Cardiopulmonary Resuscitation Score Research Articles

Kalıpyargı Tehditinin Kardiopulmoner Resüsitasyon Performansı Üzerine Etkisi: Bir Randomize Kontrollü Manken Çalışması

Objective: Stereotype threat (ST) can lead to decreased performance when individuals face the possibility of confirming negative stereotypes associated with their group. During the Coronavirus disease 2019 (COVID-19) pandemic, non-Intensive Care Unit physicians (non-ICUp) were assigned to work in ICUs. However, social media emphasized the inadequacy of knowledge and skills among these physicians. Given the negative judgments, the study aimed to evaluate the cardiopulmonary resuscitation (CPR) performances of these physicians and investigate the effect of ST. Methods: A total of 63 non-ICUp and 53 Intensive Care Unit physicians (ICUp) physicians working in COVID-19 ICUs were randomly assigned to control and experimental groups. In the experimental group, ST was manipulated by presenting the study’s aim as measuring the difference in CPR performances between ICUp and non-ICUp physicians. The control group received no information. Participants were videotaped while performing a standard CPR scenario and evaluated by independent instructors and mannequin scores. Results: Overall CPR scores were higher among ICUp. Non-ICUp performed better in the ST condition regarding effective chest compression (p=.02) and correct compression rates per minute (p=.02) compared to the control condition. However, ICUp had lower scores for correctly placing chest compressions in the ST condition (p=.03). Conclusion: The higher CPR performance among ICUp was expected. However, the hypothesis suggesting lower performance for non-ICUp under ST conditions was not supported. Inconsistent results regarding the ST effect could be influenced by moderating factors such as task difficulty, knowledge about the existing stereotype, and motivation to perform well. The interaction between the physicians’ specialty and situational factors highlights the importance of creating realistic training environments that simulate high-pressure situations, ultimately contributing to the development of competent and confident healthcare professionals. Future research should further explore the impact of ST-based training on interactions and performance among different healthcare professionals. Keywords: Stereotype threat, intensive care unit, cardiopulmonary resuscitation, CovId-19

Comparison between a low-cost model (CPR Pillow) and a mannequin in training hands only cardiopulmonary resuscitation (CPR): A randomised trial

IntroductionCPR is an important lifesaving skill that can improve outcomes of patients in cardiac arrest. Mass training of hands-only CPR is one of the ways to spread information and teach this skill. Need for expensive CPR mannequins are a limiting factor in conducting such mass training programmes. This study assessed the effectiveness of a low-cost CPR pillow model in training hands-only CPR. MethodologyTwo hundred and six undergraduate students underwent a two-hour CPR training session. They were randomly divided into two groups – mannequin group and CPR pillow group and practiced hands-only CPR on a standard mannequin and a low-cost CPR pillow model, respectively. Knowledge, attitude, and skill acquisition were objectively assessed and compared between the two groups. ResultsThere was no statistical difference in hand positioning, chest compression rate and fraction, depth and overall CPR score between the two groups trained via mannequin and CPR Pillow (P > 0.05). The CPR pillow group had better percentage of chest recoil as compared to the mannequin group (86% vs 73%; P < 0.001). ConclusionThe use of low-cost homemade CPR devices such as our CPR pillow model is an acceptable alternative to mannequin for training hands-only CPR to lay rescuers.

"Knowledge regarding cardiopulmonary resuscitation among health assistants in Nepal: A cross-sectional study".

Health assistants play a crucial role in healthcare delivery, particularly in remote and rural areas of Nepal. They should have adequate lifesaving and resuscitation skills. Therefore, assessing their cardiopulmonary resuscitation (CPR) knowledge is essential. To evaluate the knowledge of CPR among health assistants (HAs) in Nepal and explore if there were variations in knowledge scores based on the demographic characteristics of the participants. A quantitative cross-sectional research design was used. The study population included HAs registered with the Nepal Health Professional Council (NHPC) who completed three years of training. Non-probability convenience sampling was employed. Data was collected using an online survey based on the 2020 American Heart Association guidelines. Demographic information and participants' knowledge levels were noted. The study involved 500 HAs, with the majority being male and working in government hospitals. Most participants were from Madhesh Province, and the median age was 26 years. Only a fraction of the participants had received training in CPR, and none of them had ever performed CPR. The median knowledge scores were higher among males and among respondents from Madhesh, Lumbini, Karnali, and Sudhurpaschim provinces. The HA's knowledge of the correct depth of CPR compression for children (21%) and infants (17.4%) was limited. CPR scores were different according to variables like training, theory understanding, and practice duration, among others. The findings highlighted the need for more practical training and regular refresher courses to enhance HAs ability to provide life-saving interventions. The study revealed less CPR knowledge and a lack of practical training among HAs in Nepal. To improve healthcare outcomes, providing practical training and ongoing education on CPR is crucial. The findings can contribute to curriculum development and policy changes in healthcare delivery.

