Cardiopulmonary Resuscitation Training Manikin Research Articles

Under pressure: What individual characteristics lead to performance of high-quality chest compressions during CPR practice sessions?

AimDespite well-established protocols for cardiopulmonary resuscitation training, performance during real-life cardiac arrests can be suboptimal. Understanding personal characteristics which could influenceperformance of high-quality chest compressions could provide insight into the practice-performance gap. This study examined chest compressionperformance, while employing feedback and introducing code team sounds as an anxiety-inducing factor in registered nurses using a cardiopulmonary resuscitation training manikin. MethodsParticipants included 120 registered nurses with basic life support certification randomized to one of the following groups: no feedback and no code team sounds, feedback without code team sounds, or feedback with code team sounds. Chest compression sessions occurred at baseline, 30-days and 60-days. Demographic variables and anxiety level were also collected. The primary outcome was chest compression performance, defined as average percent of time with correct rate and percent with correct depth as captured by the defibrillator. Statistical analysis included linear mixed effects analysis. ResultsThe effect of feedback on chest compression performance depended on the value of other parameters. The benefit of feedback on the primary outcome depended on: age, with feedback less beneficial among older participants (p = 0.0413); and time, with feedback more beneficial with repetition (p = 0.011). These interactions also affected the outcome percent of time with correct compression depth. Increased anxiety was associated with decreased percent correct compression depth (p < 0.001). ConclusionFeedback emerged as important in determining chest compression performance. Chest compression quality was limited by the performer’s age and anxiety level. Future research should focus on identifying factors related to individual characteristics which may influence chest compression performance.

Design and Implementation of Cardiopulmonary Resuscitation Simulation Model

Cardiopulmonary resuscitation (CPR) is a life-saving procedure that can multiply a person's chances of survival after a cardiac arrest. The effectiveness of CPR procedures is heavily influenced by the individual skills of the rescuer providing assistance. Chest compressions delivered at an appropriate depth and rate, allowing full chest recoil and with minimal interruptions, are critical for improving cardiac arrest survival. The lack of quality CPR training models in developing countries has a significant impact on the quality of CPR training and skills acquired. Therefore, in this paper, we aim at improving CPR training by designing a high-fidelity CPR training manikin. The model includes a feedback mechanism for monitoring CPR performance status to allow for effective practice and rehearsal until required CPR skills are acquired. An in-depth study of existing training systems was conducted to ensure the proper design of the proposed system. The test results show that the designed manikin prototype analyses the quality of CPR performance and provides appropriate feedback to the trainee. The model can be used for training medical students and other practitioners to correctly perform CPR.

Abstract 308: Efficacy Of Distance Learning For Cardiopulmonary Resuscitation Training Utilizing Smartphone App And Mannikin Delivery-collection System

Aim of the study: Effective CPR training is important for provision of high-quality bystander cardiopulmonary resuscitation (CPR). However, the COVID-19 pandemic has hindered conventional face-to-face CPR training. To overcome the limitation, we developed a distance learning CPR training course (HEROS-Remote) that utilized a smartphone app and a delivery-collection system for CPR training manikins. The objective of the study was to evaluate the efficacy of the HEROS-Remote course by comparing chest compression quality between trainees who participated in the conventional CPR training (C-training) and HEROS-Remote course (R-training). Methods: The non-inferiority trial included adult nonhealthcare providers who applied for CPR training. Both groups underwent 2-minute post-training chest compression test followed by course survey on trainees’ course and delivery system satisfaction. The primary outcome of the study was mean chest compression depth during the 2-minute post-training test. Results: A total of 180 trainees were enrolled with 90 trainees for each training group. There was no statistically significant difference in chest compression depth between R-training and C-training groups (67.4 vs. 67.8, p=0.78) as well as proportion of adequate chest compression depth, chest compression rate, proportion of chest compressions with complete chest recoil and chest compression score (90.8 vs. 92.1, p=0.69; 110.8 vs. 110.4, p=0.60; 89.8 vs. 94.7, p=0.05; 92.7 vs. 95.5, p=0.16, respectively). In the R-training group, 90.0% of the trainees were satisfied with the course, 96% responded that the delivery system was satisfactory and convenient. Conclusion: The R-training course was noninferior to the C-training course. The distance learning CPR training method utilizing smartphone app and mannikin delivery-collection system had high user satisfaction and was logistically feasible.

