Mock Cardiac Arrest Research Articles

Simulation-Based Training Program to Improve Cardiopulmonary Resuscitation and Teamwork Skills for the Urgent Care Clinic Staff.

Lack of high-quality cardiopulmonary resuscitation (CPR) and effective team communication during cardiovascular emergencies could lead to poor patient outcomes and adverse events. Studies have shown that CPR psychomotor skills declined 3 months and plateaued up to 6 months after the completion of CPR training. The Urgent Care Clinic (UCC) interprofessional staff did not receive consistent training on CPR and teamwork skills beyond what was received from the biannual American Red Cross (ARC) Basic Life Support (BLS) training and semiannual Resuscitative Care Function mock cardiac arrest. Most participants took their last CPR training for more than 6 months (n = 12, 67%), between 3 and 6 months (n = 2, 11%), and within the last 3 months before the pre-intervention period (n = 4, 22%). The purpose of the project was to form an interprofessional team to lead the development and implementation of a theory- and evidence-based simulation-based training program to improve CPR and teamwork skills while enhancing patient safety and emergency medical readiness in the hospital and UCC. The quality improvement project utilized an interprofessional in situ simulation-based training to improve participants' CPR and teamwork skills. The UCC physicians, nurses, and medical technicians completed a CPR and teamwork simulation-based training with a high-fidelity mannequin, pre-simulation preparation, briefing, and debriefing. The project collected pre-intervention and post-intervention data for CPR competence and teamwork perceptions. A paired t-test was used to assess differences in participant CPR skills and Team Strategies to Enhance Performance and Patient Safety Teamwork Perceptions Questionnaire responses before and after the simulation-based training intervention. The 59th Medical Wing and the University of South Alabama Institutional Review Boards approved the quality improvement project. A total of 18 participants completed the ARC BLS and Team Strategies to Enhance Performance and Patient Safety simulation-based training. Most participants were medical technicians (n = 8, 44%), followed by physicians (n = 5, 28%) and (n = 5, 28%) nurses. There was a statistical significance in participants' ARC BLS scores, with a pre-simulation mean score of 45.42 and a post-simulation mean score of 89.21 (P = .000, 95% CI = 36.89-50.68). For Team Strategies to Enhance Performance and Patient Safety teamwork perceptions, there was a statistically significant increase in the participants' teamwork perception levels, with a pre-simulation mean score of 4.61 and a post-simulation mean score of 4.86 (P = .000, 95% CI = 0.20-0.31). Our results demonstrated that the participants' ARC BLS scores and UCC's team perceptions have increased after in situ simulation-based training. We did not assess the ideal time for re-training. We recommend a 3- to 6-month post-training assessment to determine the optimal time for a CPR and teamwork refresher training. A high-fidelity simulation-based program with trained facilitators that assess the healthcare providers' CPR and teamwork skills could enhance the delivery of high-quality CPR and execution of effective teamwork skills in their workplace.

Abstract 231: Single Bystander CPR Performance During Drone AED Delivery for Simulated Out of Hospital Cardiac Arrest