Earthquake disaster preparedness training programme for hearing-impaired children: a randomized quasi-experimental trial

BackgroundAn earthquake can cause enormous economic losses and casualties. When an earthquake occurs, vulnerable people such as the hearing-impaired have great difficulty in receiving warning signals and performing self-rescue. Disaster preparedness training has been shown to be effective in disaster prevention and preparedness in previous studies in the general population, such as in normal children. However, there have been no studies of disaster preparedness training in hearing-impaired children. ObjectiveTo evaluate the effectiveness of an earthquake disaster preparedness training programme for hearing-impaired children in special education schools so as to improve their knowledge, skills and attitudes towards earthquake preparedness. DesignA randomized controlled quasi-experimental design was applied. MethodsA total of 104 hearing-impaired children from several special education schools in earthquake-prone areas of Sichuan Province, China, were randomly divided into intervention (n = 55) and control (n = 49) groups. The control group received only a self-study earthquake disaster preparedness pamphlet, while the intervention group received an earthquake disaster preparedness training programme in addition to the pamphlet. The children were evaluated at pre-test (T0, before the intervention), post-test 1 (T1, immediately after the intervention) and post-test 2 (T2, two months after the intervention), using (1) a general information questionnaire, (2) a questionnaire on earthquake preparedness knowledge, attitude and behaviour among hearing-impaired children, and (3) a bandaging and haemostasis and cardiopulmonary resuscitation (CPR) performance test form (simplified version). ResultsThe questionnaire scores for the earthquake preparedness of the hearing-impaired children were low. At pre-test (T0), the total questionnaire scores of the intervention and control group were 85.49 ± 12.13 and 86.53 ± 10.99, respectively, bandaging and haemostasis scores were 53.29 ± 5.63 and 51.16 ± 7.63, respectively, and CPR scores were 51.29 ± 6.60 and 48.29 ± 9.89, respectively. At post-test 1 (T1), the total questionnaire scores of the intervention and control group were 100.26 ± 15.15 and 89.12 ± 12.69, respectively, bandaging and haemostasis scores were 79.56 ± 6.50 and 54.92 ± 7.41, respectively, and CPR scores were 75.93 ± 9.07 and 51.39 ± 9.70, respectively. At post-test 2 (T2), the total questionnaire scores of the intervention and control group were 92.45 ± 14.40 and 91.14 ± 14.24, respectively, bandaging and haemostasis scores were 72.07 ± 7.56 and 51.18 ± 6.88, respectively, and CPR scores were 68.80 ± 8.98 and 50.37 ± 8.08, respectively. After three time points, the analysis showed that the interaction between groups and time for total questionnaire score and the knowledge and behaviour dimension scores were statistically significant (P < 0.001), however, the interaction between groups and time for attitude dimension scores was not statistically significant (P ＞ 0.05). In addition, the interaction between groups and time for bandaging and haemostasis and CPR scores was statistically significant (P < 0.001). The effect size of the total of questionnaire, bandaging and haemostasis and CPR were 4.70, 5.99 and 6.95, respectively. ConclusionsThis study demonstrated that it is feasible and effective to deliver an earthquake disaster preparedness training programme for hearing-impaired children. The findings can provide a basis and reference for similar or more in-depth research on interventions for hearing-impaired children in the future. The content and form of the intervention can inform the design or improvement of disaster education curricula in special education schools.

The Effectiveness of Online-Only Blended Cardiopulmonary Resuscitation Training: Static-Group Comparison Study.

