Resuscitation Education Research Articles

Scientific verification of American Heart Association (AHA) 2005 Guidelines for Cardiopulmonary Resuscitation (CPR) and Emergency Cardiovascular Care (ECC) (G2005) and cardiopulmonary resuscitation (CPR) education

Scientific verification of American Heart Association (AHA) 2005 Guidelines for Cardiopulmonary Resuscitation (CPR) and Emergency Cardiovascular Care (ECC) (G2005) and cardiopulmonary resuscitation (CPR) education

도서 산간 지역 주민의 심폐소생술교육 희망에 대한 영향 요인 분석

= ABSTRACT = Objectives: The purpose of this study is to describe and analyze the characteristics of which laypersons want the cardiopulmonary resuscitation(CPR) education. Methods: Based on a health survey(913) of 5 remote places in Korea, tests of the differences between the group that wants the CPR education(416) and the group that doesn't(497), and a logistic regression analysis of two groups was performed on socio-economic status and health-medical conditions. Results: Even the participation rate of the CPR education in Korea is only 5.8%, which is extremely lower than other developed countries, there are statistically significant differences between the group that wants the CPR and the group that doesn't on gender( 0.001), age( 0.000), education level( 0.000), economic status( 0.007), and CPR education taken( 0.000), and health status( 0.042). Furthermore, age(OR=1.599,  0.002), age(OR=0.964,  0.000), economic status(OR=0.804,  0.028), and CPR education taken(OR=2.072,  0.026) are statistically significant factors on the willingness to receive the CPR education. Conclusions: This study indicates that there is considerable variation in socio-economic status and health-medical conditions associated with the willingness to receive the CPR education. In remote places. certain subgroups of laypersons such as high-risk patients and family members need targeted outreach programs in CPR education.

An evaluation of 9-1-1 calls to assess the effectiveness of dispatch-assisted cardiopulmonary resuscitation (CPR) instructions: design and methodology

BackgroundCardiac arrest is the leading cause of mortality in Canada, and the overall survival rate for out-of-hospital cardiac arrest rarely exceeds 5%. Bystander cardiopulmonary resuscitation (CPR) has been shown to increase survival for cardiac arrest victims. However, bystander CPR rates remain low in Canada, rarely exceeding 15%, despite various attempts to improve them. Dispatch-assisted CPR instructions have the potential to improve rates of bystander CPR and many Canadian urban communities now offer instructions to callers reporting a victim in cardiac arrest. Dispatch-assisted CPR instructions are recommended by the International Guidelines on Emergency Cardiovascular Care, but their ability to improve cardiac arrest survival remains unclear.Methods/DesignThe overall goal of this study is to better understand the factors leading to successful dispatch-assisted CPR instructions and to ultimately save the lives of more cardiac arrest patients. The study will utilize a before-after, prospective cohort design to specifically: 1) Determine the ability of 9-1-1 dispatchers to correctly diagnose cardiac arrest; 2) Quantify the frequency and impact of perceived agonal breathing on cardiac arrest diagnosis; 3) Measure the frequency with which dispatch-assisted CPR instructions can be successfully completed; and 4) Measure the impact of dispatch-assisted CPR instructions on bystander CPR and survival rates.The study will be conducted in 19 urban communities in Ontario, Canada. All 9-1-1 calls occurring in the study communities reporting out-of-hospital cardiac arrest in victims 16 years of age or older for which resuscitation was attempted will be eligible. Information will be obtained from 9-1-1 call recordings, paramedic patient care reports, base hospital records, fire medical records and hospital medical records. Victim, caller and system characteristics will be measured in the study communities before the introduction of dispatch-assisted CPR instructions (before group), during the introduction (run-in phase), and following the introduction (after group).DiscussionThe study will obtain information essential to the development of clinical trials that will test a variety of educational approaches and delivery methods for telephone cardiopulmonary resuscitation instructions. This will be the first study in the world to clearly quantify the impact of dispatch-assisted CPR instructions on survival to hospital discharge for out-of-hospital cardiac arrest victims.Trial RegistrationClinicalTrials.gov NCT00664443

Project to improve training of resuscitation nurses

Carla is an Associate Clinical Service Coordinator (formally known as a Clinical Nurse). Megan Wake is the ED Nurse Educator. Together they have worked at the Royal Adelaide Hospital for many years and have had a professional and fulfilling working career in the Emergency Department. We both have a passion and obsession with resuscitation education. This has progressed into a great working relationship and the development of education workbooks for our department.

