CPR Course Research Articles

Interprofessional In Situ Simulation’s Impact on Healthcare Personnel’s Competence and Reported Need for Training in Cardiopulmonary Resuscitation—A Pilot Study in Norway

Background/objectives: International guidelines recommend cardiopulmonary resuscitation [CPR] training every sixth month. However, research indicates that more training is needed to maintain CPR competence. The objectives of this pilot study were (a) to assess health personnel’s self-reported competence and need for more training in CPR before and after interprofessional in situ CPR simulation and (b) to assess time since the last CPR course and respondent’s reported need for more training. Also, we wanted a pilot to assess areas of improvement in a future, larger study. Methods: A questionnaire was administered to healthcare personnel in hospital wards receiving CPR training using a purposeful sampling strategy. Results: In total, 311 respondents answered the pre-intervention and 45 respondents answered the post-intervention survey. The respondents believed they had good knowledge, skills, and training in CPR, and about 2/3 of the respondents reported a need for more knowledge, skills, and training. There was a weak positive correlation between the time since the last CPR course and the perceived need for more training [p < 0.05]. There were no significant differences in self-reported competence or perceived need for more training pre- and post-intervention. The pilot detected several limitations that need improvement in a future study. Conclusions: The authors suggest that regular training is important for maintaining competence in CPR. Also, in a future study, comparisons at an individual level, as well as assessments by experts and of non-technical skills, should be included.

Resuscitation (un-)wanted: Does anyone care? A retrospective real data analysis

Background and objectivesIn case of out-of-hospital cardiac arrest (OHCA) personnel of the emergency medical services (EMS) are regularly confronted with advanced directives (AD) and do-not-attempt-resuscitation (DNACPR) orders. The authors conducted a retrospective analysis of EMS operation protocols to examine the prevalence of DNACPR in case of OHCA and the influence of a presented DNACPR on CPR-duration, performed Advanced-Life-Support (ALS) measures and decision making. Materials and methodsRetrospective analysis of prehospital medical documentation of all resuscitation incidents in a German county with 250,000 inhabitants from 1 January 2016 to 31 December 2022. Combined with data from the structured CPR team-feedback database patients characteristics, measures and course of the CPR were analysed. Statistic testing with significance level p < 0.05. ResultsIn total n = 1,474 CPR events were analysed. Patients with DNACPR vs. no DNACPR: n = 263 (17.8%) vs. n = 1,211 (82.2%). Age: 80.0 ± 10.3 years vs. 68.0 ± 13.9 years; p < 0.001. Patients with ASA-status III/IV: n = 214 (81.3%) vs. n = 616 (50.9%); p < 0.001. Initial layperson-CPR: n = 148 (56.3%) vs. n = 647 (55.7%); p = 0.40. Airway management: n = 185 (70.3%) vs. n = 1,069 (88.3%); p < 0.001. With DNACPR CPR-duration initiated layperson-CPR vs. no layperson-CPR: 19:14 min (10:43–25:55 min) vs. 12:40 min (06:35–20:03 min); p < 0.001. ConclusionIn case of CPR EMS-personnel are often confronted with DNACPR-orders. Patients are older and have more previous diseases than patients without DNACPR. Initiated layperson-CPR might lead to misinterpretation of patients will with impact on CPR-duration and unwanted measures. Awareness of this issue should be created through measures such as training programs in particular to train staff in the interpretation and legal admissibility of ADs.

Abstract P449: Closing the Gender Gap in Bystander Cardiopulmonary Resuscitation: Unveiling Disparities and Pathways to Equal Lifesaving