Basic life support (BLS) education is essential for improving bystander cardiopulmonary resuscitation (CPR) rates, but the imparting of such education faces obstacles during the outbreak of emerging infectious diseases, such as COVID-19. When face-to-face teaching is limited, distance learning-blended learning (BL) or an online-only model-is encouraged. However, evidence regarding the effect of online-only CPR training is scarce, and comparative studies on classroom-based BL (CBL) are lacking. While other strategies have recommended self-directed learning and deliberate practice to enhance CPR education, no previous studies have incorporated all of these instructional methods into a BLS course. This study aimed to demonstrate a novel BLS training model-remote practice BL (RBL)-and compare its educational outcomes with those of the conventional CBL model. A static-group comparison study was conducted. It included RBL and CBL courses that shared the same paradigm, comprising online lectures, a deliberate practice session with Little Anne quality CPR (QCPR) manikin feedback, and a final assessment session. In the main intervention, the RBL group was required to perform distant self-directed deliberate practice and complete the final assessment via an online video conference. Manikin-rated CPR scores were measured as the primary outcome; the number of retakes of the final examination was the secondary outcome. A total of 52 and 104 participants from the RBL and CBL groups, respectively, were eligible for data analysis. A comparison of the 2 groups revealed that there were more women in the RBL group than the CBL group (36/52, 69.2% vs 51/104, 49%, respectively; P=.02). After adjustment, there were no significant differences in scores for QCPR release (96.9 vs 96.4, respectively; P=.61), QCPR depth (99.2 vs 99.5, respectively; P=.27), or QCPR rate (94.9 vs 95.5, respectively; P=.83). The RBL group spent more days practicing before the final assessment (12.4 vs 8.9 days, respectively; P<.001) and also had a higher number of retakes (1.4 vs 1.1 times, respectively; P<.001). We developed a remote practice BL-based method for online-only distant BLS CPR training. In terms of CPR performance, using remote self-directed deliberate practice was not inferior to the conventional classroom-based instructor-led method, although it tended to take more time to achieve the same effect. Not applicable.

Dedicated chest compressor team: A quality improvement initiative to improve chest compression performance at in-hospital cardiac arrest events through quarterly training

BackgroundHigh-quality cardiopulmonary resuscitation (CPR) is foundational to all resuscitative efforts. Spaced practice improves learners’ skill retention. We evaluated the implementation of a quarterly CPR curriculum and skills training program for a dedicated chest compressor team to improve the quality of CPR performed during in-hospital cardiac arrest (IHCA) events and its impact on patient survival of event. MethodsBaseline observations on CPR performance within the hospital were collected in October 2018. The CPR quarterly training program was implemented in November 2018. Training included use of high-fidelity simulation manikins and team members received real-time feedback scores related to compression rate, depth and recoil. High-quality CPR scores were set at ≥ 70%. Yearly IHCA event survival data was examined in relation to the implementation of training. ResultsQuarterly CPR training of the team led to retention of CPR skills (chest compression rate, depth, and recoil). The team’s initial CPR training performance average score was 49.1%, increasing to 80.3%, with 95% (n = 37) of participants achieving a higher score after feedback during their initial training. A two-sample t-test was used for numerical data and chi-square was used for proportional data analysis. The survival of event prior to this training was 61.0% January-October 2018. Post -training, event survival rose to 73.5% (p-value 0.03) in 2019. ConclusionImplementation of a team that attends quarterly CPR training with a high-fidelity simulation manikin is attainable. This training resulted in improved CPR quality and benefited IHCA event survival.

Analysis of the adequacy of infant cardiopulmonary resuscitation according to chest compression technique based on the 2020 AHA guidelines

