating the level of knowledge and attitude towards cardiopulmonary resuscitation (CPR) among the university students in the northern region of Saudi Arabia. Methodology A cross-sectional, prospective study was conducted among the students of four northern region universities of Saudi Arabia (Jouf, Hail, Northern Borders, and Tabuk) between March and November 2017. A self-administered questionnaire was prepared in both Arabic and English languages and distributed to all the participants. All the data were collected and analyzed by using SPSS version 21. Results A total of 947 students from four universities completed the questionnaire: Jouf (57%), Hail (15%), Northern Borders (13%), and Tabuk (15%). Although 72% of students have previous knowledge about CPR, 49% of them lack knowledge about a medical emergency. Moreover, 59% failed to answer regarding CPR where only 41% wrote the ABC steps in the correct sequence. However, 67% of the participants had very poor knowledge, 89% of participants desired to receive additional CPR training course, and 49% of the students thought that CPR training should be a mandatory graduation requirement for all universities. There were no significant differences between male and female students. Students from medicine-related colleges have significantly (p < 0.001) more knowledge and scored better compared with non-medicine-related colleges. Tabuk University scored better compared to the others, but the overall knowledge and attitude scored were low. Conclusions Overall knowledge about CPR among the university students was not satisfactory; however, attitude towards CRP training was very positive. Our results suggested that there is a need for improvement of CPR education among Saudi university students, which will help to reduce the cardiac arrest mortality rate among the community.

Awareness and willingness to perform CPR: a survey amongst Flemish schoolchildren, teachers and principals

ObjectivesTraining children in cardiopulmonary resuscitation (CPR) is one of the strategies to increase bystander CPR in society. Reinforcing knowledge and awareness and increasing willingness to perform bystander CPR contributes to a better outcome after cardiac arrest. We questioned schoolchildren, teachers and principals about their awareness of the importance of CPR and about their willingness to perform CPR.MethodsDuring a four-month period, Flemish schoolchildren aged 10–18 years, teachers and principals were invited to complete a survey consisting of three parts: (1) demographics, (2) CPR (training) experience and (3) attitude towards CPR teaching and training.ResultIn total, 390 schoolchildren, 439 teachers and 100 principals completed the survey. Previous CPR training was reported by 33% of the schoolchildren (in 82% as part of the curriculum) and by 81% teachers and 82% principals. Willingness to participate in CPR training was 77% in schoolchildren, 79% in teachers and 86% in principals with 88% of the principals convinced that schoolchildren should learn how to perform CPR. Willingness to perform CPR in a real-life situation was 68% in schoolchildren, 84% in teachers and 92% in principals.ConclusionSchoolchildren are well aware of the importance of CPR and are willing to acquire the related knowledge and skills. Noteworthy is the larger awareness among principals and teachers, establishing a strong base for increasing implementation of CPR training in schools. However, a majority of children indicated a lack of training opportunities, highlighting the need for a stronger implementation.

Addressing Gaps in Cardiopulmonary Resuscitation Education: Training Middle School Students in Hands-Only Cardiopulmonary Resuscitation.

Training middle school students to perform hands-only cardiopulmonary resuscitation (HOCPR) is a potential method to increase overall rates of bystander cardiopulmonary resuscitation (CPR). We aimed to examine the feasibility of teaching this population CPR using teacher-implemented education sessions guided by American Heart Association (AHA) training kits and resources. We conducted a national HOCPR training campaign in middle schools during the 2014-2015 school year. Participating schools utilized AHA CPR training kits to train seventh and eighth grade students. We assessed pretest/posttest knowledge and comfort in performing HOCPR. We recruited 1131 schools and trained approximately 334,610 students in HOCPR. The average pretest score on knowledge questions was 50% and the average posttest score was 84%. Most students (76%) felt comfortable performing HOCPR after the education session. Overall, 98% of teachers said they would continue to implement CPR training in the future. Large-scale, teacher-implemented CPR education sessions in the middle school setting are a successful approach to increase middle school student's knowledge and comfort in performing HOCPR and to increase overall bystander CPR rates.

