Previous CPR Training Research Articles

Abstract 311: Accuracy of Automated External Defibrillator Pad Placement During Out-of-Hospital Cardiac Arrest Resuscitation Simulations

Introduction: Out-of-hospital cardiac arrest (OHCA) victims receiving defibrillation from an automated external defibrillator (AED) placed early in the chain of survival are more likely to survive. Aim: We sought to explore the accuracy of AED pad placement for lay rescuers (LR) and first responders (FR). Methods: We conducted a secondary analysis of data collected during randomized OHCA simulation trials involving LR and FR. LR received hands-only CPR and AED guidance from a simulated 9-1-1 telecommunicator. FRs did not receive telecommunicator instruction. Participants were surveyed about medical training and experience. Correct AED pad placements (anterior: AP, lateral: LP) were individually determined from video abstraction based on manufacturer’s recommendations and distance to anatomical landmarks (mid, nipple, and naval lines). Incorrect AP placement was defined as more than 6 cm medial or 10 cm inferior. Incorrect LP placement was defined as more than 6 cm superior, 9 cm inferior, or 10 cm medial. We examined the association between correct pad placement and previous CPR training (current, expired, or never) for LR and correct pad placement and self-reported recent field experience (< 1 year) with AED application for FR using Chi-square tests. Results: LR correctly placed the AP in 30/38 (79%) and the LP 30/38 (79%) simulations. Application did not differ significantly based on previous CPR training (AP p= .187, LP p=.578). The most common incorrect placement was too low for both AP (5/8, 63%) and LP (4/8, 50%). FRs applied the AP correctly in 31/36 (86%) and the LP in 22/36 (61%) simulations. Among FRs, correct pad application did not differ significantly based on recent field experience (AP p=.29, LP p=.563). The most common incorrect placement was too low for both AP (5/5, 100%) and LP (12/14, 86%). Conclusion: Both LRs and FRs may not apply AEDs per manufacturer’s recommendations. Further research is needed to improve instructions and follow-up training to ensure appropriate placement of AEDs, and to understand how improper AED placement impacts the accuracy of rhythm analysis and defibrillation success.

Knowledge and Attitudes of First Aid and Basic Life Support Among Public School Teachers in Qassim, Saudi Arabia.

This study aims to address the knowledge gap in first aid and basic life support (BLS) among teachers, expand the targeted schools to elementary and intermediate schools for boys and girls, and develop clear, focused recommendations. Furthermore, to assess the knowledge, skills, and attitude of BLS among schoolteachers in Qassim, Saudi Arabia. This cross-sectional study was conducted in the school year of 2022 to 2023. In Buraidah city and the Uyun AlJiwa and Asyah governorates of Qassim, there are a total of 906 elementary and intermediate schools employing 12,057 teachers (5447 males and 6610 females). A stratified random sampling method was used with a self-administered Arabic questionnaire. This questionnaire included multiple parts (sociodemographic data, previous training status, knowledge and skill of BLS, and assessment of the following: attitude to learn and practice CPR; barriers to performing CPR; the presence or lack of previous resuscitation experience in BLS). Data were analyzed using SPSS Statistics version 25 (IBM Corp., Armonk, NY, USA). Categorical variables were described by frequency and percentage, while continuous variables were described by mean ± SD. A normality test showed that the total knowledge and skills scale was not normally distributed. The Mann-Whitney and Kruskal-Wallis tests were used to compare the mean knowledge and skills scale across variables. The accepted level of significance was below 0.05 (p <0.05). Our study included 482 participants. Only 19.5% (94) had previous CPR training, and 80.9% (76) were trained more than two years prior to this study's data collection. The main reason for participants' fears of applying BLS was the lack of proper knowledge and skills (48.1%). The majority of the teachers, i.e., 71.0% (342), wanted more training in CPR, and 41.1% (198) thought CPR training should be mandatory at school. We found no statistical relationship between attitude toward training and the city or differences in knowledge and skills scores due to the difference in sociodemographic characteristics. Also, we found no statistical relationship between the question'Did you observe CPR on a collapsed patient?'and the city, meaning that the observation of CPR on collapsed patients is independent of the respondent's school location. Significant differences in skills scores were found between those who had CPR observation and those who did not (p = 0.014), in knowledge scores between those who had previous CPR training and those who did not (p = 0.034), and in skills scores between those who had previous CPR training and those who did not (p <0.001). We found no significant differences in knowledge and skills scores according to the place of previous CPR training (p = 0.163 and p = 0.695, respectively). This study reveals that knowledge and skills in BLS among schoolteachers need to be improved. For this reason, we emphasize the inclusion of International Liaison Committee on Resuscitation (ILCOR) recommendations in the curriculum and that they are made periodic and mandatory for teachers. Especially as we found teachers to have a positive attitude and were willing to train and help.