The quantitative and qualitative differences between the two-finger (TF) and two-thumb-encircling hands (TT) techniques were not sufficiently investigated to determine which is more effective for single-rescuer infant cardiopulmonary resuscitation (CPR). As the type of chest compression (CC) technique can impact survival rates and prognoses of patients, this study aimed to compare the adequacy of single-rescuer infant CPR CC techniques and explore participants’ CPR experiences using an exploratory sequential mixed methods design. To assess the adequacy of CC and ventilation according to technique, 70 students who completed basic life support provider certification among students from emergency medical services and nursing departments of a single college performed CC using the TF and TT techniques (4 sets of 5 cycles with a ratio of 30:2) in simulation. Meanwhile, a numeric rating scale was used to measure fatigue. SPSS (v. 25.0, IBM Corp, Armonk, NY, USA) was used to analyze the collected data by frequency analysis, descriptive statistics, paired t-test, and repeated measures analysis of variance (ANOVA). We conducted focus group interviews and analyzed CPR experiences. There were statistically significant differences between the TF and TT techniques in fatigue score (6.09 vs. 4.23 points, p &lt; 0.001), average hands-off time (6.77 vs. 7.43 s, p =0.001), mean ventilation volume (41.40 vs. 35.51 ml, p = 0.002), CC accuracy rate (65.89% vs. 77.11%, p = 0.011), mean CC rate (104.37 vs. 107.11 beats/min, p = 0.020), overall CPR score (78.26 vs. 84.37 points, p = 0.005), and overall compression score (82.60 vs. 92.54 points, p &lt; 0.001). Furthermore, we found significant differences over time in mean CC count (p = 0.030), mean ventilation volume (p = 0.042), and mean hands-off time (p = 0.029). Two categories (ambivalent attitudes and perception of pain) and five sub-categories were derived based on the results. In conclusion, as stated in the 2020 American Heart Association (AHA) guidelines, both TF and TT techniques are useful for single-rescuer infant CPR. Overall, TT technique provides higher quality of compressions at the cost of fewer ventilations. We recommend future studies of more diverse groups and techniques.

The Iterative Development and Testing of an Interactive Mobile Application for Skill Retention of Cardiopulmonary Resuscitation Among High School Students: A Pilot Study

Abstract: Background Locations concentrated with High School (HS) students tend to have lower out-of-hospital cardiac arrest (OHCA) survival rates. Mobile applications (apps) have the capability to augment cardiopulmonary resuscitation (CPR) skill retention as a low-cost, accessible training method. Methods An iterative process to develop an app to reinforce CPR skills emphasizing hand placement, compression rate, real-time feedback, and recurring tips is described. The app was tested on HS students to measure its impact on quality and comfort of CPR using Likert surveys and skills assessments before and after one month of usage. CPR Score and compression rate were measured using the Laerdal™ Little Anne Manikin QCPR software. Results Fourteen HS students participated in a prospective observational study. It was found that the use of the developed app was associated with improved CPR performance (80.43% v. 87.86%, p=0.01-0.02, 95% CI=2.20-12.66) after one month. Additionally, improvements were demonstrated in compression rate accuracy (21.43% v. 64.29%, p=0.041, 95% CI=0.132-0.725), increased comfort performing CPR (3.86 v. 4.79, p&lt;0.001, 95% CI =0.99-1.00) and comfort performing CPR on strangers (2.71 v. 4.42, p&lt;0.001, 95% CI=1.24-2.19). In addition, for every time the app was used, CPR performance increased by 0.5668% (p=0.0182). Conclusion Findings suggest that mobile apps may have promising implications as augmentative tools for CPR curriculums.

Is a homemade cardiopulmonary resuscitation (CPR) trainer non-inferior to a commercially available CPR mannequin in teaching high-quality CPR? A non-inferiority randomized control trial

IntroductionStudies demonstrate that feedback devices help students achieve mastery of critical CPR skills and shorten the time from demonstration to competence. CPR feedback devices are costly and may not be available in low resource settings or in the context of online classes. We have developed a homemade feedback enabled CPR trainer. This trainer consists of a lid with two toilet rolls stacked on top. We have shown it is feasible to generate high quality CPR using this trainer, however the ability for this trainer to successfully be used in skill acquisition is unknown.Our main objective was to assess if learning CPR on a homemade toilet paper trainer was non-inferior to a commercially available mannequin when comparing post-training CPR scores. MethodsWe conducted a parallel non-inferiority randomized control trial using a variable block randomization to a 10-min training session on either a toilet paper or commercial mannequin trainer. Primary outcome was mean overall CPR score as determined by high fidelity mannequin software. A sample size of 62 per group was calculated based on a 90% power to assess for the lower limit of a two-sided 95% confidence interval above the non-inferiority limit of 10%. Results125 participants were randomized to the toilet paper (n = 64) or commercial mannequin trainer (n = 61). There was no difference between groups in age, sex, height, weight or previous CPR training. There was an absolute difference of 2% (CI 95% 3.3 to 7.3%) in mean overall CPR score between groups (toilet paper = 82% (SD 15.9%), commercial mannequin = 84% (SD 15%). ConclusionA homemade CPR trainer was non-inferior to a commercially available trainer. This study provides preliminary evidence supporting the use of a homemade, easily accessible trainer for basic compression-only CPR skill acquisition.