Introduction: Gender disparities in CPR persist, with women receiving CPR less frequently than men during out-of-hospital cardiac arrests. This abstract emphasizes the importance of addressing this disparity through awareness campaigns and offers innovative strategies for prevention, including gender-sensitive CPR training methods and a community program example from New Orleans. Methods: A comprehensive literature review was conducted to identify studies on gender disparities in bystander CPR. Factors contributing to these disparities were analyzed, including hesitations related to physical contact, challenges in recognizing cardiac arrest in women, and societal biases. Survival data were assessed to highlight the lifesaving potential of gender-equal CPR. Results: Research revealed that gender disparities in CPR provision are common, influenced by factors such as reluctance to perform chest compressions on women, difficulties in identifying cardiac arrest in female patients, and the perpetuation of gender stereotypes. These factors result in significantly different survival rates, with women facing a higher risk of worse outcomes. Discussion: Addressing gender disparities in bystander CPR provision requires a multifaceted approach, including community-based CPR training programs that emphasize gender sensitivity. These programs should feature anatomically correct CPR training dolls with breast attachments to ensure trainees are prepared to perform CPR on anyone. It is crucial that CPR course instruction also incorporate information on gender disparities to raise awareness among trainees. Public awareness campaigns should work to dispel myths and biases related to gender and CPR, promoting more equitable lifesaving practices. An exemplary program from New Orleans demonstrates the impact of community-based initiatives. In this effort, community members were trained in CPR using gender-inclusive materials, including CPR dolls with breast attachments. The training included statistical information on gender disparities, bias assessments, survivor testimonials, and discussions aimed at dispelling myths about providing CPR to women. This program successfully empowered the community with the knowledge and skills to overcome gender biases in CPR, promoting gender-equitable lifesaving measures. Conclusion: Preventing gender disparities in bystander CPR provision to women is essential to enhance survival rates for female cardiac arrest victims. Using public platforms to advocate for these initiatives and emphasizing the need for collaborative efforts to eliminate gender bias in lifesaving practices and CPR training is crucial. By illuminating the issue, proposing innovative solutions, and sharing successful community programs, a standard can be cultivated where every individual, regardless of gender, receives timely and effective CPR.

Readiness and Challenges in Cardiopulmonary Resuscitation Teaching: A Preliminary Perspective Amongst Malaysian Secondary School Principles

Introduction: Malaysia has not legalized CPR teaching in the national curriculum, leaving it to school principals to implement the teaching of CPR who may have limited knowledge. This study aims to investigate Malaysian secondary school principals’ level of readiness, defined as knowledge, attitude, willingness to teach CPR, and barriers to implementation. Methods: Malaysian secondary school principals were invited to complete a survey that consisted of five parts: (1) demographics, (2) CPR knowledge, (3) attitude towards CPR, (4) willingness to teach CPR, and (5) barriers to implementing CPR teaching. Results: A total of 54 secondary school principals responded to the survey. Three (5.6%) principals passed the CPR test. More than 80% agreed CPR course is important for students, mandatory to be taken before graduation and best taught by certified teachers. Principals are willing to qualify themselves and teachers with CPR certification and to provide funding to support and hire an outsider to teach CPR courses. Funding, teachers’ readiness for skills and knowledge proficiency, and curriculum burden are perceived as potential barriers to successful CPR teaching. One-way MANOVA analysis showed that gender (p = .257), age (p = .108), qualifications (p = .321), teaching experience (p = .194), and administrative experience (p = .193) did not have a significant effect on the combined dependent variables. Conclusion: Malaysian secondary school principals are aware of the importance of CPR and were willing to acquire the knowledge, skills, funds, equipment, and support in ensuring its implementation in the national curriculum.

Willingness and Barriers to Undertaking Cardiopulmonary Resuscitation Reported by Medical Students after the SARS-CoV-2 Pandemic-Single-Center Study.

Most of the studies in the field of willingness and barriers to resuscitation (CPR) were conducted before the SARS-CoV-2 pandemic. The aim of the study was to assess the number and types of barriers to CPR among medical students after the pandemic ended. This study was based on a survey. The data was collected from 12 April 2022 to 25 May 2022. A total of 509 complete questionnaires were obtained. The number of barriers depending on the time elapsed from the last CPR course did not differ significantly (Me = 4 [IQR 2-6] vs. Me = 5 [IQR 3-7]; p = 0.054, respectively). The number of all barriers reported by respondents differed significantly and was higher in those reporting fear of coronavirus (Me = 4 [IQR 2-6] vs. Me = 7 [IQR 4-9]; p < 0.001, respectively). A total of 12 out of all 23 barriers were significantly more frequent in this group of respondents. Barriers to CPR are still common among medical students, even despite a high rate of CPR training. The pandemic significantly affected both the number and frequency of barriers. The group of strangers and children, as potential cardiac arrest victims, deserve special attention. Efforts should be made to minimize the potentially modifiable barriers.

A Comparison of Skill Retention from Two Instructor-Led BLS CPR Courses

CPR skill retention is vitally important on successful resuscitation outcomes. This study examined college students’ retention of Adult CPR skills 6 months following participation in an instructor-led CPR course presented in two different formats.