CPR Quality Assessment in Schoolchildren Training.

Whilst CPR training is widely recommended, quality of performance is infrequently explored. We evaluated whether a checklist can be an adequate tool for chest compression quality assessment in schoolchildren, compared with a real-time software. This observational study (March 2019-2020) included 104 schoolchildren with no previous CPR training (11-17 years old, 66 girls, 84 primary schoolchildren, 20 high schoolchildren). Simultaneous evaluations of CPR quality were performed using an observational checklist and real-time software. High-quality CPR was determined as a combination of 70% correct maneuvers in compression rate (100-120/min), depth (5-6 cm), and complete release, using a real-time software and three positive performance in skills using a checklist. We adjusted a multivariate logistic regression model for age, sex, and BMI. We found moderate to high agreement percentages in quality of CPR performance (rate: 68.3%, depth: 79.8%, and complete release: 91.3%) between a checklist and real-time software. Only 38.5% of schoolchildren (~14 years-old, ~54.4 kg, and ~22.1 kg/m2) showed high-quality CPR. High-quality CPR was more often performed by older schoolchildren (OR = 1.43, 95%IC:1.09-1.86), and sex was not an independent factor (OR = 1.26, 95%IC:0.52-3.07). For high-quality CPR in schoolchildren, a checklist showed moderate to high agreement with real-time software. Better performance was associated with age regardless of sex and BMI.

Students’ knowledge and attitudes toward basic life support

&lt;span lang="EN-US"&gt;Students spend a significant proportion of their day in colleges and healthcare facilities where they might experience medical emergencies, or unexpected accidents, that occur in these places. Nursing students are expected to play a key role in performing basic life support. This study is to evaluate knowledge, attitudes and training status with regard to basic life support (BLS). An online cross-sectional survey was conducted in Taif University, Saudi Arabia. 170 students agreed to fill out a questionnaire. The questions used in the questionnaire were prepared according to 2015 AHA guidelines. The majority of subjects (52.9%) reported that they had attended a BLS course. The mean age of the study population was 21.64 years. Previous CPR training had a significant effect on the correct responses (P &amp;lt;0.01). This study found significant differences between the students observed: (58.3%) of students with previous BLS training felt capable of providing CPR to their fellow college students, compared to (42.7%) in the group without previous training (P =0.01). Importantly, over all subjects the attitude to learning on a BLS training course was positive. Inconclusions this study corroborates previous reports that the knowledge, skills and attitudes of trained students are better than those of untrained students.&lt;/span&gt;

Knowledge of and attitudes towards cardiopulmonary resuscitation among junior doctors and medical students in Upper Egypt: cross-sectional study