Evaluation of the Effect of Pre-Job Training on New Pediatric Nurses Based on Onion Model

To determine the effect of pre job training on onion model among new pediatric nurses. One hundred and seventeen pediatric nurses that commenced work on July 1, 2019 after 2 w of conventional training and 94 nurses that received the onion mode of training for 2 w before July 1, 2020 were recruited as the control and experimental groups respectively. The theoretical, practical and training quality scores of the new nurses were compared. The experimental group had significantly higher theoretical score (78.53±4.96 vs 69.27±11.38), Cardiopulmonary resuscitation score (92.39±4.06 vs 91.38±3.12), intradermal injection score (94.97±3.16 vs 92.35±3.96) and training quality evaluation score (99.07±4.5 vs 97.27±7.51) compared to that of the control group (p<0.05 for all). The onion training model can improve the theoretical and practical skills of new nurses and the quality of pre-job training.

The Effectiveness of a New Dispatcher-Assisted Basic Life Support Training Program on Quality in Cardiopulmonary Resuscitation Performance During Training and Willingness to Perform Bystander Cardiopulmonary Resuscitation: A Cluster Randomized Controlled Study.

A new dispatcher-assisted basic life support training program, called "Home Education and Resuscitation Outcome Study (HEROS)" was developed with a goal to provide high-quality dispatcher-assisted cardiopulmonary resuscitation (CPR) training, with a focus on untrained home bystanders. This study aimed to determine whether the HEROS program is associated with improved quality in CPR performance during training and willingness to provide bystander CPR compared with other basic life support programs without dispatcher-assisted CPR (non-HEROS). This clustered randomized trial was conducted in 3 district health centers in Seoul. Intervention group was trained with the HEROS program and control group was trained with non-HEROS program. The primary outcome was overall CPR quality, measured as total CPR score. Secondary outcomes were other CPR quality parameters including average compression depth and rate, percentages of adequate depth, and acceptable release. Tertiary outcomes were posttraining survey results. Difference in difference analysis was performed to analyze the outcomes. Among total 1929 trainees, 907 (47.0%) were trained with HEROS program. Compared with the non-HEROS group, the HEROS group showed higher-quality CPR performances and better maintenance of their CPR quality throughout the course (total scores of 84% vs. 80% for first session and 72% vs. 67% for last session; difference in difference of 12.2 vs. 13.2). Other individual CPR parameters also showed significantly higher quality in the HEROS group. The posttraining survey showed that both groups were highly willing to perform bystander CPR (91.4% in the HEROS vs. 92.3% in the non-HEROS) with only 3.4% of respondents in the HEROS group were not willing to volunteer compared with 6.2% in the non-HEROS group (P < 0.01). The HEROS training program helped trainees perform high-quality CPR throughout the course and enhanced their willingness to provide bystander CPR.

Do Rescuers' Physiological Responses and Anxiety Influence Quality Resuscitation under Extreme Temperatures?