Simulating blood pressure and end tidal CO2 in a CPR training manikin

Background and ObjectiveThe American Heart Association supports titrating the mechanics of cardiopulmonary resuscitation (CPR) to blood pressure and end tidal carbon dioxide (ETCO2) thresholds during in-hospital cardiac arrest. However, current CPR manikin training systems do not prepare clinicians to use these metrics to gauge their performance, and currently provide only feedback on hand placement, depth, rate, release, and interruptions of chest compressions. We addressed this training hardware deficiency through development of a novel CPR training manikin that displays simulated blood pressure and ETCO2 waveforms in real time on a simulated clinical monitor visible to the learner, reflecting the mechanics of chest compressions provided to the manikin. Such a manikin could improve clinicians’ CPR technique while also training them to titrate CPR quality to physiologic blood pressure and ETCO2 targets as performance indicators. MethodsWe used data and key findings from 4 human and 6 animal studies (including 132 human subjects, 61 pigs, and 16 dogs in total) to develop an algorithm that simulates blood pressure and ETCO2 waveforms based on compression mechanics for a pediatric patient. We modified an off-the-shelf infant manikin to incorporate a microcontroller sufficient to process the aforementioned algorithm, and a tablet computer to wirelessly display the simulated waveform. We recruited clinicians with in-hospital CPR experience to perform compressions with the manikin and complete a post-test survey on their satisfaction with designated elements of the manikin and display. Results34 clinicians performed CPR on the prototype manikin system that simulates real-time bedside monitoring of blood pressure and ETCO2. 100% of clinicians surveyed reported “satisfaction” with the blood pressure waveform. 97% said they thought depth was accurately reflected in blood pressure (0% inaccurate, 3% not sure). 88% reported an accurate chest compression rate modification effect on blood pressure and ETCO2 (3% inaccurate, 9% not sure) and 59% an accurate effect of leaning (6% inaccurate, 35% not sure). Most importantly, all 34 respondents responded “yes” when asked if they thought this system would be helpful for CPR training. ConclusionA CPR manikin that simulates blood pressure and ETCO2 was successfully developed with acceptable relevance, performance and feasibility as a CPR quality training tool.

Teaching Cardiopulmonary Resuscitation to Young Children (

Out-of-hospital cardiac arrest is a major public health concern. Research has shown that initiation of cardiopulmonary resuscitation (CPR) by lay bystanders increases survival rates. Evidence also shows that CPR training, delivered in various ways, is successful in a wide age range of children. This study was conducted to assess if children (average age of 12) were able to perform high quality chest compressions and whether this can be achieved by supplementing CPR instructional video with other methods to time delivery of compressions. A total of 160 study subjects were divided into 3 groups. The CPR instructional video was played for all 3 groups. One group (n = 53) was instructed to time their compressions with a popular music. Another group (n = 56) was assigned to a specially designed video game whereby they practiced how to time chest compressions. The control group (n = 51) consisted of those who only watched the video. Each group was divided in teams of 3 and observed for successful delivery of chest compressions on the little Anne Adult CPR training manikins. The control group performed a mean of 88 compressions per minute (CPM) out of which a mean of 72 clicks were appreciated. The music group performed 104 CPM with 74 clicks. Meanwhile, the video game group performed 102 CPM with 78 clicks. This study demonstrated sixth graders are capable of learning and performing effective hands only bystander CPR and this can and should be taught in schools even as young as the sixth grade level.

European cardiovascular nurses’ and allied professionals’ knowledge and practical skills regarding cardiopulmonary resuscitation

Cardiopulmonary resuscitation (CPR) remains a cornerstone in the treatment of cardiac arrest, and is directly linked to survival rates. Nurses are often first responders and need to be skilled in the performance of cardiopulmonary resuscitation. As cardiopulmonary resuscitation skills deteriorate rapidly, the purpose of this study was to investigate whether there was an association between participants' cardiopulmonary resuscitation training and their practical cardiopulmonary resuscitation test results. This comparative study was conducted at the 2014 EuroHeartCare meeting in Stavanger ( n=133) and the 2008 Spring Meeting on Cardiovascular Nursing in Malmö ( n=85). Participants performed cardiopulmonary resuscitation for three consecutive minutes CPR training manikins from Laerdal Medical®. Data were collected with a questionnaire on demographics and participants' level of cardiopulmonary resuscitation training. Most participants were female (78%) nurses (91%) from Nordic countries (77%), whose main role was in nursing practice (63%), and 71% had more than 11 years' experience ( n=218). Participants who conducted cardiopulmonary resuscitation training once a year or more ( n=154) performed better regarding ventilation volume than those who trained less (859 ml vs. 1111 ml, p=0.002). Those who had cardiopulmonary resuscitation training offered at their workplace ( n=161) also performed better regarding ventilation volume (889 ml vs. 1081 ml, p=0.003) and compression rate per minute (100 vs. 91, p=0.04) than those who had not. Our study indicates a positive association between participants' performance on the practical cardiopulmonary resuscitation test and the frequency of cardiopulmonary resuscitation training and whether cardiopulmonary resuscitation training was offered in the workplace. Large ventilation volumes were the most common error at both measuring points.