BackgroundCardiopulmonary resuscitation (CPR) is a fundamental skill that should be acquired by all medical community members. This study aims to evaluate the knowledge and attitudes of junior doctors and medical students towards CPR and CPR training at Beni-Suef University Hospital in Upper Egypt, a representative region with conditions common to LMIC settings.Participants and methodsIn this cross-sectional study, a total of 205 participants (60 junior doctors and 145 medical students) responded to a self-administered questionnaire assessing their knowledge regarding basic life support (BLS) and CPR techniques in neonates, children, and adults, in addition to attitudes towards the importance and necessity of CPR and CPR training.ResultsOf the 60 junior doctors that participated in the study, only 31.7% had adequate knowledge of CPR, but up to 95% reported positive attitudes towards CPR training. Among the 145 medical student participants, only 6.2% had adequate knowledge of CPR, while 91% reported positive attitudes towards training. Deficiencies in CPR knowledge were more apparent in questions related to CPR in children and neonates. Junior doctors and medical students with previous CPR training demonstrated significantly better CPR knowledge than their counterparts without prior training. A statistically significant positive correlation was detected between CPR knowledge and attitude towards CPR training among medical students (r = 0.41, p < 0.001).ConclusionThe results of this study demonstrate suboptimal and inadequate CPR knowledge among junior doctors and medical students in a representative hospital in Upper Egypt. However, participants reported overwhelmingly positive attitudes and eagerness towards the implementation of CPR training. Further research needs to be done to establish CPR skill proficiency as well as to investigate barriers to CPR training, effectiveness of available programs, and the potential implementation of such a program in Egypt and other LMICs.

Socioeconomic disparities in layperson CPR training within a large U.S. city

Aim of the studyWe sought to understand how individual factors and neighborhood characteristics are associated with a layperson's likelihood of being trained in CPR. We hypothesized that higher socioeconomic status (educational attainment, and median household income (MHI)) would be associated with a higher likelihood of previous CPR training. MethodsThrough the Mobile CPR Project, a program providing hands-only CPR and AED education in Philadelphia, we surveyed participants regarding socioeconomic factors and prior CPR training. Survey questions pertained to race, gender, education, prior CPR training, automated external defibrillator (AED) awareness, and residential area. Community MHI was extrapolated via residential address and census tract data. ResultsFrom 7/2016 to 4/2018, 1703 subjects completed surveys, including location information, prior to participating in a Mobile CPR Project training event. Of these, 70% were female, 70% were non-white, mean age was 42 ± 20 years, and MHI was $39,318 [IQR $27,708–$60,795]. Subjects residing in census tracts with MHI below the cohort median were significantly less likely to have ever received CPR training (lowest quartile: OR 0.65, CI 0.49–0.85, p = 0.002). In multiple logistic regression controlling for age, race, gender, MHI, and education, higher educational attainment was associated with a higher likelihood of ever receiving CPR training (OR 7.96 Masters or Doctoral compared to less than high school, CI 5.24–12.11, p < 0.001). ConclusionsThere is a strong association between socioeconomic factors (MHI and educational attainment) and likelihood of prior layperson CPR training.

CorPatch® – A smartphone-based BLS guidance and feedback system: Improvements in laypersons’ chest compressions

Purpose of the study: Survival after out-of-hospital cardiac arrest depends on high quality chest compressions. Even if bystander CPR is initiated before arrival of ambulance, the quality of chest compressions is often poor. A BLS Guidance System (BGS) was developed using a Chest Compression Feedback Device (CCFD) with sensor, which was connected to a smartphone app. Objective was to study the impact of BGS on the quality of compressions performed by lay rescuers with no previous CPR training.

Evaluating Barriers to Bystander CPR among Laypersons before and after Compression-only CPR Training