Background: Drones have great potential to speed the delivery of AEDs in the critical first few minutes of OHCA. However, it is unclear whether bystanders can balance high-quality cardiopulmonary resuscitation (CPR) with AED deployment. The 2015 AHA CPR guidelines recommend a chest compression (cc) rate of 100-120/minute, cc depth of 50-60mm, and cc fraction of >60%. Method: We performed mock cardiac arrest simulations using bystander volunteers, including simulated 911 call, telephone-assisted dispatcher CPR instructions, bystander CPR, drone-delivered AED, and AED application. CPR performance was recorded by a Laerdal Resusci Anne Quality Feedback System and compared between two groups of participants: recent CPR training (<2 years) versus remote (>2 years) or no CPR training. Prior data had shown CPR skill degradation after 2 years. Chi-squared tests compared demographics; T-tests compared age and CPR performance data. Results: Between 9/2019-3/2020, 5 simulations were conducted with 51 participants. The mean age was 39.7 years, 56.9% were female, and 78.4% had a college or graduate degree. Racial/ethnic makeup consisted of 64.7% White, 15.7% African-American, 15.7% Asian, and 11.8% Hispanic. 41.2% had recent CPR training (n=21); 58.8% had remote CPR training (n=19) or no CPR training (n=11). There were no differences in demographics by CPR training groups. Participants with recent CPR training had shorter time from CPR initiation to AED shock delivery (3:45 vs. 4:14 [min:sec], p=0.01) and a trend toward higher percent of time with cc depth (77.4% vs 50.4%, p=0.11) and higher cc fraction (46.8% vs 42.9 %, p=0.12). There were no differences for percent of time with cc rate or CPR recoil. Conclusion: Overall, CPR quality was low regardless of prior CPR training status. Those recently trained had shorter resuscitation time and appeared to have better CPR performance. Realization of a drone AED networks may require novel CPR programs focused on high-quality CPR.

Abstract 244: Real World Evaluation of Implementing a Mock Cardiac Arrest Program

Introduction: In 2019, the Veterans Health Administration (VHA) began rolling out a national initiative to create a standardized mock code training program through the Resuscitation Education Initiative (REdI). We partnered with REdI and the local REdI Mock Code Program team at a Midwestern VA medical center to evaluate the launch of this mock cardiac arrest training program using a mixed methods approach. Methods: The REdI mock cardiac arrest program provided training to VA medical center clinical and non-clinical staff using didactic, small group, and hands-on simulation activities over a 2-day site visit in January 2019 where all facets of the resuscitation team were reviewed. Following this training visit at one VA medical center, 10 mock cardiac arrests were conducted between March 2019 and December 2019. One mock cardiac arrest included a hospital-wide activation and nine were conducted on individual units without activation of the cardiac arrest response team. The research team was composed of clinical and methodological experts who observed 8 of the mock cardiac arrests. We used an observation template to record structured data elements and take field notes during the mock code (e.g., how participants made decisions, assigned roles and quality of communication between the participants). At the end of the mock code, facilitators and the study team collected oral and written feedback from the participants. Results: In the 8 mock cardiac arrests observed, we identified 54 participants. Participants overwhelmingly rated the mock cardiac arrests as positive (83.3%, 45/54). Debriefing-feedback after the mock cardiac arrest was identified as the most helpful aspect (42.6%, 23/54). Areas for improving implementation of the mock cardiac arrest training program focused primarily on the need for a better introduction to the exercise. This included understanding the manikin’s functionality (9.3%, 5/54) and the expectation that participants should perform CPR just as they would in an actual cardiac arrest event (7.4%, 4/54). Two critical takeaways frequently cited by participants related to performance during the mock cardiac arrest were a need for better communication (20.4%, 11/54) and defined roles (18.5%, 10/54). Conclusions: Implementation of a mock cardiac arrest program was positively received by participants at a VA medical center. Moreover, participants identified both opportunities for improving resuscitation performance and optimizing learning experiences as part of program implementation.

MP55: Reducing barriers to successful cardiac resuscitation: intervention in elementary schools