Airtraq Laryngoscope Versus the Conventional Macintosh Laryngoscope During Pediatric Intubation Performed by Nurses: A Randomized Crossover Manikin Study With Three Airway Scenarios.

We hypothesized that the Airtraq laryngoscope (Airtraq LLC, Bonita Springs, Fla) is beneficial for intubation of pediatric manikins while performing cardiopulmonary resuscitation (CPR). In the present study, we evaluated the effectiveness of the Macintosh (MAC) laryngoscope (HEINE Optotechnik, Munich, Germany) and Airtraq in 3 simulated CPR scenarios. A randomized crossover simulation trial was designed. Eighty-three nurses intubated the trachea of a PediaSIM CPR training manikin (FCAE HealthCare, Sarasota, Fla) using the MAC and Airtraq in a normal airway scenario, normal airway with chest compression scenario, and difficult airway with chest compression scenario. The participants were directed to perform a maximum of 3 attempts in each scenario. The success rate, time to intubation, Cormack & Lehane grade, dental compression, and the ease of intubation were measured. All participants performed successful intubation with the Airtraq in all 3 scenarios. In all scenarios, the success rate was significantly higher and the time to intubation was significantly shorter with the Airtraq than with the MAC. Glottic visualization using the Cormack-Lehane scale was also better when using Airtraq in all scenarios. In this manikin study, we found that the Airtraq can be used successfully for the intubation of pediatric manikins with normal and difficult airways by medical staff without previous experience in pediatric intubation. Moreover, intubation can be achieved without interrupting chest compression. The use of the Airtraq compared with the MAC led to faster time to intubation. Nevertheless, we recommend that the performance of the Airtraq and the MAC during CPR should be further evaluated in a clinical setting.

A randomized comparison of the Laryngoscope with Fiber Optic Reusable Flexible Tip English Macintosh blade to the conventional Macintosh laryngoscope for intubation in simulated easy and difficult child airway with chest compression scenarios

IntroductionWe hypothesized that the Laryngoscope with Fiber Optic Reusable Flexible Tip English Macintosh blade (TMAC) is beneficial for the intubation of child manikins while performing cardiopulmonary resuscitation (CPR). In the present study, we evaluated the effectiveness of the conventional Macintosh laryngoscope (MAC) and TMAC in 3 simulated CPR scenarios. MethodsA randomized crossover simulation trial was designed. One hundred seven paramedics intubated the trachea of a PediaSIM CPR training manikin (FCAE HealthCare, Sarasota, FL) using the MAC and TMAC in a normal airway scenario (scenario A), normal airway with chest compression scenario (scenario B), and difficult airway with chest compression scenario (scenario C). The participants were directed to make a maximum of 3 attempts in each scenario. The success rate, time required for intubation, Cormack-Lehane grade, dental compression, and the ease of intubation were measured. ResultsThe median time of intubation with MAC and TMAC in scenario A was 19.6 (interquartile range [IQR], 18-23) vs 19 (IQR, 16.2-21.8); in scenario B, 29.5 (IQR, 25-31) vs 26 (IQR, 23.5-29) seconds; and in scenario C, 38 (IQR, 32.5-45) vs 29 (IQR, 25-31) seconds, respectively. The overall efficacy for each of the scenarios was as follows: in scenario A, it was 100% vs 100%; in scenario B, it was 79.4% vs 100% (P = .007); and in scenario C, it was 68.2% vs 90.7% (P < .001), respectively. ConclusionsThe TMAC seems to be a superior intubating device compared with the conventional MAC when used in simulated normal and difficult child airway with chest compression scenarios. Future studies should explore the efficacy of TMAC in pediatric clinical emergency settings.