Abstract P152: Video Self-instruction of Cardiopulmonary Resuscitation Skills for Hospital Personnel in Guatemala

Background: Barriers to cardiopulmonary resuscitation (CPR) education are magnified in the developing world by relative cost and course availability. Though Guatemala has a developed medical infrastructure there are few certified CPR instructors and only one agency providing courses. An AHA video self-instruction (VSI) course is now available in Spanish but no data exist regarding its utility and implementation. Objectives: We sought to: (1) implement a pilot CPR education program in Guatemala using VSI and (2) assess attitudes and opportunities for secondary training by subjects (a “multiplier effect”). Methods: Hospital personnel were voluntarily trained using an established 30 min VSI program translated into Spanish, and subsequently demonstrated skill performance. CPR quality was recorded by direct observation and a CPR-sensing defibrillator without feedback. A post-training interview was performed to collect demographic information and attitudes regarding CPR training and the VSI program. Results: A total of 49 participants completed the study. Mean age (SD) was 36 (8), 86% were female, 65% were employees in clinical areas, and 29% had any prior CPR training. Regarding skills performance, 88% evaluated the patient prior to beginning CPR, 65% called for help, and 100% of participants gave 2 rescue breaths prior to each set of chest compressions. Mean (SD) chest compression depth was 38 mm (16) with adequate (>38 mm) depth noted in 51% of participants. Mean (SD) compression rate was 97 (17) per minute and adequate rate (80 –120 per min) was noted in 70%. Survey data revealed that 94% of participants (stated they would take the VSI kit home to practice and teach family and community members. Participants, blinded to actual price in the US ($25–30), stated they were willing to pay an average of $24 US dollars for the VSI kit (n=44). Conclusions: A previously-validated VSI CPR training kit, translated into Spanish, can be effectively implemented among hospital staff in a developing country in Latin America. Attitudes towards home training and dissemination were positive; further work will be required to establish rates of secondary CPR training.

International Perspectives

Humanitarian efforts by a large number of groups have provided care in many developing countries around the world, including southeast Asia. Beginning around 2000, Project Vietnam, a humanitarian organization supported, in part, by California Chapter 4 of the American Academy of Pediatrics, expanded its already established presence within Vietnam to include a focus that specifically addressed efforts to improve neonatal care and reduce mortality in that country. I became a part of this effort and joined the expanding team devoted to this mission. Part of the impetus for this change by the organization was the establishment of goals by the Vietnamese Ministry of Health (MoH) and the leaders of pediatrics within the country. These goals, stimulated by the millennium goals of the World Health Organization, were aimed at improving the care of newborns and developing systems of care to accomplish sustainable results in this important area of health care. Over the past 9 years, much progress has been made and many lessons have been learned in Vietnam. The improvements have led to reductions in mortality and to the expanded availability of higher-quality modern care for increasing numbers of patients. Such advances have come about through the hard work and dedication of individuals and several organizations such as Project Vietnam as well as the partnership with key leaders within the country. Perhaps as important as these tangible improvements is the information learned from successes and failures that may serve as the foundation of an organizational structure or paradigm that can be used to guide similar efforts elsewhere in the world. The following discussion is a compilation of experiences and descriptions of some of the centrally important events in which we have been involved. The models that have grown out of this include important generalizations with utility elsewhere. Although related by a …

Videoconferencing can be used to assess neonatal resuscitation skills

Objective To examine the hypothesis that an instructor in a remote site can accurately assess the practical skills of a provider performing a simulated neonatal resuscitation (megacode) using videoconferencing. Methods Using volunteer NRP providers and instructors, two local telemedicine sites were linked using six telephone lines. Camera angles, sound settings and equipment placement were optimized. Instructors tested providers at the other site. Instructors recorded their observations on checklists based on those of the Neonatal Resuscitation Program (NRP), and all participants completed feedback forms and gave verbal feedback. Based on the results of the pilot study, the protocol and recording tools were developed, and providers at a rural centre were tested. Tests were carried out with local and remote instructors. Observations of local and remote instructors were collected independently, and compared. Opinions of providers were also collected. Results Observations of the local and remote instructors on the performances of the providers were consistent; 15 of 18 megacodes reached the required standard. Six telephone lines were required for transmission without noticeable delay in sound transmission. Viewing quality was sufficient for remote instructors to provide feedback on ventilation technique. Providers indicated that videoconferencing did not interfere with their performance and would willingly repeat the experience. Cronbach’s alpha for assessment of the technical features was 0·80 or greater for all groups. Conclusions Videoconferencing can be used to test resuscitation providers in remote centres. It can enhance neonatal resuscitation education in areas where experienced instructors are in short supply.