Recognition of out-of-hospital cardiac arrest during emergency calls and public awareness of cardiopulmonary resuscitation in communities: A multilevel analysis

BackgroundFor an effective dispatcher-assisted cardiopulmonary resuscitation (CPR) program, recognition of out-of-hospital cardiac arrest (OHCA) by a dispatcher is the first step in initiating bystander CPR. This study evaluated whether CPR awareness in the community is associated with recognition of arrest, dispatcher-provided CPR instructions, and bystander CPR. MethodsAll emergency medical services (EMS)-treated adult OHCAs with cardiac etiology were enrolled between 2013 and 2015, excluding cases witnessed by EMS providers. Exposure was CPR awareness in the community where the OHCA occurred. Endpoints were recognition of arrest, dispatcher-provided CPR instructions, and bystander CPR. Multilevel logistic regression analysis was performed to calculate adjusted odds ratios (AORs) per 10% increment in community CPR awareness adjusting for potential confounders. ResultsOf 44,185 eligible OHCAs, 20,255 (45.8%) cases were recognized by a dispatcher, 17,858 (40.4%) received dispatcher-provided CPR instructions, and 22,255 (50.4%) received bystander CPR (39.8% with dispatcher assistance and 10.6% without dispatcher assistance). Compared with OHCAs that occurred in the communities with low awareness, dispatchers were more likely to provide CPR instructions to the caller, and bystanders were more likely to perform CPR for OHCAs that occurred in the communities with high CPR awareness. AORs (95% CIs) per 10% increment in public awareness of CPR in the community were 1.05 (1.01–1.10) for recognition of arrest, 1.11 (1.06–1.16) for dispatcher-provided CPR instructions, and 1.07 (1.03–1.11) for bystander CPR. ConclusionsPublic CPR awareness of the communities where OHCAs occurred was associated with recognition of arrest during an emergency call, dispatcher-provided CPR instructions, and bystander CPR.

Does Non-Targeted Community CPR Training Increase Bystander CPR Frequency?

Objective: Only 37% of out-of-hospital cardiac arrests (OHCA) receive bystander Cardiopulmonary resuscitation (CPR) in Kent County, MI. In May 2014, prehospital providers offered one-time, point-of-contact compression-only CPR training to 2,253 passersby at 7 public locations in Grand Rapids, Michigan. To assess the impact of this intervention, we compared bystander CPR frequency and clinical outcomes in regions surrounding training sites before and after the intervention, adjusting for prehospital covariates. We aimed to assess the effect of this broad, non-targeted intervention on bystander CPR frequency, type of CPR utilized, and clinical outcomes. We also tested for differences in geospatial variation of bystander CPR and clinical outcomes clustered around training sites. Methods: Retrospective, observational, before-after study of adult, EMS-treated OHCA in Kent County from January 1, 2010 to December 31, 2015. We generated a 5-kilometer radius surrounding each training site to estimate any geospatial influence that training sites might have on bystander CPR frequency in nearby OHCA cases. Chi-squared, Fisher's exact, and t-tests assessed differences in subject features. Difference-in-differences analysis with generalized estimating equation (GEE) modeling assessed bystander CPR frequency, adjusting for training site, covariates (age, sex, witnessed, shockable rhythm, public location), and clustering around training sites. Similar modeling tested for changes in bystander CPR type, return of spontaneous circulation (ROSC), survival to hospital discharge, and cerebral performance category (CPC) of 1–2 at hospital discharge. Results: We included 899 cases before and 587 cases post-intervention. Overall, we observed no increase in the frequency of bystander CPR or favorable clinical outcomes. We did observe an increase in compression-only CPR, but this was paradoxically restricted to OHCA cases falling outside radii around training sites. In adjusted modeling, the bystander CPR training intervention was not associated with bystander CPR frequency (β −0.002; 95% CI −0.16, 0.15), compression-only CPR (β −0.06; 95% CI −0.15, 0.02), ROSC (β −0.06; 95% CI −0.21, 0.25), survival (β −0.02; 95% CI −0.11, 0.06), or favorable neurologic outcome (β −0.01; 95% CI −0.07, 0.09). Conclusions: We observed no impact in bystander CPR performance or outcomes from a blanket, non-targeted approach to community CPR education. The effect of targeted CPR education in locales with known low bystander CPR rates should be tested in this region.