The evaluation of physiological responses during the performance of external chest compressions in simulated hypo and microgravityStatus: PendingCategory: CPR Quality

The aim of this study was to evaluate physiological responses during cardiopulmonary resuscitation (CPR) in hypogravity (hypoG) and microgravity (microG) simulations, and to compare these with 1G (Earth's gravity). A CPR training manikin was used with an indicator for depth and frequency of compressions, along with surface electromyography (EMG), a mobile heart rate (HR) monitor and the Borg Scale. A body suspension device was used to reduce body weight during CPR in hypoG and microG simulations.

Is There Any Difference in Cardiopulmonary Resuscitation Performance According to Different Instructional Models of Cardiopulmonary Resuscitation Education for Junior and Senior High School Students?

Objective This study aims to determine whether or not cardiopulmonary resuscitation (CPR) skills differ according to different instructional models for CPR education and training for junior and senior high school students. Methods This was a prospective and randomised study including 519 junior and senior high school students. After the lecture on CPR, students practiced the skill on the manikin. Group 1 used model 1 and Group 2 used model 2 for practical training and practical skills and CPR performance quality were evaluated. Results Data from skill tests were analysed in 229 students in group 1 and 210 students in group 2. The total score of sequence skill tests was 17.8±2.0 points. During 2 cycles, no chest elevation was observed in 33.3% and was significantly lower in group 1. There were no significant differences in the frequency of proper ventilation and in ventilation volume between the 2 groups. Excessive ventilation was more frequently observed in group 1 and insufficient ventilation was observed more frequently in group 2. The percentage of the frequency of a proper chest compression rate was 80.5±31.2% and there were no significant differences in proper and insufficient depths, mean rate and recoil of the chest in chest compression between the 2 groups. Conclusions There were differences in CPR skills according to different CPR training manikins. Therefore, certain conditions seem to be considered in selection of instructional models for CPR psychomotor skills. (Hong Kong j.emerg.med. 2011;18:375-382)

Comparison of Experimental Chest Compression Data to a Theoretical Model for the Mechanics of Constant Peak Displacement Cardiopulmonary Resuscitation

The objective was to validate an existing theoretical model for the mechanics of constant peak displacement cardiopulmonary resuscitation (CPR) using experimental data taken using various back support surfaces at different chest compression (CC) rates. A CPR simulator was used to perform constant peak displacement CC on a weighted full-body CPR training manikin supported on surfaces of varying stiffness at different CC rates. The net sternum-to-spine displacement, combined chest and mattress displacement, and axial reaction force were measured during each test. The experimental results were compared to theoretical predictions from the constant peak displacement CPR model. The theoretical model predictions matched the experimental data to within a mean difference of 11.7% at a CC rate of 42 compressions per minute (cpm), 10.0% at a CC rate of 60 cpm, and 10.1% at a CC rate of 96 cpm, for a target maximum sternal displacement of 5.0 cm. The model predictions also show that when the back support stiffness is less than 250 N/cm, the benefit of using a backboard is greater than for stiffer support surfaces. Good quantitative agreement between the experimental data and the theoretical model suggests that the constant peak displacement CPR model provides reasonable prediction of CC mechanics during CPR over a wide range of CC rates. Conflicts in the literature are also explained by showing that backboards can significantly enhance CPR CC performance when the back support stiffness is less than 250 N/cm, while for surfaces with higher stiffness, the benefit of using a backboard is reduced.

The impact of backboard size and orientation on sternum-to-spine compression depth and compression stiffness in a manikin study of CPR using two mattress types

Objectives To explore how backboard orientation and size impact chest compressions during cardiopulmonary resuscitation (CPR). Methods Experiments were conducted on a full-body CPR training manikin using a custom-built simulator. Two backboards of different sizes were tested in longitudinal (head to toe) and latitudinal (side to side) directions to assess the impact of size and orientation on chest compressions during CPR. The net sternum-to-spine displacement, combined mattress and sternal displacement as well as the axial reaction force were measured during each test. Results The difference in net compression depth between the larger and smaller backboards ranged between 0.08 ± 0.30 cm and 1.47 ± 0.13 cm, while the difference in back support stiffness varied between 103.7 ± 211 N/cm and 688.1 ± 180.3 N/cm. The difference in net compression depth between the longitudinal and latitudinal backboard orientations ranged from 0.07 ± 0.32 cm to 0.34 ± 0.18 cm, while for the back support stiffness the difference was between 13.4 ± 50.0 N/cm and 592.2 ± 211.0 N/cm. Conclusions The effect of backboard size on chest compression (CC) performance during CPR was found to be significant with the larger backboard producing deeper chest compressions and higher back support stiffness than the smaller backboard. The impact of backboard orientation was found to depend on the size of the backboard and type of mattress used. Clinicians should be aware that although a smaller backboard may be easier for rescuers to manipulate, it does not provide as effective back support or produce as deep chest compressions as a larger backboard.