Effect of emergency care simulator combined with problem-based learning in teaching of cardiopulmonary resuscitation

To evaluate the teaching effects of emergency care simulator (ECS) combined with problem-based learning (PBL) in teaching of cardiopulmonary resuscitation (CPR). 42 medical students were randomly divided into 2 equal groups, control group receiving PBL and training of specific operation such as artificial respiration, external cardiac compression, tracheal intubation, and defibrillation, and ECS group receiving ECS training in addition. Then test was given to record the scores in artificial respiration. A questionnaire survey was conducted to collect the feedback. There were no significant differences in the scores of artificial respiration, external cardiac compression, tracheal intubation, and defibrillation between the 2 groups (all P > 0.05). There were significant differences between the Control group and the ECS group (P < 0.05). The percentages of students with enhanced emergency awareness, emergency skill, team spirit and cooperative effort, with improved analytic skill in clinical setting and in amalgamating the theoretic learning with textbook knowledge and clinical practice were all higher in the ECS group than in the control group (all P < 0.05). More than 86% of the students considered that there was significant difference between these two groups. Using ECS combined with PBL in teaching CPR technique directly involves the medical students in "emergency practice", resolving of "all sorts of problems", enhancing emergency awareness, and emergency skill. It can improve teaching quality significantly that is in accordance with the development of modern medicine.

111: A Survey on Developing Basic Cardiopulmonary Resuscitation Education Course for Middle School Students

The importance of basic life support (BLS) education for the public is being emphasized recently for increasing the survival of patients in out of hospital cardiac arrest. For this, enforcing early BLS education through school education is effective. It is not requested as an obligation in our country yet. Some school health educators are enforcing their own education programs, but they are not accomplished through unified education methods, courses, and teaching materials. We enforced this study in order to develop an education course that could be actually practiced in middle schools, by investigating the present recognition and the practice level of education which is before enforcing unified education among middle school students.

A Proposed Framework for Developing a Plan for Research in Lifesaving and Water Safety

Lifesaving has come a long way since 1878 in Marseille, when the first world lifesaving congress was held. The last half of the 19th century and up to World War I saw a dramatic and worldwide increase in sea trade, augmented by improved technology. The oceans became crowded, while concerns for safety lagged far behind the increase in tonnage by sea (Golden & Tipton, 2002). An escalation in armed conflict fanned the fire. Drowning statistics were at an all-time high. A tiny but significant seafaring nation like Norway approached 750 drownings per year at the peak, nearly 8 times the current toll and, per capita, over 20 times as great as today (Solberg & Nesheim, 2006). Little wonder that both governments and private individuals became alarmed, and initiatives to reduce this tragedy emerged. Local efforts led the way, appearing in the form of awareness campaigns, resuscitation education, learn-to-swim campaigns, lifesaving programs, and sea rescue. Several major cities worldwide had already formalized ambitious programs (e.g., The Society for Rescue of Drowning Persons, Amsterdam, 1767, in Bierens, 2006). The seeds of national consolidation were sown, and the first national lifesaving associations were in their fetal stage. The Marseille conference gathered like-minded persons and organizations and institutionalized the need to share and to learn from one another. A secondary effect of the congress was that seeing the progress of others in the nationalization of lifesaving accelerated this development in other countries. The next 25–30 years saw the birth of dozens of national lifesaving associations. As we all know, the Federation Internationale de Sauvetage Aquatique was launched in 1910. World Life Saving came later (1971), catering to the special needs of surf lifesaving, and in historic meetings in Leuven, Belgium, in 1993, these were merged into the International Life Saving Federation (ILS) of today. Many of these national associations have flourished and achieved a high degree of professional competence and experience and have been able to reach a large portion of their citizens. Some have succeeded in the political arena, influencing their governments to establish certain safety standards. In spite of increased international contact, the national agencies have maintained strong cultural traditions. A considerable variety of philosophies, methods, techniques, and programs still exists. Within the aquatic-research community,

Consensus vs.evidence in medicine: resuscitation

Despite advances in medical education, equipment and facilities, survival rates following cardiac arrest over a 40-year period have not improved significantly. Attempts to scientifically review resuscitation techniques commenced in 1966, with the American Heart Association publishing recommended standards and guidelines in 1974, 1980 and 1986. In 1987, the Heart Foundation of South Africa convened a National CPR Symposium with a view to achieving national consensus guidelines for the teaching, training and performance of CPR. This was followed by the formation of a Southern African Resuscitation Council in 1989 in order to foster and co-ordinate the practice and teaching of resuscitation and to promote uniformity and standardization of resuscitation techniques. With the creation of Resuscitation Councils worldwide, an International Liaison Committee on Resuscitation (ILCOR) was established in 1992, comprising representatives from the American Heart Association, the Heart and Stroke Foundation of Canada, the European Resuscitation Council, the Australian Resuscitation Council and the Resuscitation Council of Southern Africa. ILCOR’s mission is to provide a consensus mechanism by which the international science and knowledge relevant to emergency cardiovascular care can be identified and reviewed. ILCOR has published more than 18 scientific Advisory Statements, including the 2000 and 2005 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations. A Universal Cardiac Arrest Algorithm was designed, reflecting major consensus recommendations placed in chronological sequence. Since the publication of the 2005 International Consensus, survival rates appear to be doubling or tripling worldwide.