2018 National consensus on cardiopulmonary resuscitation training in China

To promote the technical training and scientific popularization of cardiopulmonary resuscitation (CPR) in China, the Cardiopulmonary Resuscitation Specialized Committee of Chinese Research Hospital Association combined with the Science Popularization Branch of the Chinese Medical Association wrote "2018 National consensus on cardiopulmonary resuscitation training in China". The formation was based on the general outline about "2016 National consensus on cardiopulmonary resuscitation in China", and to implement the important strategies included the "three pre" policy, prevention, precognition, and pre-warning, before the cardiac arrest (CA); the "three modernization" methods, standardized, diversified and individualized, during the CA; and the "three life" strategies, the rebirth, the extra and the extended, after the CA; and also combined with the concrete National conditions and clinical practice of China area. The document summarized the evidence of published science about CPR training till now, and recommend the establishment of "the CPR Training Triangle" according to the Chinese National conditions. The bases of the triangle were system, training and person, the core of which was CPR science. The main contents were: (1) The "three training" policy for CPR training: the cultivation of a sound system, which included professional credibility, extensive mobilization and continuous driving force, and the participation of the whole people and continuous improvement; the cultivation of scientific guidelines, which included scientific content, methods and thinking; and the cultivation of a healthy culture, which included the enhancement of civic quality, education of rescue scientifically, and advocate of healthy life. (2) The "three training" program of CPR training: training professional skills, which included standard, multiple, and individual skills; training multidimensional, which included time, space, and human; and training flexible, including problem, time, and innovation oriented. (3) The "three party" direction of CPR training, the application for achievement translation, which included scientific translations, skill propagators, and cultural advocates; the precision disseminators, which included accurate communication sources, channels, and dissemination of the audience; and theoretical innovation guides, which included scientific, popular science and communication theory. That integrated the wisdom of scholars, melt the thought of genius, and created the act of envoy for Chinese and foreign CPR training. The training program should be suitable for different trainee, no matter who is trainer or trainee. The release of the expert consensus on the 2018 CPR training will make the National CPR education into the new training era with definite direction, clear target and fully standard of China.

Dispatcher CPR Instructions Across the Age Continuum.

Survival rates following out-of-hospital cardiac arrest (OHCA) increase two to three times when cardiopulmonary resuscitation (CPR) is started by bystanders, as compared to starting CPR when Emergency Medical Services (EMS) arrives. Municipalities that have implemented dispatcher-assisted bystander CPR programs have seen increased rates of bystander CPR. Cardiopulmonary resuscitation instructions are given for victims of all ages, but it is unknown if offering instructions results in similar rates of EMS-documented bystander CPR across the age continuum in these municipalities. The aim of this study was to determine if there is a difference in EMS-documented bystander CPR rates based on the age group of the OHCA victim when dispatcher CPR instructions are available in the community. This was a three-year, retrospective chart review of OHCA patients in two municipalities within a single county that provided dispatcher-assisted CPR instructions. Bystander CPR and patient age were determined based on EMS documentation. Age was stratified into three groups: child (0-12 years), adult (13-54 years), and geriatric (≥55 years). Chi square was used to compare the rate of bystander CPR in each age group. During the study period, 1,993 patients were identified as being in OHCA at the time of EMS arrival. The overall bystander CPR rate was 10%. The highest rate of bystander CPR was in the child age group (19%). The lowest rate of bystander CPR was in the geriatric age group (9%). There was a statistically significant difference between age groups (P≤.01). The rate of EMS-documented bystander CPR was low, even though these municipalities provided dispatcher-assisted CPR instructions. The highest rates of bystander CPR were observed in children (0-12 years). Future investigations should determine why this occurs and if there are opportunities to modify dispatcher coaching based on patient age so that bystander CPR rates improve. WeinmeisterKL, LernerEB, GuseCE, AteyyahKA, PirralloRG. Dispatcher CPR instructions across the age continuum. Prehosp Disaster Med. 2018;33(3):342-345.

“All citizens of the world can save a life” — The World Restart a Heart (WRAH) initiative starts in 2018

“All citizens of the world can save a life”. With these words, the International Liaison Committee on Resuscitation (ILCOR) is launching the first global initiative – World Restart a Heart (WRAH) – to increase public awareness and therefore the rates of bystander cardiopulmonary resuscitation (CPR) for victims of cardiac arrest. In most of the cases, it takes too long for the emergency services to arrive on scene after the victim’s collapse. Thus, the most effective way to increase survival and favourable outcome in cardiac arrest by two- to fourfold is early CPR by lay bystanders and by “first responders”. Lay bystander resuscitation rates, however, differ significantly across the world, ranging from 5 to 80%. If all countries could have high lay bystander resuscitation rates, this would help to save hundreds of thousands of lives every year. In order to achieve this goal, all seven ILCOR councils have agreed to participate in WRAH 2018. Besides schoolchildren education in CPR (“KIDS SAVE LIVES”), many other initiatives have already been developed in different parts of the world. ILCOR is keen for the WRAH initiative to be as inclusive as possible, and that it should happen every year on 16 October or as close to that day as possible. Besides recommending CPR training for children and adults, it is hoped that a unified global message will enable our policy makers to take action to address the inequalities in patient survival around the world.