Introduction: The incidence of out-of-hospital cardiac arrest (OHCA) in school is approximately 2.1 for 100,000 per year. Although rare, it is a devastating event for the local community. Schools with public access to automated external defibrillators (AED) and an emergency response plan have demonstrated increased survival rates of up to 70% for students who suffer cardiac arrest. Previous studies identified numerous barriers to successful cardiac resuscitation in public school systems. The main objectives of this study were to identify those barriers in the Quebec region elementary school system and to assess the impacts of an AED focused training session. Methods: A previously validated survey focused on the potential barriers to successful defibrillation in OHCA and on demographic variables was sent to 139 elementary schools. Later, 92 employees within three elementary schools who responded to the survey were evaluated before and after receiving training on the use of AED in a mock cardiac arrest scenario. The primary outcome was the time to first shock and the secondary outcomes included correct AED pad placement and safety of the procedure. Results: Survey response rate was 53%, which is comparable to previous studies assaying barriers to cardiac resuscitation in public school systems. 95% of school respondents reported the presence of an AED on the school premises but 46% stated that no formal AED training course was provided to employees. Out of the four schools who reported a previous OHCA, only one had access to an AED at the time of the event. Following focused AED training, 92% of school workers successfully completed a defibrillation sequence in a mock scenario, from 53% before (p < 0.001, McNemar test). The time to first shock went from 66 seconds (95% CI 63-70) to 47 seconds (95% CI 45-49; -29%, p < 0.001). Proper pad placement was the most problematic step for participants and personnel who reported previous training had better performance (OR 3.15, 95% CI 1.33-7.42, p = 0.009). Conclusion: Most elementary schools in the Quebec region have access to AEDs. However, inadequate AED training represents a significant barrier to successful defibrillation in the event of an OHCA. Our results showed that a simple focused AED training could improve the performance of school workers and optimize the chain of survival.

Abstract 461: Evaluation of the Impact of Additional Structured Cardiac Arrest Training on Internal Medicine Residents in a Community Hospital

Introduction: There are approximately 200,000 cases of in-hospital cardiac arrest (IHCA) annually in the United States. Of these cases, only 40-50% achieve return of spontaneous circulation (ROSC) and only 20-30% are discharged. Though most hospital staff are trained in cardiac arrest resuscitation, a significant disparity in resuscitation has been noted between different hospital settings. We thus instituted additional structured cardiac arrest training in an Internal Medicine residency program, to supplement the biennial advanced cardiac life support (ACLS) training. Hypothesis: We hypothesized that institution of a dedicated structured cardiac arrest team (code team) in addition to monthly training for those on the team, would improve the confidence, skills, and leadership level, of residents at managing an IHCA situation. Methods: A structured code team with specific roles for each resident was instituted in a New York City-based community hospital. Training was guided by audio-visual lectures and then reinforced by performing mock cardiac arrest drills. Resident assessments were done pre and post-training through an anonymous standardized questionnaire. Summative measures of mean confidence, mean ACLS skills, and leadership were evaluated. Uni and bivariate analysis, and T-tests for statistical significance were performed using STATA 15 software. Results: Our sample of 32 residents showed an increase in mean learning scores across all the three domains. Confidence scores increased from 7.23 to 8.44, ACLS skills increased from 7.40 to 8.57 and leadership scores increased from 6.56 to 7.88. Paired T-tests demonstrated high significance (P<0.000). Conclusion: This study demonstrates the effectiveness of additional structured cardiac arrest training on confidence, skills, and leadership of resident physicians in an Internal Medicine program. The next phase of this study will be to re-evaluate knowledge and confidence at 3 and 6 months after training.

Abstract 29: A Neighborhood Local Volunteer Response Network Improves Response Time for Cardiac Arrest