The effectiveness of cardiopulmonary resuscitation instruction: Animation versus dispatcher through a cellular phone

We developed a cardiopulmonary resuscitation (CPR) instruction programme using motion capture animation integrated into cellular phones. We compared the effectiveness of animation-assisted CPR instruction with dispatcher-assisted instruction in participants with no previous CPR training. This study was a single blind cluster randomized trial. Participants were allocated to either animation-assisted CPR (AA-CPR; 8 clusters, 44 participants) group or dispatcher-assisted CPR (DA-CPR; 8 clusters, 41 participants). The overall performance and time of each step of CPR cycle were recorded on a checklist by 3 assessors. The objective performances were evaluated using the Resusci Anne SkillReporter Manikin. Differences between the groups were compared using an independent t-test adjusted for the effect of clustering. The AA-CPR group had a significantly better checklist score (p<0.001) and time to completion of 1 CPR cycle (p<0.001) than the DA-CPR group. In an objective assessment of psychomotor skill, the AA-CPR group demonstrated more accurate hand positioning (68.8+/-3.6%, p=0.033) and compression rate (72.4+/-3.7%, p=0.015) than DA-CPR group. However, the accuracy of compression depth (p=0.400), ventilation volume (p=0.977) and flow rate (p=0.627) were below 30% in both groups. Audiovisual animated CPR instruction through a cellular phone resulted in better scores in checklist assessment and time interval compliance in participants without CPR skill compared to those who received CPR instructions from a dispatcher; however, the accuracy of important psychomotor skill measures was unsatisfactory in both groups.

Newly graduated doctors’ competence in managing cardiopulmonary arrests assessed using a standardized Advanced Life Support (ALS) assessment

Several studies using a variety of assessment approaches have demonstrated that young doctors possess insufficient resuscitation competence. The aims of this study were to assess newly graduated doctors' resuscitation competence against an internationally recognised standard and to study whether teaching site affects their resuscitation competence. The entire cohort of medical students from Copenhagen University expected to graduate in June 2006 was invited to participate in the study. Participants' ALS-competence was assessed using the Advanced Life Support Provider (ALS) examination standards as issued by the European Resuscitation Council (ERC). The emergency medicine course is conducted at three different university hospital teaching sites and teaching and assessment might vary across sites, despite the common end objectives regarding resuscitation teaching issued by the university. Participation was accepted by 154/240 (64%) graduates. Only 23% of the participants met the ALS pass criteria. They primarily lacked skills in managing cardiopulmonary arrest. There were significant differences in ALS-competence between teaching sites. Newly graduated doctors do not have sufficient competence in managing cardiopulmonary arrests according to the current guidelines published by ERC. There were significant differences in ALS-competence between sites. Change in teaching and assessment practice in undergraduate emergency medicine courses is needed in order to increase the level of ALS-competence of newly graduated doctors.

Application of computer simulation in emergency nurses' teaching of cardiopulmonary resuscitation

目的 分析和评价计算机模拟技术在急诊护士心肺复苏教学中的应用.方法 使用挪威Laerdal公司生产的SimMan综合模拟人和美国医学教育科技公司(METI)生产的高仿真模拟人(HPS)对我院急诊科60名护士进行心肺复苏诊治的模拟培训,并进行电脑评分.对参加培训的护士反馈问卷进行统计分析.结果 培训前护士人工呼吸平均分数为(60.54±32.42),培训后分数为(81.35±23.58);胸外按压平均分数(68.75±32.84),培训后分数为(82.53±26.49).护士经培训后心肺复苏能力明显提高(P＜0.05).结论 计算机模拟技术在急诊护士心肺复苏教学中可发挥巨大作用,它具有无风险、可重复性、可控性、培养团队精神等优点。

Evaluating the Effectiveness of Dispatch‐assisted Cardiopulmonary Resuscitation Instructions