Objective: Bystander CPR is an essential part of out-of-hospital cardiac arrest (OHCA) survival. EMS and public safety jurisdictions have embraced initiatives to teach compression-only CPR to laypersons in order to increase rates of bystander CPR. We examined barriers to bystander CPR amongst laypersons participating in community compression-only CPR training and the ability of the training to alleviate these barriers. The barriers analyzed include fear of litigation, risk of disease transmission, fear of hurting someone as a result of doing CPR when unnecessary, and fear of hurting someone as a result of doing CPR incorrectly. Methods: Laypersons attending community compression-only CPR training were administered surveys before and after community CPR training. Data were analyzed via standard statistical analyses. Results: A total of 238 surveys were collected and analyzed between September 2015 and January 2016. The most common reported motivation for attending CPR training was “to be prepared/just in case” followed by “infant or child at home.” Respondents reported that they were significantly more likely to perform CPR on a family member than a stranger in both pre-and post-training responses. Nevertheless, reported self-confidence in and likelihood of doing CPR on both family and strangers increased from pre-training to post-training. There was a statistically significant decrease in reported likelihood of all four barriers to prevent respondents from performing bystander CPR when pre-training responses were compared to post-training responses. Previous CPR training and history of having witnessed a sudden cardiac arrest (SCA) were both associated with decreased barriers to CPR, but previous training had no effect on reported likelihood of or confidence in performing CPR. Conclusion: The training initiative studied significantly reduced the reported likelihood of all barriers studied to prevent respondents from performing bystander CPR and also increased the reported confidence in doing CPR and likelihood of doing CPR on both strangers and family. However, it did not alleviate the pre-training discrepancy between likelihood of performing CPR on strangers versus family. Previous CPR training or certification had no impact on likelihood of or confidence in performing CPR.

Abstract 12023: The Effectiveness Teaching Continuous Chest Compression CPR Using a Combined Program of Watching a Brief Video, Seeing a Live CPR Demonstration Performed on a Mannequin and Using the Celtic Cell Phone Application for Real Time Feedback

Introduction: CPR training via cell phone application is an effective way to train laypersons in CPR. However, it is unclear whether using a combination of watching a brief video and live demonstration of CPR as well as receiving real time feedback via a cell phone application improves CPR quality, responsiveness and confidence. Objective: To determine if viewing a brief chest compression only (CCO) CPR video, watching a live demonstration and receiving real time feedback via the Celtic cell phone app. is an effective modality in training laypersons CCO-CPR leading to improved performance, responsiveness, and confidence. Methods: This was a prospective cohort control analysis from June 2014 till January 2016. Participants had little or no previous CPR training. Participants were consented and filled out an 8-question survey regarding baseline confidence in performing CPR. A CPR content quiz was answered to determine fluency in CPR. All participants then performed CPR on a mannequin while receiving real time feedback via the Celtic cell phone app. Finally they received formal “verbal” and “visual” training on CCO-CPR. Compression rate was categorized as very good if their compressions per minute (cpm) were &gt;90, Ok if CPM was 80-89 and poor if CPM was &lt;80. Compression depth categories were: Excellent: &gt;2.0 inches, Good: 1.5-2.0 inches and Poor: &lt;1.5 inches. Results: There were statistically significant improvements in percentage of participants (N=67) with very good compression rates (OR=49.1; 95% CI: 17.8, 135.0) and excellent compression depth (OR=26.5; 95% CI: 7.3, 96.1) from before to after the training and feedback using the Celtic app. Average score for confidence questions (difference=4.34; 95% CI: 3.67, 5.00); willingness to perform CPR in cardiac arrest patients (OR=6.83; 95% CI: 2.75, 17.01); and percent of content knowledge (difference=30.2; 95% CI: 25.0, 35.4) were significantly improved. Conclusions: CCO-CPR training via a combined program of watching a brief CCO video and live demonstration as well as getting real-time feedback via the Celtic cell phone application demonstrated statistically significant improvements in both target compression rate and depth as well as confidence in laypersons attempting to perform CCO-CPR.