Abstract 147: Volunteer Responders Often Provide Emotional Support To Relatives Of Out-of-hospital Cardiac Arrest Patients Even After Arrival Of The Emergency Medical Services

Introduction: Volunteer responders (VR) are dispatched to OHCA to fetch an AED and provide CPR. However, often more than one volunteer responder arrives, allowing additional responders to handle tasks beyond resuscitative efforts. We aimed to assess which tasks dispatched VR performed during resuscitation attempts and the proportion of VR providing emotional support to patient relatives. Method and Results: This was an observational study with prospectively collected data from Denmark's national volunteer responder cohort between April 2020 and May 2022. We included 18,489 VR who accepted an alarm and arrived at a presumed cardiac arrest. All VR who received an alarm received a survey 90 minutes after, which included questions regarding their handling of tasks (response rate 86.1%). Of 18,489 volunteers, 6,612 (35.8%) arrived before EMS. Among all VR who arrived at the cardiac arrest scene, 3,424 (18.5%) performed CPR, 1,851 (10.0%) attached an AED, and 3,447 (18.6%) provided support for relatives. In univariate logistic regression models, VR provision of CPR was significantly associated with being healthcare educated (OR: 1.76, 95% CI: 1.61-1.93), police or firefighter (OR: 3.28, 95% CI: 2.96-3.64). Further, odds for CPR provision increased with recent CPR course (OR: 2.48, 95% CI: 2.09-2.93). VR provision of CPR was significantly associated with an increasing number of VR arriving before EMS. Odds for the provision of CPR were doubled in cases where three or more VR arrived before EMS (OR:6.06, 95% CI: 5.29-6.94) compared to cases where one VR arrived (OR: 3.15, 95% CI: 2.70-3.69). When VR arrived after EMS, 14.9 % provided support for relatives (Fig 1). Conclusion: Volunteer responders’ engagement in OHCA is associated with educational background and the number of volunteers arriving before EMS. Provision of support for relatives is the most frequently handled task, even at arrival after the EMS.

Cardiopulmonary resuscitation skill training and retention in teens (CPR START): A randomized control trial in high school students

AimHigh school students are currently the largest group of individuals in the US receiving CPR training every year. This study examines the effect of adding a real-time visual feedback device to a standard instructor-led CPR course on skill acquisition and retention in high school students. MethodsAll study participants underwent baseline CPR skill testing and received a standard instructor-led compression-only CPR course. We then randomized students to a ‘Feedback Group’, consisting of 2 min of CPR training using a real-time visual feedback device, or ‘Standard Group’ that continued to practice on the inflatable manikin. CPR skills for all students were tested afterwards using the feedback device and reported as a compression score (CS) derived from their chest compression depth, rate, hand position, and full chest recoil. We compared the CS at baseline, week-0 (immediately post-intervention), week-10, week-28, and week-52 between groups. ResultsA total of 220 students were included in the analyses (Feedback Group = 110, Standard Group = 110). Both groups showed similar CPR performance at baseline. At week-0, the Feedback Group had a significantly higher CS compared to the Standard Group (adjusted difference: 20% [95% CI: 11%–29%; p < 0.001]). This difference attenuated over time but remained significant at the week-10 and week-28 follow-up; however, by the week-52 follow-up, there was no significant difference between groups. ConclusionsUsing a real-time visual feedback device during CPR training significantly improves skill acquisition and retention in high school students and should be integrated into the high school CPR curriculum.

MATERNAL CARDIAC ARREST AND THE USE OF MODIFIED ADVANCED CARDIAC LIFE SUPPORT: A CASE FROM MERCY STIMULATION TRAINING LAB