Background: Minutes are crucial in the treatment of out-of-hospital cardiac arrest (CA). Immediate chest compressions and early defibrillation are keys to good outcomes. Local neighborhood volunteer (vol) response programs may decrease delays to early CPR and AED use. We hypothesized that a coordinated effort of alerting trained neighborhood vols simultaneously with 911 activation of professional EMS providers would provide earlier CPR and defibrillation in such communities. Methods: We developed a program of simultaneously alerting CPR and AED trained neighborhood vols and the local EMS system for cardiac arrest events in a retirement community in Southern Arizona, encompassing approximately 17,300 homes and 21,500 residents. EMS services are provided by 5 stations within the community boundaries. Within a single housing development neighborhood, 9 vols and the closest EMS station were involved in 3 days of mock CA notifications (total of 12 different alerts at various times during daytime hours were sent). This provided a total of 120 response opportunities, 12 for EMS and 108 for vols. The distance to the mock event and the time from alert to arrival were recorded and compared. Results: In the selected 55+ neighborhood, the two groups differed significantly in both distance to the mock cardiac arrest event and in response times. The volunteers average 0.33±0.19 miles from the mock CA incidences while the closest EMS station was 3.3 miles from the tested neighborhood (p<0.0001). Response times (time from call to arrival) were also different. The earliest Vol arrived at 1min 30sec±48sec*, 2 Vols & AED at 1min 38 sec±53sec*, all arriving Vols at 3min 23 sec*, and EMS at 7min 20 sec±1min 13sec (*p<0.0001 vs EMS). Conclusion: When the neighborhood volunteers in this testing period were geographically closer to the mock CA event, they arrived significantly sooner to the scene than did the EMS service. The mean time of arrival for at least 2 vols with an AED was 5 min 42 sec faster than the professional rescuers. The implications for such a time saving could be as much as a 240% increase (25% to 85%) in survival for those with shockable rhythms.

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 (>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<0.001) and slower (median (IQR): 84 (74 - 107) min-1 vs. 107 (97 - 112) min-1, p<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<0.001) and significantly more hands-off time pr. minute (median (IQR): 5 (2 - 10) sec vs. 0 (0 - 1) sec, p<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<0.001) and slower (mean (SD): 93 (18) min-1 vs. 111 (11) min-1, p<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.

Evaluation of a newly developed media-supported 4-step approach for basic life support training

ObjectiveThe quality of external chest compressions (ECC) is of primary importance within basic life support (BLS). Recent guidelines delineate the so-called 4“-step approach” for teaching practical skills within resuscitation training guided by a certified instructor. The objective of this study was to evaluate whether a “media-supported 4-step approach” for BLS training leads to equal practical performance compared to the standard 4-step approach.Materials and methodsAfter baseline testing, 220 laypersons were either trained using the widely accepted method for resuscitation training (4-step approach) or using a newly created “media-supported 4-step approach”, both of equal duration. In this approach, steps 1 and 2 were ensured via a standardised self-produced podcast, which included all of the information regarding the BLS algorithm and resuscitation skills. Participants were tested on manikins in the same mock cardiac arrest single-rescuer scenario prior to intervention, after one week and after six months with respect to ECC-performance, and participants were surveyed about the approach.ResultsParticipants (age 23 ± 11, 69% female) reached comparable practical ECC performances in both groups, with no statistical difference. Even after six months, there was no difference detected in the quality of the initial assessment algorithm or delay concerning initiation of CPR. Overall, at least 99% of the intervention group (n = 99; mean 1.5 ± 0.8; 6-point Likert scale: 1 = completely agree, 6 = completely disagree) agreed that the video provided an adequate introduction to BLS skills.ConclusionsThe “media-supported 4-step approach” leads to comparable practical ECC-performance compared to standard teaching, even with respect to retention of skills. Therefore, this approach could be useful in special educational settings where, for example, instructors’ resources are sparse or large-group sessions have to be prepared.

Pre-training evaluation and feedback improve medical students’ skills in basic life support

Background: Evaluation and feedback are two factors that could influence simulation-based medical education and the time when they were delivered contributes their different effects.Aim: To investigate the impact of pre-training evaluation and feedback on medical students’ performance in basic life support (BLS).Methods: Forty 3rd-year undergraduate medical students were randomly divided into two groups, C group (the control) and pre-training evaluation and feedback group (E&F group), each of 20. After BLS theoretical lecture, the C group received 45 min BLS training and the E&F group was individually evaluated (video-taped) in a mock cardiac arrest (pre-training evaluation). Fifteen minutes of group feedback related with the students’ BLS performance in pre-training evaluation was given in the E&F group, followed by a 30-min BLS training. After BLS training, both groups were evaluated with one-rescuer BLS skills in a 3-min mock cardiac arrest scenario (post-training evaluation). The score from the post-training evaluation was converted to a percentage and was compared between the two groups.Results: The score from the post-training evaluation was higher in the E&F group (82.9 ± 3.2% vs. 63.9 ± 13.4% in C group).Conclusions: In undergraduate medical students without previous BLS training, pre-training evaluation and feedback improve their performance in followed BLS training.