Quality of CPR performed by trained bystanders with optimized pre-arrival instructions

ObjectiveTelephone-CPR (T-CPR) can increase initiation of bystander CPR. We wanted to study if quality oriented continuous T-CPR would improve CPR performance vs. standard T-CPR. MethodNinety-five trained rescuers aged 22–69 were randomized to standard T-CPR or experimental continuous T-CPR (comprises continuous instructions, questions and encouragement). They were instructed to perform 10min of chest compressions-only on a manikin, which recorded CPR performance in a small, confined kitchen. Three video-cameras captured algorithm time data, CPR technique and communication. Demography and training experience were captured during debriefing. ResultsParticipants receiving continuous T-CPR delivered significantly more chest compressions (median 1000 vs. 870 compressions, p=0.014) and compressed more frequently to a compression rate between 90 and 120min−1 (median 87% vs. 60% of compressions, p<0.001), compared to those receiving standard T-CPR. This also resulted in less time without compressions after CPR had started (median 12s vs. 64s, p<0.001), but longer time interval from initiating contact with dispatcher to first chest compression (median 144s vs. 84s, p<0.001). There was no difference in chest compression depth (mean 47mm vs. 48mm, p=0.90) or in demography, education and previous CPR training between the groups. ConclusionIn our simulated scenario with CPR trained lay rescuers, experimental continuous T-CPR gave better chest compression rate and less hands-off time during CPR, but resulted in delayed time to first chest compression compared to standard T-CPR instructions.

Current knowledge of and willingness to perform Hands-Only™ CPR in laypersons

IntroductionRecent simplified guidelines recommend Hands-Only™ CPR for laypersons and efforts to educate the public of these changes have been made. We determined current knowledge of and willingness to perform Hands-Only™ CPR. MethodsDesign—prospective anonymous survey. Setting—academic suburban emergency department. Subjects—adult patients and visitors in a suburban ED. Survey instrument—33 item closed question format based on prior studies that included baseline demographics and knowledge and experience of CPR. Main outcome—knowledge of and willingness to perform Hands-Only™ CPR. Data analysis—descriptive statistics. Univariate and multivariate analyses were performed to determine the association between predictor variables and knowledge of and willingness to perform Hands-Only™ CPR. ResultsWe surveyed 532 subjects; mean age was 44±16; 53.2% were female, 75.6% were white. 45.5% were college graduates, and 44.4% had an annual income of greater than $50,000. 41.9% had received prior CPR training; only 10.3% had performed CPR. Of all subjects 124 (23.3%) had knowledge of Hands-Only™ CPR, yet 414 (77.8%) would be willing to perform Hands-Only™ CPR on a stranger. Age (P=0.003) and income (P=0.014) predicted knowledge of Hands-Only™ CPR. A history of a cardiac related event in the family (P=0.003) and previous CPR training (P=0.01) were associated with likelihood to perform Hands-Only™ CPR. ConclusionsLess than one fifth of surveyed laypersons knew of Hands-Only™ CPR yet three quarters would be willing to perform Hands-Only™ CPR even on a stranger. Efforts to increase layperson education are required to enhance CPR performance.

Training hospital providers in basic CPR skills in Botswana: Acquisition, retention and impact of novel training techniques

ObjectiveGlobally, one third of deaths each year are from cardiovascular diseases, yet no strong evidence supports any specific method of CPR instruction in a resource-limited setting. We hypothesized that both existing and novel CPR training programs significantly impact skills of hospital-based healthcare providers (HCP) in Botswana. MethodsHCP were prospectively randomized to 3 training groups: instructor led, limited instructor with manikin feedback, or self-directed learning. Data was collected prior to training, immediately after and at 3 and 6months. Excellent CPR was prospectively defined as having at least 4 of 5 characteristics: depth, rate, release, no flow fraction, and no excessive ventilation. GEE was performed to account for within subject correlation. ResultsOf 214 HCP trained, 40% resuscitate ≥1/month, 28% had previous formal CPR training, and 65% required additional skills remediation to pass using AHA criteria. Excellent CPR skill acquisition was significant (infant: 32% vs. 71%, p<0.01; adult 28% vs. 48%, p<0.01). Infant CPR skill retention was significant at 3 (39% vs. 70%, p<0.01) and 6months (38% vs. 67%, p<0.01), and adult CPR skills were retained to 3months (34% vs. 51%, p=0.02). On multivariable analysis, low cognitive score and need for skill remediation, but not instruction method, impacted CPR skill performance. ConclusionsHCP in resource-limited settings resuscitate frequently, with little CPR training. Using existing training, HCP acquire and retain skills, yet often require remediation. Novel techniques with increased student: instructor ratio and feedback manikins were not different compared to traditional instruction.