SESSION TITLE: Medical Student/Resident Critical Care Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: October 18-21, 2020 INTRODUCTION: Amniotic fluid embolism (AFE) is one of the dreaded causes for cardiac arrest in pregnancy; a catastrophic complication which affects 1.9 to 6.1 women per 100,000 deliveries. Cardiac arrest in pregnancy is complicated and requires modified advanced cardiac life support (ACLS) and a multidisciplinary team approach. Literature suggests clinical simulation sessions increase confidence among physicians regarding their ability to manage maternal cardiac arrest in practice. The following case exemplifies the effectiveness of Mercy's weekly simulation training lab and mock code blues in preparing residents to respond to uncommon ACLS scenarios. CASE PRESENTATION: A 31 year old woman presented to the operating room for a planned low transverse cesarean section. Upon presentation the patient was asymptomatic and vital signs were stable. Immediately after delivery of the fetus, the patient suddenly became pulseless, hypotensive and bradycardic. Cardiopulmonary resuscitation was immediately initiated and a code blue was called. Laboratory data showed acute acidosis and acute thrombocytopenia. Patient met the diagnostic criteria of amniotic fluid embolism and the diagnosis was confirmed during resuscitation (Figure 1). CPR course is illustrated in (Figure 2). Bedside transthoracic echocardiogram showed a large highly mobile embolus in the right atrium. A shared decision was made to transfer the patient to a tertiary care center after return of spontaneous circulation was achieved. DISCUSSION: Maternal cardiac arrest is a complex catastrophic clinical scenario which requires a multidisciplinary team familiar with and confident in using modified ACLS algorithms. The Mercy Weekly Simulation Training curriculum included 7 AFE mock code blues that prepared 60 internal medicine (IM) residents to address the knowledge gaps and ensure proficiency in providing advanced cardiac life support. In this case, 5 IM residents responded to the code under the supervision of obstetricians, intensivists, cardiologists and anesthesiologists. Previous studies displayed that simulation sessions increase confidence among physicians regarding the ability to appropriately manage maternal cardiac arrest in clinical practice.Mercy's Weekly Simulation Training Lab ensured adequate training among all residents regarding advanced cardiac life support (ACLS) in pregnancy prior to this event. During this code our residents demonstrated high quality care and knowledge addressing maternal modified ACLS which resulted in a positive outcome. CONCLUSIONS: This case highlights the importance of simulation training sessions; through simulation training our team reinforced resuscitation skills further increasing resident confidence while concomitantly improving patient outcomes. Reference #1: Barsuk JH, Willams MC, Wayne DB, et al. Telling the whole story about simulation-based education. Obstet Gynecol. 2017; 96: 1273–1273. Reference #2: Lee A, Sheen JJ, Richards S. Intrapartum Maternal Cardiac Arrest: A Simulation Case for Multidisciplinary Providers. MedEdPORTAL. 2018;14:10768. Published 2018 Oct 2 Reference #3: Vaden Hoek TL, Morrison, LJ, Sguster M, Et al. Cardiac Arrest In Special Situations. AHA. 2010 10 Nov 2;122(18 Suppl 3):S829-61. DISCLOSURES: No relevant relationships by Andrew Ajemian, source=Web Response No relevant relationships by Waddah Malas, source=Web Response No relevant relationships by Michael Markos, source=Web Response No relevant relationships by Payman Sattar, source=Web Response No relevant relationships by Michael Thompson, source=Web Response

ACTIVIDADES DEPORTIVAS CON SOPORTE MUSICAL: ¿UNA NUEVA FORMA DE APRENDER REANIMACIÓN CARDIOPULMONAR?

El objetivo del estudio fue analizar la viabilidad de enseñar RCP en actividades deportivas con apoyo musical y evaluar si este nuevo enfoque iguala los resultados de un curso tradicional de reanimación cardiopulmonar (RCP). Participaron 84 estudiantes universitarias sin conocimientos de RCP distribuidas en dos grupos de forma aleatoria. El primero recibió formación de RCP sólo manos integradas en una clase de aeróbic y el otro recibió un curso de RCP de manera convencional. Los resultados en la clase coreografiada comparados con el curso tradicional fueron: Profundidad media de compresiones (41,64 vs 42,92; p= 0,446), re-expansión correcta (65,47% vs 72,47%; p=0,423), frecuencia de compresiones en un minuto (102,50 vs 138,53; p&lt;0,001), compresiones totales (202,50 vs 277,95; p&lt; 0,001). Los dos métodos formativos alcanzaron resultados similares por lo que la introducción de la enseñanza de RCP en actividades deportivas puede ser un nuevo método formativo.

Dispatcher assisted CPR: Is it still important to continue teaching lay bystander CPR?