Basic Life Support:A Call for Reevaluation by Nurse Educators

FORMAL EVALUATION OF THE STUDENT'S NURSING SKILLS IS FUNDAMENTAL TO THE UNDERGRADUATE NURSING CURRICULUM. An exception is basic life support (BLS) skills. The fact that these skills elude formal evaluation is alarming as research demonstrates that nursing students perform BLS skills poorly (Madden, 2006; Moule & Knight, 1997). This author urges that schools of nursing incorporate BLS skill evaluation into the undergraduate curriculum. Typically, schools of nursing require that students certify in BLS, but certification only validates the student's knowledge at one point in time. Following certification, a period of skill and knowledge deterioration takes place that Alspach (2005) attributes to the inability of the brain to form a procedural memory of the task. Students may complete the nursing program with the false notion that they are still competent in BLS. Formal skill evaluation is the accurate appraisal of a skill using techniques that have been tested for reliability and validity. Without formal evaluation of BLS, lack of competence may go unnoticed, and minimal learning may take place. As a nursing student, I had first-hand experience with the deterioration of skills and knowledge. Prior to joining the emergency response team (ERT), I had been through the certification process and considered myself an expert in BLS. However, following formal evaluation by the ERT team, my areas of deficiency were clearly apparent. I was able to remedy my errors and learn from my mistakes. I also worked as a peer mentor in my school's nursing laboratory for the last two years of the nursing program and observed students practicing other nursing skills, but never their BLS skills. As a student and mentor, I can attest that students will not practice a skill unless they know they cannot perform it correctly, or unless the skill is to be evaluated. Since the evaluation of BLS skills is not incorporated into the curriculum and appears to be inconsequential, students do not spend time fine-tuning these skills. But Niemi- Murola, Makinen, and Castren (2007) studied nursing and medical students' attitudes toward cardiopulmonary resuscitation and current practice guidelines and reported that nursing students would have liked to learn more BLS in their prelicensure education. Simulation and monitoring feedback devices are useful tools for maintaining BLS competency. The use of such devices may eliminate questions such as how hard do I push? and how fast should I go? Ackermann (2007) found that nursing students' BLS performance in a mock cardiac arrest scenario using high-fidelity simulation manikins was significantly better than the performance of a control group trained using standard American Heart Association training. …