Exploring the implementation of family-witnessed resuscitation.

Cardiac arrest is a traumatic event, both for patients and their family members. Traditionally, healthcare professionals have often been reluctant to offer family members the opportunity to witness cardiopulmonary resuscitation (CPR) attempts. However, professional bodies globally have begun to recommend the use of family-witnessed resuscitation (FWR) during CPR, identifying a range of potential benefits including supporting the patient, increasing family members' confidence in healthcare professionals and, in some cases, promoting acceptance of the patient's death. This article explores the benefits of, and barriers to, the implementation of FWR during CPR. Despite the perceived benefits of FWR identified by professional bodies, healthcare professionals, and patients and their families, the evidence indicates there is ongoing reluctance among some healthcare professionals to incorporate FWR in practice. Therefore, standardised global policies aimed at the multidisciplinary implementation of FWR are required. Additionally, multidisciplinary training and education in CPR should be readily available, particularly in areas where CPR is frequently used, such as emergency departments.

"Please. Don't. Die.": A Grounded Theory Study of Bystander Cardiopulmonary Resuscitation.

Bystander cardiopulmonary resuscitation (CPR) is an important determinant of survival from out-of-hospital cardiac arrest (OHCA), yet rates of bystander CPR are highly variable. In an effort to promote bystander CPR, the procedure has been streamlined, and ultrashort teaching modalities have been introduced. CPR has been increasingly reconceptualized as simple, safe, and easy to perform; however, current methods of CPR instruction may not adequately prepare lay rescuers for the various logistical, conceptual, and emotional challenges of resuscitating a victim of cardiac arrest. We adopted a constructivist grounded theory methodology to qualitatively explore bystander CPR and invited lay rescuers who had recently (ie, within 1 week) intervened in an OHCA to participate in semistructured interviews and focus groups. We used constant comparative analysis until theoretical saturation to derive a midrange explanatory theory of bystander CPR. We constructed a 3-stage theoretical model describing a common experiential process for lay rescuer intervention in OHCA: Being called to act is disturbing, causing panic, shock, and disbelief that must ultimately be overcome. Taking action to save the victim is complicated by several misconceptions about cardiac arrest, where victims are mistakenly believed to be choking, and agonal respirations are misinterpreted to mean the victim is alive. Making sense of the experience is challenging, at least in the short term, where lay rescuers have to contend with self-doubt, unanswered questions, and uncomfortable emotional reactions to a traumatic event. Our study suggests that current CPR training programs may not adequately prepare lay rescuers for the reality of an OHCA and identifies several key knowledge gaps that should be addressed. The long-term psychological consequences of bystander intervention in OHCA remain poorly understood and warrant further study.

Comparison of Cardiopulmonary Resuscitation Quality Between Standard Versus Telephone-Basic Life Support Training Program in Middle-Aged and Elderly Housewives

For cardiac arrests witnessed at home, the witness is usually a middle-aged or older housewife. We compared the quality of cardiopulmonary resuscitation (CPR) performance of bystanders trained with the newly developed telephone-basic life support (T-BLS) program and those trained with standard BLS (S-BLS) training programs. Twenty-four middle-aged and older housewives without previous CPR education were enrolled and randomized into two groups of BLS training programs. The T-BLS training program included concepts and current instruction protocols for telephone-assisted CPR, whereas the S-BLS training program provided training for BLS. After each training course, the participants simulated CPR and were assisted by a dispatcher via telephone. Cardiopulmonary resuscitation quality was measured and recorded using a mannequin simulator. The primary outcome was total no-flow time (>1.5 seconds without chest compression) during simulation. Among 24 participants, two (8.3%) who experienced mechanical failure of simulation mannequin and one (4.2%) who violated simulation protocols were excluded at initial simulation, and two (8.3%) refused follow-up after 6 months. The median (interquartile range) total no-flow time during initial simulation was 79.6 (66.4-96.9) seconds for the T-BLS training group and 147.6 (122.5-184.0) seconds for the S-BLS training group (P < 0.01). Median cumulative interruption time and median number of interruption events during BLS at initial simulation and 6-month follow-up simulation were significantly shorter in the T-BLS than in the S-BLS group (1.0 vs. 9.5, P < 0.01, and 1.0 vs. 10.5, P = 0.02, respectively). Participants trained with the T-BLS training program showed shorter no-flow time and fewer interruptions during bystander CPR simulation assisted by a dispatcher.