PurposeThe aim of this study was to compare on manikin chest compressions only CPR performance carried out by untrained volunteers following Dispatcher assisted Cardiopulmonary Resuscitation (DACPR), and then by the same trained volunteers immediately after chest compressions only CPR course and 4months after the CPR course. Method38 university student volunteers with no previous experience in CPR took part in three on manikin chest compressions only CPR skill evaluations: first in a DACPR, then after chest compressions only CPR course (ACPRC) and lastly, four months after a CPR course (4MACPRC). Only 22 completed the whole process. ResultsIn DACPR 7.89% of participants carried out cardiac compressions outside the thorax. The mean average time from collapse to first compression was reduced in 4MACPRC (40.77 s), as compared to DACPR (144.54s); p<0.001).The following parameters were significantly better in 4MACPRC than in DACPR: Average compression depth (44.72 vs 25.22; p<0.001), average compression rate (106.1 vs 87.90; p<0.001), total number of compressions in 3min (317 vs 245; p<0.001), percentage of correct compressions (53.00% vs 4.72 %; p<0.001) and percentage of correct hand positioning (95.40 vs 91.09; p<0.001). ConclusionsEven though chest compressions only DACPR allows lay bystanders to be able to carry out cardiac compressions in 92.1% of cases, these were delivered later and were less efficient than chest compressions only CPR given by trained bystanders after a CPR course and four months after the course.

Peyton's 4-Steps-Approach in comparison: Medium-term effects on learning external chest compression - a pilot study.

Introduction: The external chest compression is a very important skill required to maintain a minimum of circulation during cardiac arrest until further medical procedures can be taken. Peyton’s 4-Steps-Approach is one method of skill training, the four steps being:Demonstration, Deconstruction, Comprehension and Execution. Based on CPR skill training, this method is widely, allegedly predominantly used, although there are insufficient studies on Peyton’s 4-Steps-Approach for skill training in CPR in comparison with other methods of skill training. In our study, we compared the medium- term effects on learning external chest compression with a CPR training device in three different groups: PEY (Peyton’s 4-Steps-Approach), PMOD (Peyton’s 4-Steps-Approach without Step 3) and STDM, the standard model, according to the widely spread method “see one, do one” (this is equal to Peyton’s step 1 and 3).Material and Methods: This prospective and randomised pilot study took place during the summer semester of 2009 at the SkillsLab and Simulation Centre of the University of Cologne (Kölner interprofessionelles Skills Lab und Simulationszentrum - KISS). The subjects were medical students (2nd and 3rd semester). They volunteered for the study and were randomised in three parallel groups, each receiving one of the teaching methods mentioned above. One week and 5/6 months after the intervention, an objective, structured single assessment was taken. Compression rate, compression depth, correct compressions, and the sum of correct checklist items were recorded. Additionally, we compared cumulative percentages between the groups based on the correct implementation of the resuscitation guidelines during that time.Results: The examined sample consisted of 134 subjects (68% female; age 22±4; PEY: n=62; PMOD: n=31; STDM: n=41). There was no difference between the groups concerning age, gender, pre-existing experience in CPR or time of last CPR course. The only significant difference between the groups was the mean compression rate (bpm): Group 1 (PEY) with 99±17 bpm, Group 2 (PMOD) with 101±16 bpm and Group 3 (STDM) with 90±16 bpm (p=0,007 for Group 3 vs. Group 1 and Group 3 vs. Group 2, Mann-Whitney- U-Test). We observed no significant differences between the groups after the second assessment.Conclusion: Our study showed that there are no essential differences in external chest compression during CPR performed by medical students dependent on the teaching method (Peyton vs. “Non-Peyton”) implemented with regard to the medium-term effects. The absence of benefits could possibly be due to the simplicity of external chest compression.

Abstract 16229: The Performance of Dispatcher Assisted Cardiopulmonary Resuscitation Among Elderly Laypersons is Inferior Compared to Young Laypersons: A Simulation Study