External chest compressions using a mechanical feedback device

External chest compressions (ECC) are essential components of resuscitation and are usually performed without any adjuncts in professional healthcare. Even for healthcare professionals during in-hospital and out-of-hospital resuscitation poor performance in ECC has been reported in recent years. Although several stand-alone devices have been developed none has been implemented as a standard in patient care. The aim of this study was to examine if the use of a mechanical device providing visual feedback and audible assistance during ECC improves performance of healthcare professionals following minimal and simplified instructions. In a prospective, randomized cross-over study 81 healthcare professionals performed ECC for 3min (in the assumed setting of a secured airway) twice on a manikin (Skillreporter ResusciAnne®, with PC-Skillreporting System Version 1.3.0, Laerdal, Stavanger, Norway) in a mock cardiac arrest scenario. Group1 (n=40) performed ECC with the device first followed by classic ECC and group2 (n=41) in the opposite order. Minimal instructions were standardized and provided by video instruction (1min 38s). Endpoints were achievement of a mean compression rate between 90 and 110/min and a mean compression depth of 40-50mm. In addition participants had to answer questionnaires about demographic data, professional experience and recent recommendations for ECC as well as their impression of the device concerning the ease of use and their personal level of confidence. Data were analyzed for group-related and inter-group differences using SAS (Version 9.1.3, SAS Institute, Cary, NC). A total of 81 healthcare professionals regularly involved in resuscitation attempts in pre-hospital or in-hospital settings took part in the study with no differences between the groups: females 35.8% (n=52), emergency medical technicians 32.1% (n=26), anesthesia nurses 32.1% (n=26), physicians (anesthesiology) 45% (n=29). In group1 33 out of 40 (82.5%; 99.7±4.82/min; 95% confidence interval 95% CI: 98.1-101.2/min) reached the correct range for compression rate and 29/40 (72.5%; 44.0±4.95mm; 95% CI: 42.4-45.6mm) the correct compression depth using the assisting device. Afterwards they conducted classic ECC without the device and deteriorated significantly: correct compression rate was achieved by 12/40 (30%, p≤0.0001; 110.6±11.0/min (95% CI: 107.1-114.1/min), while 25/40 (62.5%; 44.5±5.63mm; 95% CI: 42.6-46.3mm) met the correct compression depth. Group2 performed poorer in ECC without assistance and 5/41 (12.2%; 104.5±21.35/min; 95% CI: 97.8-111.3/min) reached the correct rate whereas 21/41 (51.2%; 39.6±7.61mm; 95% CI: 37.2-42.0mm) compressed to the appropriate depth. Using the device there was a significant improvement in the second evaluation with 34/41 (82.9%, p≤0.0001; 101.7±4.68/min; 95% CI: 100.2-103.2/min) reaching the correct rate and 36/41 (87.8%, p≤0.0001; 43.9±4.16mm; 95% CI: 42.6-45.2mm) the correct depth. The tested device is easy to use after instruction of less than 3min and improves ECC performance of healthcare professionals in simulated cardiac arrest with respect to compression depth as well as compression rate.

Comparison of the quality of chest compressions on a dressed versus an undressed manikin: A controlled, randomised, cross-over simulation study.

BackgroundUndressing the chest of a cardiac arrest victim may delay the initiation of chest compressions. Furthermore, expecting laypeople to undress the chest may increase bystander reluctance to perform cardiopulmonary resuscitation (CPR). Both of these factors might conceivably decrease survival following cardiac arrest. Therefore, the aim of this study was to examine if the presence or absence of clothes affected the quality of chest compressions during CPR on a simulator manikin.MethodsThirty laypeople and 18 firefighters were randomised to start CPR on the thorax of a manikin that was either clothed (three layers) or not. Data were obtained via recordings from the manikin and audio- and video-recordings. Measurements were: maximum compression depth; compression rate; percentage of compressions with correct hand positioning; percentage of compressions with complete release (≤ 10 mm), and percentage of compressions of the correct depth (range 40-50 mm). Laypeople were given a four-hour European Resuscitation Council standardised course in basic life support and tested immediately after. Firefighters were tested without additional training. Mock cardiac arrest scenarios consisted of three minutes of CPR separated by 15 minutes of rest.ResultsNo significant differences were found between CPR performed on an undressed manikin compared to a dressed manikin, for laypeople or firefighters. However, undressing the manikin was associated with a mean delay in the initiation of chest compressions by laypeople of 23 seconds (N = 15, 95% CI: 19;27).ConclusionsIn this simulator manikin study, there was no benefit gained in terms of how well CPR was performed by undressing the thorax. Furthermore, undressing the thorax delayed initiation of CPR by laypeople, which might be clinically detrimental for survival.