Chest compression quality in healthcare professionals

Purpose of the study: Cardiopulmonary resuscitation has been known as one of the determinants of survival in cardiac arrest and the quality of the resuscitation provided also correlates with outcome. Tools analyzing compressions and ventilations and providing feedback to the operator performing CPR, have been shown to improve CPR performance. This study was undertaken to assess the quality of cardiac compressions provided by healthcare personnel of the Maggiore Hospital Bologna, analyzed in a simulated session with and without audiovisual feedback (FB). Materials and methods: All hospital personnel was invited to participate in a simulated session to evaluate the proficiency in cardiac compressions (CC). Each participant was asked to perform a trial of 2 min of CC, answer a predefined set of questions and then perform 2 more minutes of CC. Participants were randomized to one of two groups, the first performing the sequence CC with feedback-questions-CC without feedback and the second the sequence CC without feedback-questions-CC with feedback. We use a commercially available monitor/defibrillator with CPR quality and audio recording capabilities (MRx-QCPR, Philips Medical Systems). We use also a Resusci Anne manikin and data regarding the quality of CPR were collected with Q-CPR Review (Laerdal Medical). Results: We present a preliminary data on 72 participants. The age of the participants was 38 ± 8.4. The mean compression rate was 109.26 ± 25.61 min−1 when chest compressions were performed without feedback and 104.77 ± 13.03 min−1 when performed with feedback (p < 0.01). The average compression depth was 46.37 ± 12.73 mm without and 44.48 ± 5.87 with Q-CPR guidance (p < 0.01). Conclusions: We confirm previous study about the effectiveness of quality CPR feedback on chest compressions quality and we will evaluate at the end of this study the correlation with previous CPR training of each participants.

Skill retention is enhanced after previous brief CPR training

Introduction: Short courses are a way to encourage lay people to learn CPR (1) and since 2001 the French Red Cross has proposed a 1-h CPR course to the general public. Our aims were to assess the retention of knowledge and skills in persons who have already followed a short CPR course compared to totally lay people. Materials and methods: The evaluation of skills was performed on a population of college students. Each CPR skill was assessed using Little Anne™ Laerdal manikins with “YES” if the technique was efficient and “NO” if it was not performed or performed inefficiently. Parametric tests were used to compare the two groups. Results: Six hundred and two children (aged 13.6 ± 3.4 years) were included. Two hundred and twenty three (37%) were beforehand had trained in first aid as they had completed a 1-h CPR course 2.3 ± .8 years ago. Compared to totally lay people, better performances were noted in the assessment of responsiveness (49 [22%] versus 56 [14.7%], p < .05), opening airway (30 [13.5%] versus 13 [3.4%], p < .0001) and assessment of signs of life (35 [15.7%] versus 29 [7.6%], p < .005) were significantly higher in the previously trained group. Quality of CPR was also significantly better in the previously trained group, with better chest compressions (33 [14.8%] versus 12 [3.2%], p < .0001) and better rescue breathing (16 [7.2%] versus 7 [1.8%], p < .005). No difference was observed between the two groups in calling for help (38 [17.0%] versus 81 [21.3%], ns). Conclusion: Most of CPR skills are better memorised in a previously trained group, suggesting that short training CPR courses were efficient although the quality of CPR in itself was poor, probably because of a relatively long time between the first course and the evaluation of skills. This point emphasises the importance of repeated refresher training for a better retention of knowledge and skills.