Introduction: Standardized instructions in dispatcher assisted CPR (DA-CPR) increase the rate and quality of bystander CPR. Most cardiac arrests occur in private homes and the most likely bystander to initiate CPR is an elderly layperson. Studies on elderly performing DA-CPR are sparse. The aim of this study was to compare the performance of DA-CPR between elderly and young laypersons. Hypothesis: DA-CPR performance is inferior among elderly laypersons compared to young laypersons. Methods: The study was performed in two substudies. Substudy 1 compared the performance of DA-CPR between elderly (&gt;65 years) and young (18 - 40 years) laypersons. Substudy 2 evaluated the attainable level of CPR skills after attending a standardized CPR course. CPR was performed in a mock cardiac arrest scenario in both substudies. CPR quality data was obtained from the manikin and video recordings. CPR performance was evaluated by two assessors. The primary endpoint was chest compression depth during DA-CPR. Secondary endpoints included chest compression rate, time to first compression and hands-off time. Results: In total, 120 laypersons were included. Substudy 1 (DA-CPR): Elderly laypersons performed significantly shallower (mean (SD): 39 (19) mm vs. 56 (14) mm, p&lt;0.001) and slower (median (IQR): 84 (74 - 107) min-1 vs. 107 (97 - 112) min-1, p&lt;0.001) chest compressions compared to young laypersons. Elderly laypersons had significantly longer time to first compression (mean (SD): 104 (38) sec vs. 71 (11) sec, p&lt;0.001) and significantly more hands-off time pr. minute (median (IQR): 5 (2 - 10) sec vs. 0 (0 - 1) sec, p&lt;0.001) than young laypersons. Substudy 2 (End-of-course assessment): Elderly laypersons performed significantly shallower (mean (SD): 50 (14) mm vs. 64 (8) mm, p&lt;0.001) and slower (mean (SD): 93 (18) min-1 vs. 111 (11) min-1, p&lt;0.001) chest compressions compared to young laypersons. Conclusions: Performance of DA-CPR is inferior among elderly laypersons compared to young laypersons. The study found an acceptable quality of CPR skills among both elderly and young laypersons after CPR-training.

Police officer attitudes towards performing cardiopulmonary resuscitation in western part of Turkey

resuscitation (CPR) and to improve resuscitation skills of future doctors. Method: The key learning objectives are etiology and pathophysiologyof cardiac arrest, physiologyofCPR, acute and long-term treatment, andquality of survival. The subjects are addressed in lectures by experts, tutorials, practicals and assessed in a theoretical and practical exam. Tutorials are based on Problem Based Learning covering four cases. Practicals consist of a CPR course, ins and outs of recording an electrocardiogram, visit to a dispatch center, introduction to the ambulance and paramedics activities, extracorporeal CPR and insights into implantable cardioverter defibrillators and pacemakers. Results: In January 2015 the course ‘Resuscitation Medicine’ was held for the sixth time. Until now 400 medical students have successfully attended and received a certificate. During the last edition 100 students participated, being one third of the total of first year medical students of Maastricht University. Discussion:Over time an incline in participantswas noted, suggesting that more students are recognizing the importance of this course as a need for future doctors. The course also stimulatesmedical students to become CPR instructor and also to participate in research programs on resuscitation medicine and education 2. As CPR instructor, students will maintain their CPR skills and improve their teaching skills. CPR instructors of Taskforce QRS Maastricht teach CPR skills primarily to secondary school students; this could lead to an improvement of survival chances of SCA victims by increased bystander CPR.

Visual assessment of CPR quality during pediatric cardiac arrest: Does point of view matter?

AimIn many clinical settings, providers rely on visual assessment when delivering feedback on CPR quality. Little is known about the accuracy of visual assessment of CPR quality. We aimed to determine how accurate pediatric providers are in their visual assessment of CPR quality and to identify the optimal position relative to the patient for accurate CPR assessment. MethodsWe videotaped high-quality CPR (based on 2010 American Heart Association guidelines) and 3 variations of poor quality CPR in a simulated resuscitation, filmed from the foot, head and the side of the manikin. Participants watched 12 videos and completed a questionnaire to assess CPR quality. ResultsOne hundred and twenty-five participants were recruited. The overall accuracy of visual assessment of CPR quality was 65.6%. Accuracy was better from the side (70.8%) and foot (68.8%) of the bed when compared to the head of the bed (57.2%; p<0.001). The side was the best position for assessing depth (p<0.001). Rate assessment was equivalent between positions (p=0.58). The side and foot of the bed were superior to the head when assessing chest recoil (p<0.001). Factors associated with increased accuracy in visual assessment of CPR quality included recent CPR course completion (p=0.034) and involvement in more cardiac arrests as a team member (p=0.003). ConclusionHealthcare providers struggle to accurately assess the quality of CPR using visual assessment. If visual assessment is being used, providers should stand at the side of the bed.