New visual feedback device improves performance of chest compressions by professionals in simulated cardiac arrest

Introduction Quality of external chest compression (ECC) is a key component of Basic Life Support. Different approaches to improve rescuers’ performance have been evaluated, but few attempts have been made to invent simple devices to improve performance. This study evaluates a new visual feedback system for ECC for healthcare professionals. Methods Ninety-three healthcare professionals volunteered (14 emergency medical technicians, 45 paramedics, 34 physicians; age 32 ± 7.2 (range 21–61); 72% male) in this randomized cross-over study. All subjects were tested on a manikin (Skillreporter ResusciAnne ®, Laerdal, Stavanger, Norway) in identical mock cardiac arrest scenario and asked to perform 2 min of continuous ECC (secured airway): Group A ( n = 46): ECC with device first, followed by ECC without device a minimum of 45 min later; group B ( n = 47): vice versa. Primary endpoints: mean compression rate 90–120 min −1; mean compression depth 38–51 mm. Data were analyzed using repeated measure logistic regression model for binary categorized endpoints and repeated measure ANOVA test for continuous endpoints. Results Correct compression depth was achieved by 45.2% of subjects (95%-CI: 30.5–64.9 mm) without vs. 73.1% (95%-CI: 40.3–57.4 mm) with device ( p < 0.001); correct compression rate was achieved by 62.4% (95%-CI: 78–147.8 min −1) without vs. 94.6% (95%-CI: 87.3–126.6 min −1) with device ( p < 0.001). Overall, 85% of the subjects thought the feedback system was helpful and 80.6% would use it if available. Conclusions The new visual feedback device significantly improved ECC performance (compression rate and depth) by healthcare professionals in simulated cardiac arrest. Most participants found the device easy to use.

Retention of skills in medical students following minimal theoretical instructions on semi and fully automated external defibrillators

There is consent that the use of automated external defibrillators (AED) by laypersons improves survival rates in case of cardiac arrest, but no evident consensus exists on the content and duration of training for this purpose. Acceptance of the implementation of Public Access Defibrillation programmes will depend on practical and target-oriented training concepts. The aim of this prospective randomised interventional study was to evaluate long-term effects of a specific, minimal training programme on using semiautomatic and fully automatic AEDs in simulated cardiac arrest. In a mock cardiac arrest scenario 59 medical students with no specific previous medical education were tested during their first semester at medical school. Students who passed any medical emergency training were excluded. The subjects were evaluated before and after attending specified instructions of 15 min duration and after a period of 6 months. Main end points were time to first shock, electrode-positioning and safety throughout the procedure. Mean time to first shock without prior instructions was 77.7+/-17.05 s. After instruction there was a significant improvement to 56.5+/-9.5 s (p<or=0.01) and after 6 months this time had only slightly elongated (59.9+/-8.9 s; p<or=0.01). Initially, correct electrode placement was observed in 84.4%. No difference was found immediately and 6 months after instructions (93.2% and 98.3%). All individuals performed safely. First year medical students with minimal instruction are able to use semiautomatic as well as fully automatic AED sufficiently fast and safe without prior training. A significant improvement in time to first shock can be detected up to 6 months after receiving non-specific instructions of 15 min duration.

Human factors impact successful lay person automated external defibrillator use during simulated cardiac arrest

With the dissemination of automated external defibrillators in the community, there is increasing lay person use, along with less formal automated external defibrillator training and retraining. Therefore, the "ease of use" factors related to the human-device interface may be vital for successful use. We sought to determine whether human factor differences would result in differences in parameters of successful or safe use by lay persons in the setting of simulated cardiac arrest. We measured parameters of successful and safe use with two automated external defibrillator devices among two groups of volunteers, those trained with a brief video tape and those without any training (completely naive). Both devices (the Philips FR2 or the HS1) are used in public access defibrillator settings. Volunteers entered a mock cardiac arrest scenario after randomization to either the naive (untrained) group or to a video-trained group. Both the FR2 and HS1 were found to be completely safe when used by video-trained and by naive groups of participants, with no adverse events observed (total, n = 256). For both devices, video-trained participants demonstrated high rates of successful defibrillation in the simulated testing (86% for FR2 and 89% for HS1). With the FR2, video-trained participants were significantly more successful compared with naive, untrained participants (86% vs. 48% successful use; p < .001). However, for the HS1, there was no significant difference in success rates for the video-trained vs. naive, untrained groups (89% vs. 87%; p = .79). Both devices are safe with either video-trained or naive users. The successful use of each device is high when participants view the training videotape designed for the device. An important difference in successful use was observed for naive users where the HS1 showed improved successful use compared with the FR2. Because defibrillation in the community may increasingly be attempted by lay persons whose training is remote or who have not been trained at all, the "naive" scenario may be increasingly relevant to automated external defibrillator use. Collectively, these data support the notion that human factors associated with ease of use may play a critical factor in survival rates achieved by specific devices.