Teaching and training cardiopulmonary resuscitation (CPR) through simulation is a priority in Health Sciences degrees. Although CPR is taught as a simulation, it can still be stressful for the trainees since it resembles a real-life circumstance. The aim of this study was to assess the physiological effects and anxiety levels of health sciences undergraduates when faced with CPR process in different temperatures (room temperature, extremely cold, or extremely warm). This was a descriptive cross-sectional before–after study conducted during the 2018/2019 academic year with 59 students registered in the Faculty of Health Sciences of the Castilla-La Mancha University (UCLM). State Trait Anxiety Inventory (STAI) questionnaires were distributed among the students before and after the CPR simulation. We found greater level of situational anxiety in undergraduates faced with extreme adverse temperature scenarios (extreme heat and cold), especially in conditions of extreme heat compared to controlled environment (at room temperature). We discovered differences regarding sex, in which men scored 6.4 ± 5.55 points (STAI after CPR score) and women scored 10.4 ± 7.89 points (STAI after CPR score). Furthermore, there was less lactate in blood, before and during the event in individuals with anxiety. In addition, beginning in Minute 7, we observed a remarkable decrease (but not significant) in the performance of rescuers with anxiety. Programs targeted at promoting coping mechanisms to reduce anxiety before a critical clinic situation should be implemented in academic training.

Assessing the quality of CPR performed by a single lifeguard, two lifeguards and a lifeguard with a bystander after water rescue: a quasi-experimental trial.

High-quality cardiopulmonary resuscitation (CPR) could improve survival of drowning victims. The purpose of the study is to assess the impact of fatigue caused by water rescue on subsequent CPR quality and the influence of a bystander's participation on CPR quality in a lifeguard rescue. This was a simulated quasi-experimental study with a sample of 14 lifeguards and 13 laypersons. Each lifeguard performed 2 min single-rescuer CPR as baseline measurement. In three separate trials, a single lifeguard swam 50 m to perform a water rescue in a pool and returned with the manikin another 50 m. After each rescue, 10 min of CPR was performed by a single lifeguard, two lifeguards or a lifeguard with a layperson with no CPR training. Paired t-test and repeated analysis of variance were used to analyse CPR quality variables. Baseline CPR quality was adequate for most measures except compression depth and re-expansion. After water rescue, the single lifeguard trial showed no significant differences compared with baseline. CPR score and ventilation score of the single-lifeguard trial was higher than that of the lifeguard-bystander trial (p=0.027, p<0.001). Both the two-lifeguard trial (p=0.025), and lifeguard-bystander trial (p=0.010) had a lower percentage of breaths with correct ventilation volume and higher percentage of breaths with excessive ventilation volume (p=0.007, p=0.011, respectively) than the single-lifeguard trial. No-flow time of the lifeguard-bystander trial was longer than other trials (p<0.001). Although CPR given by the lifeguard was not optimal, fatigue generated by a water rescue has no impact on the quality of subsequent CPR performed by a trained lifeguard for 10 min. Untrained bystanders assisting in CPR in a drowning event is unlikely to be helpful.

Incivility and Clinical Performance, Teamwork, and Emotions: A Randomized Controlled Trial.

Incivility has been identified as a common occurrence in health care settings. While anecdotal evidence exists that these behaviors negatively impact patient care, more robust evidence is lacking. This randomized controlled trial investigated the effects of exposure to incivility on clinical performance, teamwork, and emotions. Teams of nurses were randomly assigned to a control or experimental group. The experimental group was exposed to incivility. Both groups were then prompted to perform basic life support on a high-fidelity manikin. Teams were scored on cardiopulmonary resuscitation (CPR) performance and teamwork. Individuals completed measures of affect and a cognitive test. There were no differences in CPR, cognitive or teamwork scores, or emotional state. However, 66% of the experimental group had a major error in their CPR performance. None of the control groups made the same error. These findings support anecdotal evidence that exposure to incivility may contribute to errors in clinical performance.

Randomized Controlled Trial of Advance Care Planning Video Decision Aid for the General Population

ContextAdvance care planning (ACP) in a healthy general population could improve the quality of care when a health problem arises. ObjectivesThe purpose of this study was to evaluate the efficacy of video decision support aid in increasing the intention to document ACP in the general healthy population. MethodsIn this randomized controlled trial, we enrolled 250 members of the general population (aged 20 years and older and determined to be healthy), stratified by age and sex. The intervention was a video that provided information about ACP and end-of-life care options such as cardiopulmonary resuscitation (CPR) and palliative care. An attention-control arm was given a booklet about advance directives. Primary outcome was a change in intention to document ACP. Secondary outcomes included the intention to refuse CPR at terminal status, CPR and palliative care knowledge score, and the Hospital Anxiety and Depression Scale. ResultsAbout 250 participants were randomly assigned, half to the video-assisted intervention group and half to the attention-control group. Within one week postintervention, the intention to document ACP was significantly higher in the video-assisted intervention arm (68.0% vs. 39.2%; P < 0.001), and changes in the intention to document ACP were significantly greater in the video group than in the brochure group (P = 0.008; Δ = 14.4%). Palliative care knowledge score was also significantly increased in the video group (P = 0.036). ConclusionA well-constructed video decision support intervention can increase the intention to document ACP in the general population that presumably had little opportunity to discuss ACP with physicians.