Mechanical versus manual chest compression during CPR in a cardiac catherization setting

Summary Background: Cardiopulmonary resuscitation (CPR) during treatment-resistant cardiac arrest in the catheterisation laboratory is exceedingly difficult, for practical reasons and on grounds of efficacy and safety. Mechanical chest compression devices may provide more constant CPR in this setting. Methods: Using a CPR training manikin we simulated a prolonged resuscitation situation during cardiac catheterisation requiring continuous chest compressions over ten minutes. We compared a team of three experienced resuscitators with the performance of a mechanical chest compression device (LUCASTM). Results: No overall differences in compression rate could be documented between manual and mechanical chest compression rate during ten minutes of continuous CPR (105/min vs 101/min; p = ns), but there was considerable variation with manual compression (88/min – 121/min). Mechanical chest compression resulted in more constant and correct depth of chest compressions compared to manual performance (98% vs 70%; p <0.01), even if a device failure occurred (95% vs 70%; p <0.01). Resuscitator fatigue was reflected in a mean of 21% (range 0–45%) too shallow compressions in the manual CPR group (vs 1% in the device CPR group; p <0.05). We documented comparable time frames of overall interruption of CPR due to installation of the mechanical device (10 seconds, range 9–11 seconds) and the overall time due to resuscitator changes (9 seconds, range 8–12 seconds) over ten minutes of continuous CPR. Manual CPR resulted in too deep compression in 8% of the compressions, whereas no deep compressions were noted for mechanical CPR (p = ns). Conclusion: Mechanical CPR devices may offer some advantages over manual CPR in the setting of prolonged resuscitation during cardiac catheterisation in treatmentresistant cardiac arrest requiring continuous chest compressions during PCI.

Test cases: in-hospital, scenario-based cardiopulmonary resuscitation training

Test cases are a method for unannounced scenario-based cardiopulmonary resuscitation (CPR) training and evaluation. The aim of this feasibility study is to describe the method in a hospital setting. The test cases described were performed by advanced life support (ALS) instructors at a county hospital in northern Europe. Many patients die from sudden cardiac arrest (SCA) inside hospitals all over the world. The survival rate is closely correlated with well-performed CPR, including time to first defibrillation. Earlier reports have claimed major deficiencies in CPR performance and skills retention and in hospital routines for CPR education and organisation. There are problems in translating skills from safe training environments to real SCA situations. The International Liaison Committee of Resuscitation (ILCOR) recommends more evaluation of additional training methods for health care professionals. This is, to our best knowledge, the first report of the use of test cases as a training and evaluation method. From 3 May 2005 to 8 November 2008, 23 test cases were performed at different locations in the hospital. All involved personnel knew the test was going to take place, but they did not know when. They were instructed to act as in an authentic SCA situation. This included alarming the hospital medical emergency team (MET). The MET also participated in the test cases to create realistic multidisciplinary training situations. A CPR training manikin (with a rhythm simulation module) was used to simulate the patient. A skills reporter, a protocol and a stopwatch were used for timing and technique assessment. The actions taken were assessed in relation to international guidelines. After the test cases, briefings were held with the personnel in order to allow them to express their points of view and to receive feedback regarding their performance. The focus was primarily on the team, but also on individual performances. All test cases were performed during office hours. The mean time from discovery of the manikin to first defibrillation was 2.73 ± 0.51 minutes (range 2.05–3.90 minutes). In eight of 23 cases, time to first defibrillation exceeded the stipulated 3 minutes. In all cases automated external defibrillators (AEDs) were used by nursing ward staff for the first defibrillation. The mean time to arrival of any of the members of the MET was 4.96 ± 1.70 minutes (range 3.05–9.80 minutes). The mean percentage of correctly performed chest compressions was 67.30 ± 24.99% (range 0–95%). The mean percentage of correctly performed ventilations was 40.00 ± 26.40% (range 0–90%). Test cases are feasible as an additional multidisciplinary training and evaluation method for in-hospital CPR. They create realism and can help in translating skills from safe training environments to real SCAs. They also provide baseline information regarding in-hospital CPR organisation. Further test cases are needed to show whether CPR performance can be improved using this method.