Reluctance of paramedics and emergency medical technicians to perform mouth-to-mouth resuscitation

Recently, a reluctance of lay and medical personnel to perform mouth-to-mouth resuscitation (MMR) in hospital and community settings has been documented, with 45% of respondents declining to perform MMR on a stranger. In the present study, we examined whether the perceived risk and fear of contracting infectious diseases diminishes the willingness of paramedics and emergency medical technicians (EMTs) to perform MMR. Seventy-seven EMTs and 27 paramedics responded to a questionnaire, administered by one of two physicians, containing mock cardiac arrest scenarios that were designed to assess willingness to perform MMR as a citizen responder. Faced with a situation in which an adult stranger required MMR, 57% of the participating EMTs and all of the paramedics stated that they would refuse to perform MMR. None of the paramedics and only 32.5% of the EMTs stated that they would perform MMR on a man in a gay neighborhood. In addition, 23% of the EMTs and 37% of the paramedics indicated that they would refuse to perform MMR on a child. White respondents were more willing than nonwhite respondents to perform MMR. Twenty-nine percent of the prehospital-care providers had been in situations requiring MMR in the community, and 40% either had walked away or did only external compression. Of those participating paramedics and EMTs who had performed MMR in emergency situations, only 45% indicated that they would do so again. The respondents indicated that they would not be willing to administer MMR because of the fear of contracting infectious agents, especially the human immunodeficiency virus. Despite the proven effectiveness of MMR in saving lives, paramedics and EMTs are highly reluctant to perform MMR as citizen responders. Their perceived risks of contracting infectious agents during MMR are high, despite the low actual risks. We recommend that instruction in cardiopulmonary resuscitation for providers of prehospital care, the medical community, and the general public should emphasize the benefits of providing MMR, the actual low risks of contracting infectious diseases during administration of MMR, and the use of widely available and effective barrier masks to minimize any risks due to administration of MMR.

Reluctance of Internists and Medical Nurses to Perform Mouth-to-Mouth Resuscitation

Physicians and nurses constitute a major part of citizen cardiopulmonary resuscitation responders and serve as educators and resource personnel concerning cardiopulmonary resuscitation. We decided to determine if fear of infectious disease has dampened physician and nurse response to perform mouth-to-mouth resuscitation (MMR). Four hundred thirty-three internists and one hundred fifty-two medical nurses responded to presentations of mock cardiac arrest scenarios. Forty-five percent of the physicians and 80% of the nurses would refuse to do MMR on a stranger. Between 18% and 25% of nurses and attending internists would not do MMR on a child. Being born in the United States or white racial background decreased the reluctance of the respondents to perform MMR. Only 15% of the respondents would do MMR on a stranger in a gay neighborhood. All respondents that would not do MMR stated that their reason involved fear of contracting communicable diseases, especially acquired immunodeficiency syndrome. Internists and medical nurses are highly reluctant to perform MMR. We recommend that the teaching of MMR should emphasize performance on children and family members where willingness to perform MMR is high. We urge public education along with widespread availability of effective barrier masks to resuscitate MMR itself.