EURECA One 2014: ROSC analysis

INTRODUCTION Cardiac arrest survival rate after out of hospital cardiopulmonary resuscitations is pretty low and goes from 1,7% to 6,1%. The return of spontaneous circulation is the first step towards complete recovery of the patient after experiencing cardiac arrest. Predictors of sustainable ROSC include witnessing of collapse by laymen, initial heart rhythm, bystander initiation of CPR, early EMS engagement, early defibrillation and short duration of medical transport. AIM: It is to investigate the return of ROSC in regards to epidemiological and demographic characteristics, treatment and outcome (survival after a month) with shockable initial rhythm for a six-month sample. METHOD: Prospective observational study where data were gathered through particular questionnaire that concerned OHCA (out-of-hospital cardiac arrest) on the territory of Vojvodina during six month period (from October 1st 2104. until March 31st 2015.). The data that were used are registered in the data base of European programme EuReCA One 2014. RESULTS: 276 patients that have had OHCA on the territory of Vojvodina were analyzed - the incidence of 40,63 per 100 000. EMS conducted CPR in 51,16% (N=155, n=22,82/100 000), ROSC was established in 30,32% (N=47, n=6,92/100 000), and 30 days survival was documented in 9,03% of the cases (N=14, n=2,06/100 000). Shockable rhythm was initially recognized with 59,57% of the patients (N=28, n=4,10/100 000). CONCLUSION: Cardiopulmonary resuscitation sets the return of spontaneous circulation (ROSC) as its primary objective, which depends great deal on key factors affecting the course of CPR, and positive variables for CPR course are initial shockable rhythm, witnessing of cardiac arrest by layman or EMS, heart condition as the presumed cause, female gender and age under 80 years.

Board #120 - Research Abstract Use of a Commercially Available High-fidelity Mannequin with QCPR as a Realistic Model to Simulate Sudden Cardiac Arrest in a Collapsed Athlete (Submission #9334)

Hypothesis Because of the rarity of sudden cardiac arrest, it is difficult to prepare sports medicine personnel to recognize and manage the distressed athlete. There is no teaching model that simulates a real-life, on-site situation. Without use, proficiency attained in a one-day CPR course quickly attenuates. This project was undertaken to develop a sudden cardiac arrest training scenario using a commercially available high-fidelity simulator. Further, our purpose was to determine if an education program based on utilization of this model would improve ATCs speed of assessment, effectiveness of resuscitation and timeliness of AED acquisition and utilization. Methods Nineteen ATC’s from two Division I Universities underwent training and assessment of a simulated cardiac arrest scenario utilizing the Laerdal SimMan 3G simulator, a commercially available mannequin with a built-in Quality of CPR (QCPR) measurement device. Participants were athletic training staff and Graduate athletic teaching assistants certified in Basic Life Support. The initial (pretest) simulation was conducted in-situ with an athlete having chest pain in the exam room. Initially, the simulated patient was stable and rapidly progressed to an unconscious state. Available equipment included a trainer field bag and AED. The timing of resuscitative tasks was collected as data points via Laerdal’s debriefing log and analyzed using a paired t-test. The simulation educational program included a didactic component coupled with CPR practice with real-time feedback on accurate compression depth and rate utilizing the mannequin’s QCPR feature. Post-test simulation assessment was conducted two months after the education program. Results Nine of the twelve data points collected demonstrated improvement in times (P <0.05) in the post-test following the education program for Athletic Trainers. The nine data points included: pulse check, initiation of CPR, call 911, attachment of AED, analyzing with AED, defibrillation and CPR compression depth. No significant improvements were observed in times related to assessment of breathing and initiation of ventilations. Upon presentation of the simulated collapsed athlete, a decrease in intervention times was seen across the data points and chest compression rate and depth improved following the education program. Conclusion While there is no substitute for real-life experience, commercially available high-fidelity mannequins capable of delivering QCPR feedback appear to be an effective teaching and assessment tool for evaluation of sudden cardiac arrest in a collapsed athlete. This study demonstrates that an education program with ATCs improves reaction times and performance in management of sudden cardiac arrest using this high-fidelity manikin model system. Following this study, both Division I Universities have incorporated high-fidelity manikin-based scenarios into their annual basic life support education. Further studies should be considered with two aims; one in which the ATCs receive a typical BLS course and one which complements with high-fidelity simulation to determine knowledge and skill retention.