Managing “Real” Anesthesia Emergencies on Human Simulators

Managing “Real” Anesthesia Emergencies on Human Simulators

Ease of ventilation through the cuffed oropharyngeal airway (COPA), the laryngeal mask airway and the face mask in a cardiopulmonary resuscitation training manikin

The aim of this study was to compare ease of ventilation of a cardiopulmonary resuscitation manikin using a cuffed oropharyngeal airway (COPA), a laryngeal mask airway (LMA) and a face mask, by two groups of people with different levels of earlier experience in cardiopulmonary resuscitation (CPR). Enrolled were, 108 people identified as experienced (54), or inexperienced (54), in CPR. Training equipment included a manikin, a COPA ( n=10), an LMA ( n=4), a face mask ( n=4) and self-inflating bag-valve device. The same investigator explained the theoretical use and practice of the three techniques with the subjects in groups of three. The variables recorded were the number of attempts needed to achieve correct placement (and a tidal volume of 200 ml, was achieved), the insertion time for the COPA and the LMA, and the average time taken to achieve the first ten correct ventilations. The face mask and LMA required fewer attempts for correct placement than did the COPA. The LMA also took less time to insert than the COPA. The face mask required a significantly shorter total time with all attempts and the mean time of placement and time to achieve ten correct ventilations was shorter than with either the LMA or the COPA ( P=0.0001). We conclude that the face mask offers an easier and quicker way to provide ventilation for CPR manikins than does the COPA or the LMA. Earlier experience affects the ease of insertion of the LMA and the total time needed to achieve effective ventilation.

Sternal Force-Displacement Relationship During Cardiopulmonary Resuscitation

A viscoelastic model is presented to describe the dynamic response of the human chest to cyclic loading during manual cardiopulmonary resuscitation (CPR). Sternal force and displacement were measured during 16 clinical resuscitation attempts and during compressions on five CPR training manikins. The model was developed to describe the clinical data and consists of the parallel combination of a spring and dashpot. The human chests' elastic and damping properties were both augmented with increasing displacement. The manikins' elastic properties were stiffer and both elastic and damping properties were less dependent on displacement than the humans'.

Prevention of transmission of infection during mouth-to-mouth resuscitation

The risk of infection transmitted during mouth-to-mouth or mouth-to-nose resuscitation procedures is difficult to define but is possibly quite low. However, the perceived risk is sufficient to cause serious concern for many individuals, including trained hospital personnel as well as the general public, and may preclude prompt and effective action. A novel airway device was evaluated for the retention of infective droplets and fluid permeability under simulated resuscitation conditions using a cardiopulmonary resuscitation training manikin. Retention of a 0.5-5.0 micron aerosol of Staphylococcus aureus cells was greater than 80% at flow rates of 6 l/min while under simulated resuscitation conditions the trapping of bacteria, originating predominantly from saliva, was over 90%. These data suggest that this device may afford significant protection against transmission of infection during exhaled air resuscitation manoeuvres.

Hepatitis B Virus in a Cardiopulmonary Resuscitation Training Course

A group exposure to cardiopulmonary resuscitation training manikins contaminated by saliva from a participant during the immediate presymptomatic infectious stage of "e" antigen-positive hepatitis B recently occurred. None of the 18 susceptible participants developed serologic or clinical evidence of new hepatitis B infection during the six-month postexposure observation period. The risk of transmission in this setting appears to be low. Postexposure prophylaxis does not appear indicated.

A hypochlorite solution for removing bacteria from CPR manikins

To study the effectiveness of a dilute hypochlorite solution in removing bacteria from cardiopulmonary resuscitation (CPR) manikins, cultures from several areas of manikins disinfected with hypochlorite were compared with those from manikins disinfected with another protocol, and bacteria which grew were counted and identified. The use of dilute hypochlorite resulted in significant reduction of bacterial numbers (P less than .0005), without damaging manikin components or provoking unpleasant reaction from trainees. Dilute hypochlorite disinfection of CPR training manikins after each class session might greatly reduce the possibility of transmitting pathogenic bacteria or other microorganisms between participants in resuscitation practice.