Impact of Hand Dominance on Effectiveness of Chest Compressions in a Simulated Setting: A Randomised, Crossover Trial

Aim External cardiac compressions (ECC) are a critical component in determining the effectiveness of cardiopulmonary resuscitation (CPR). Guidelines prior to the 2010 International Liaison Committee on Resuscitation directed rescuers to place the heel of the dominant hand directly on the chest when performing ECC, however current guidelines are silent on this issue. Existing research is inconsistent in findings, and heterogeneous in design and participants. The aims of this pilot study were to: 1) investigate the impact of hand dominance on effectiveness of ECC; and 2) generate outcome data to inform sample size calculations for a larger future study. Methods This study utilised a single blinded, prospective randomised crossover trial design. Each participant was allocated to a ‘dominant hand on chest’ (DHOC) or ‘non-dominant hand on chest’ (NDHOC) group. On a simulation manikin, participants in the DHOC group performed 3 minutes of ECC with dominant hand on the chest and non-dominant hand supporting, followed by a ‘rest and recovery’ period and then a second 3-minute period of ECC with the hand reversed such that the non-dominant hand was on the chest. The NDHOC group performed the same series of compressions but in reverse order. The primary outcome measure was effectiveness of ECC, determined by a percentage-based ‘CPR score’ (‘CS’). Secondary outcomes were compression depth, rate and release. The Wilcoxon rank-sum (Mann-Whitney) test was used due to the non-normal distribution of the data. Due to the crossover design, hierarchical linear regression was used to assess for a period or cross over effect. Results For the primary outcome of this study, we have found no significant difference in CS between DHOC and NDHOC (69.9% (SD=29.9) vs. 69.1% (SD=34.1); p=0.92), respectively. There were no differences in the secondary outcomes of compression rate and depth, though compression release was improved in the DHOC group (53% vs. 42%; p=0.02). Conclusion In this randomised crossover study conducted in a simulation context there was no difference in ECC effectiveness measured by an overall effectiveness outcome according to placement of the dominant or non-dominant hand on the chest during compressions. A modest improvement in ECC release was seen in the dominant hand on chest group. While the study was underpowered, the results support an approach involving rescuers placing whichever hand they are most comfortable with on the chest irrespective of handedness.

A Brain-Based Instruction Simulation Approach to Improve Code Team Response in an Internal Medicine Unit

Background and Objectives. The code team course is a 3-hour, interactive course that follows a 4-phase brain-based lesson plan for simulation. Interprofessional teams receive instruction and practice in evidence-based teamwork, communication, and individual skills. Methods. This quantitative research included a pre-test and post-test design in an urban Department of Medicine. Sixteen groups (n=109) participated in the course over a period of eight weeks. Classroom metrics included pre- and post-course High-Quality cardiopulmonary resuscitation (CPR) and code team didactic knowledge assessed by Wilcoxon rank-sum tests. In addition, four in-situ mock code simulations were conducted to provide the researchers with baseline and post-intervention data. Code team performance assessment scores were tallied and compared between baseline and post-intervention by Fisher’s Exact Test. Results. The classroom metrics produced significant results. High-Quality CPR scores were higher post-training than pre-training (median score 4 vs. 3, respectively; p=0.006). Didactic knowledge test scores were also significantly higher (median score 90 vs. 70, respectively; p &lt;0.001). In-situ team performance improved in several areas. There was a significant improvement in the area of cardiac code management in the day shift group. The percent “done well” improved from 25% (5/20) to 100% (20/20) (p= &lt;0.001). Conclusion. The results of this pilot study suggest that code team training using the 4-phase BBL plan for simulation is associated with improvements in interprofessional team knowledge and performance during cardiac emergencies. It is equally important that the training is conducted over a short period in order to ensure that all team members are properly prepared.