Push hard, push fast: quasi-experimental study on the capacity of elementary schoolchildren to perform cardiopulmonary resuscitation

BackgroundThe optimal age to begin CPR training is a matter of debate. This study aims to determine if elementary schoolchildren have the capacity to administer CPR efficiently.MethodsThis quasi-experimental study took place in a Quebec City school. Eighty-two children 10 to 12 years old received a 6-hour CPR course based on the American Heart Association (AHA) Guidelines. A comparison group of 20 adults who had taken the same CPR course was recruited. After training, participants’ performance was evaluated using a Skillreporter manikin. The primary outcome was depth of compressions. The secondary outcomes were compression rate, insufflation volume and adherence to the CPR sequence. Children’s performance was primarily evaluated based on the 2005 AHA standards and secondarily compared to the adults’ performance.ResultsSchoolchildren did not reach the lower thresholds for depth (28.1 +/− 5.9 vs 38 mm; one-sided p = 1.0). The volume of the recorded insufflations was sufficient (558.6 +/222.8 vs 500 ml; one-sided p = 0.02), but there were a significant number of unsuccessful insufflation attempts not captured by the Skillreporter. The children reached the minimal threshold for rate (113.9 +/−18.3 vs 90/min; one-sided p < 0.001). They did not perform as well as the adults regarding compression depth (p < 0.001), but were comparable for insufflation volume (p = 0.83) and CPR sequence.ConclusionsIn this study, schoolchildren aged 10–12 years old did not achieve the standards for compression depth, but achieved adequate compression rate and CPR sequence. When attempts were successful at generating airflow in the Skillreporter, insufflation volume was also adequate.

Abstract 19508: Remote Supervised Reinforcement of Cardiopulmonary Resuscitation Skills by Telephone Improves One-Year Retention: A Randomized-Controlled Trial

Objective: Bystander CPR is an effective way of improving the outcome of out of hospital cardiac arrest (OHCA). However, the survival rate of OHCA remains &lt; 10% due to rapid skill deterioration following CPR training. We explored the effect of two remote supervised review models (audio-visual [AV] and audio-visual-practice [AVP]) on CPR skill retention. Method: Family members of patients at high risk of sudden cardiac arrest (SCA) were recruited from communities in Beijing, China. All subjects received a 90-min CPR course, and a CPR instruction booklet for review at home as needed. At the end of the course, if the subjects passed the skill test, they were randomized into one of the 3 groups (AV, AVP, and control) using sealed envelopes. The AV group was provided with a CPR instruction video (CPR-V) and asked to watch it every 3 months. The AVP group was provided with a practice dummy (designed for the project) as well as a CPR-V, and asked to practice their skills on the dummy while watching the CPR-V every 3 months. Both groups were given telephone follow up every 3 months to encourage compliance. The controls were given a placebo video without follow up. CPR skills were re-assessed after 12 months using Resusci Anne recording manikins. The subjects, the instructors, and the evaluators were blinded to the group assignment. Results: Of the 262 family members who finished the study, the retention rates of overall, and key elements of CPR skills were significantly higher in the AVP and AV groups, compared to the control group. Skill retention was higher in the AVP group compared to the AV group. Conclusion: Both review models improved long-term CPR skill retention for family members of high-risk patients with SCA. The AVP model was more effective than the AV model especially for skills related to performing high quality chest compression.

Performance outcomes of an online first aid and CPR course for laypersons

Objective: The study evaluated the effectiveness of an online first aid course by comparing it with the traditional instructor-led course. An effective online course increases course accessibility and mitigates the major deterrent to widespread layperson training. Design: A comparison group design evaluated performances among 25 laypersons self-selecting the traditional course and 46 self-selecting the online course. Setting: Online participants completed the course in a location and at a time convenient to them. Traditional participants completed the course at testing sites. All attended a testing site for skills testing. Method: Eight instructors participated in traditional course delivery, skills review and practice, and skills testing. They assessed participants’ performance using standard checklists. Resuscitation mannequins captured objective performance data. Results: Instructors assessed all participants as passing all skills tests. None passed using the objective data but online course participants outperformed traditional course participants. Conclusions: The online course is effective. Its accessibility permits broader dissemination and use.