To determine the frequency of agonal breathing during cardiac arrest (CA), its impact on the ability of 9-1-1 dispatchers to identify CA, and the impact of dispatch-assisted cardiopulmonary resuscitation (CPR) instructions on bystander CPR rates. A before-after observational study enrolling out-of-hospital adult CA patients where resuscitation was attempted in a single city with basic life support with defibrillation/advanced life support tiered emergency medical services. Victim, caller, and system characteristics were measured during two successive nine-month periods before (control group) and after (intervention group) the introduction of dispatch-assisted CPR instructions. There were 529 CAs between July 1, 2003, and December 31, 2004. Victim characteristics were similar in the control (n = 295) and intervention (n = 234) period; mean age was 68.3 years; 66.7% were male; 50.1% of CAs were witnessed; call-to-vehicle stop was 6 minutes, 37 seconds; ventricular fibrillation/ventricular tachycardia occurred in 29.9%; and the survival rate was 4.0%. Dispatchers identified 56.3% (95% confidence interval [CI] = 48.9% to 63.0%) of CA cases; agonal breathing was present in 37.0% (95% CI = 30.1% to 43.9%) of all CA cases and accounted for 50.0% (95% CI = 39.1% to 60.9%) of missed diagnoses. Callers provided ventilations in 17.2% and chest compressions in 8.3% of cases as a result of the intervention. Long time intervals were observed between call to diagnosis (2 minutes, 38 seconds) and during ventilation instructions (2 minutes, 5 seconds). Bystander CPR rates increased from 16.7% in the control phase to 26.4% in the intervention phase (absolute rate, 9.7%; 95% CI = 8.5% to 11.3%; p = 0.006). This trial demonstrates an increase in bystander CPR rate after the introduction of dispatch-assisted CPR. Agonal breathing occurred frequently and had a negative impact on the recognition of CA. There were long time intervals between call initiation and diagnosis of CA and during mouth-to-mouth ventilation instructions.

Dispatcher-assisted telephone-guided cardiopulmonary resuscitation: an underused lifesaving system

Our purpose with this investigation was to (i) estimate how often telephone-guided cardiopulmonary resuscitation was offered from emergency medical service dispatchers in Stockholm, (ii) study the willingness to perform cardiopulmonary resuscitation, and (iii) assess factors that could mislead the dispatcher in identifying the patient as a cardiac arrest victim. In this prospective study, 313 consecutive emergency calls of out-of-hospital cardiac arrest were obtained from the Swedish Cardiac Arrest Register. Seventy-six cases of out-of-hospital cardiac arrest fulfilled the inclusion criteria. All alarm calls were tape-recorded and analyzed according to a standardized protocol. Dispatchers offered bystanders telephone instructions for cardiopulmonary resuscitation in 47% (n=36) of the cases and, among these, cardiopulmonary resuscitation instructions were given in 69% (n=25). Only 6% (n=2) of bystanders were not willing to perform cardiopulmonary resuscitation. Signs of breathing (suspected agonal breathing) were described in 45% of the cases. Cardiopulmonary resuscitation was offered to 23% (n=10) of patients with signs of breathing versus 92% (n=23) of those who were not breathing (P<0.001). Despite the fact that the vast majority of bystanders are willing to take part in telephone-guided cardiopulmonary resuscitation, emergency medical service dispatchers offer telephone-guided cardiopulmonary resuscitation in about only half of cases. Signs of breathing (agonal breathing) are often mistaken for normal breathing and are a cause of delay in the diagnosis of cardiac arrest.

Evaluating the Effectiveness of Dispatch-assisted Cardiopulmonary Resuscitation Instructions

Evaluating the Effectiveness of Dispatch-assisted Cardiopulmonary Resuscitation Instructions

The Effectiveness of Cardiopulmonary Resuscitation Instruction, Animation Versus Dispatcher Through Cellular Phone: Cluster Randomized Trial

The Effectiveness of Cardiopulmonary Resuscitation Instruction, Animation Versus Dispatcher Through Cellular Phone: Cluster Randomized Trial

Strategy of resuscitation education in our facilities

Strategy of resuscitation education in our facilities

The need for head rotation and abdominal compressions during bystander cardiopulmonary resuscitation

The current AHA-ECC guidelines for basic life support focus on the provision of good chest compressions with minimal interruptions for patients with presumed out-of-hospital cardiac arrest. Moreover, international consensus guidelines now support the use of chest compression-only cardiopulmonary resuscitation (CPR) instructions for dispatcher-assisted CPR given over the phone to untrained bystanders. However, evidence that strongly challenge these recommendations have been overlooked. A review of this evidence argues for the need for head rotation (a hands-free method of airway control) and abdominal compressions during bystander CPR.