Effectiveness of 5, 10, 15-min Video Self-Instruction in Cardiopulmonary Resuscitation Training

This study examines the effect of video self-instruction (VSI) on cardiopulmonary resuscitation (CPR) performance and attitude. A five-minute video clip of adult CPR was shown once to a five-minute VSI group, twice to a ten-minute VSI group, and three times to a 15-minute VSI group. CPR self-assessment scores and manikin assessed performance were collected twice, one before and one after VSI. A paired t-test was used to compare self-assessment scores from before and after VSI; one-way ANOVA was used to compare CPR scores. When self-assessment scores from before and after VSI were compared, the five-minute VSI group showed a statistically significant difference (p=.03) in performances; the ten-minute VSI group showed a statistically significant difference (p=<.00) in knowledge and performances; and the 15-minute VSI group showed a statistically significant difference (p=.02) in knowledge, performances, and attitude. When manikin-assessed performance was compared, the 15-minute VSI group had a score relatively close to the guideline. In terms of accuracy in artificial respiration, there was a statistically significant difference (p=<.00) among the three groups, with the 15-minute VSI group scoring the highest. Self-instruction through repeated viewing of CPR videos affected positively not only CPR knowledge but also performance and attitude.

The impact of the use of a CPRMeter monitor on quality of chest compressions: a prospective randomised trial, cross-simulation.

Drowning is a common issue at many pools and beaches, and in seas all over the world. Lifeguards often act as bystanders, and therefore adequate training in high-quality cardiopulmonary resuscitation (CPR) and use of adequate equip-ment by lifeguards is essential. The aim of this study was to evaluate the impact of the recently introduced CPRMeter (Laerdal, Stavanger, Norway) on quality of CPR, if used by moderately experienced CPR providers. In particular, we tested the hypothesis that using the CPRMeter improves quality of chest compression by lifeguards compared to standard non-feedback CPR. The study was designed as prospective, randomised, cross-over manikin trial. Fifty lifeguards of the Volunteer Water Rescue Service (WOPR), a Polish nationwide association specialised in water rescue, participated in this study. Participants were randomly assigned 1:1 to one of two groups: a feedback group and a non-feedback group. Participants swim a distance of 25 m in the pool, and then they were asked to haul a manikin for the second 25 m, simulating rescuing a drowning victim. Once participants finished the second 25-m distance, participants were asked to initiate 2-min basic life support according to the randomisation. The median quality of CPR score for the 2-min CPR session without feedback was 69 (33-77) compared to 84 (55-93) in the feedback group (p < 0.001). Compression score, mean depth, rate of adequate chest compressions/min, and overall mean rate during the CPR session improved significantly in the feedback group, compared to the non-feedback group. Using the visual real-time feedback device significantly improved quality of CPR in our relatively unexperienced CPR providers. Better quality of bystander CPR is essential for clinical outcomes, and therefore feedback devices should be considered. Further clinical studies are needed to assess the effect of real-time visual devices, especially in bystander-CPR.

The application of scene simulation teaching on cardiopulmonary resuscitation training for the practice students in emergency department

Objective To compare scene simulation teaching method with traditional methods on training in cardiopulmonary resuscitation (CPR) for the practice students. Methods A convenience sample of 62 nursing students in the emergency department of our hospital in 2014 were recruited as the observation group, and 75 practice students in 2013 were recruited as the control group. The observation group used the scene simulation teaching method for students and the control group used the traditional methods. The students' theoretical knowledge, operation skill of CPR and total score of core capability were compared between two groups. Results The theoretical knowledge, operation skill of CPR and total score of core capability in the observation group were (85.23±6.36), (86.90±4.85), (217.98±6.06), significantly higher than those of the control group, which were (75.36±7.77), (82.38±8.84), (209.33±8.91), t= 8.02, 3.60 and 6.50, P<0.01. Conclusions The scene simulation teaching method is an effective form of emergency department training in CPR, help to improve students practice ability and the ability of emergency cardiopulmonary resuscitation. Key words: Cardiopulmonary resuscitation; Clinical clerkship; Emergency service, hospital; Scene simulation teaching method