CPR training without an instructor: development and evaluation of a video self-instructional system for effective performance of cardiopulmonary resuscitation

Self-Training Video Module versus Instructor Taught Pediatric Basic Life Support According to Peyton Model: Report of an Experience

Background

Bystander cardiopulmonary resuscitation is an important predictor of out-of-hospital arrest prognosis in the pediatric population. The purpose of this study was to assess the effectiveness of two educational methods, a video module and Peyton model with manikin, in parent's education.

Materials and Methods

We enrolled 140 subjects, 70 in each group. We assess their knowledge, attitude, and practice about pediatric basic life support (BLS) before and after two different types of educational interventions.

Results

Mean attitude, knowledge, and practice score were significantly higher after educational intervention in both groups. Knowledge and total practice score were significantly higher in the Peyton group compared with DVD group (P = 0.02 and 0.000, respectively). The rate of totally correct chest compression was 53% in Peyton/manikin group versus 24% in DVD/lecture group and the difference was meaningful statistically (P = 0.0003).

Conclusion

Any educational intervention has a significant effect on the Iranian parent's knowledge and practice about child BLS, but education through manikin can increase this impact.

Effectiveness of video self-instruction training on cardiopulmonary resuscitation retention of knowledge and skills among nurses in north-western Nigeria

Background

Adaptable cardiopulmonary resuscitation/basic life support (CPR/BLS) training are required to reduce cardiac arrest mortality globally, especially among nurses. Thus, this study aims to compared CPR knowledge and skills retention level between instructor-led (control group) and video self-instruction training (intervention group) among nurses in northwestern Nigeria.

Methods

A two-arm randomized controlled trial study using double blinding method was conducted with 150 nurses from two referral hospitals. Stratified simple random method was used to choose eligible nurses. For video self-instruction training (intervention group), participants learnt the CPR training via computer in a simulation lab for 7 days, in their own available time whereas for instructor-led training (control group), a 1-day program was conducted by AHA certified instructors. A generalized estimated equation model was used for statistical analysis.

Results

Generalized Estimated Equation showed that there were no significant differences between the intervention group (p = 0.055) and control group (p = 0.121) for both CPR knowledge and skills levels respectively, whereas higher probability of having good knowledge and skills in a post-test, one month and three-month follow-up compared to baseline respectively, adjusted with covariates (p < 0.05). Participants had a lower probability of having good skills at 6-month follow-up compared to baseline, adjusted with covariates (p = 0.003).

Conclusion

This study showed no significant differences between the two training methods, hence video self-instruction training is suggested can train more nurses in a less cost-effective manner to maximize resource utilization and quality nursing care. It is suggested to be used to improve knowledge and skills among nurses to ensure cardiac arrest patients receive excellent resuscitation care.

Initial implementation of the resuscitation quality improvement program in emergency department of a teaching hospital in China

Background

Cardiopulmonary resuscitation (CPR) skills may decay over time after conventional instructor-led BLS training. The Resuscitation Quality Improvement® (RQI®) program, unlike a conventional basic life support (BLS) course, is implemented through mastery learning and low-dose, high-frequency training strategies to improve CPR competence. We facilitated the RQI program to compare the performance of novices vs those with previous BLS training experience before RQI implementation and to obtain their confidence and attitude of the RQI program.

Methods

A single-center observational study was conducted from May 9, 2021 to June 25, 2021 in an emergency department of a tertiary hospital. The performance assessment data of both trainees with a previous training experience in conventional BLS course (BLS group) and the novice ones with no prior experience with any BLS training (Non-BLS group) was collected by RQI cart and other outcome variables were rated by online questionnaire. Outcome measurements included chest compression and ventilation in both adult-sized and infant-sized manikins.

Results

A total of 149 participants were enrolled. Among them, 103 participants were in BLS group and 46 participants in Non-BLS group. Post RQI training, all the trainees achieved a passing score of 75 or more, and obtained an improvement in CPR performance. The number of attempts to pass RQI for compression and ventilation practice was lower in the BLS group in both adult and infant training sessions (P < 0.05). Although the BLS group had a poor baseline, it had fewer trials and the same learning outcomes, and the BLS group had better self-confidence. Trainees were well adapted to the innovative training modality, and satisfaction among all of the participants was high. Only the respondents for non-instructor led training, the satisfaction was low in both groups (72.8% in BLS group vs 65.2% in No-BLS group, strongly agreed).

Conclusion

Among novices, RQI can provide excellent CPR core skills performance. But for those who had previous BLS training experience, it was able to enhance the efficiency of the skills training with less time consumption. Most trainees obtained good confidence and satisfaction with RQI program, which might be an option for the broad prevalence of BLS training in China.

Comparing the effectiveness of a group-directed video instruction versus instructor-led traditional classroom instruction for learning cardiopulmonary resuscitation skills among first-year medical students: A prospective randomized controlled study

Introduction: Bystander cardiopulmonary resuscitation (CPR) training is inconsistent among students and the public. Existing CPR teaching courses are costly, time-consuming, and inconsistent. This study aimed to determine the association between overall CPR competency and two teaching modules, a group-directed video instruction module versus an instructor-led traditional classroom instruction module. Methods: This randomized prospective interventional study involved first year medical students of Universiti Sains Malaysia Health Campus from November 2018 until January 2019. Pass-fail scores representing the overall CPR, individual skill performance, and willingness to perform CPR for strangers and family members were collected. Factors associated with reluctance to perform CPR were assessed in a questionnaire. Results: A total of 99 participants were included, 50 in the group-directed video instruction as the intervention module and 49 in the traditional classroom instruction as the control module. There was no statistical significance between the pass and fail outcomes for both video module (p=0.436). Participants in both modules performed similarly in 8 out of 12 individual CPR skills. There was a significant difference in the distribution of skill scores between the pass and fail outcomes (p=<0.001). The intervention module is non-inferior compared to the control module, in relation to CPR willingness rates for strangers (p=0.999) and family members (p=0.117) after the training. Conclusions: The group-directed video self-instruction method is as effective as the instructor-led traditional classroom method to help participants to be competent and willing to perform CPR. It can be used as an independent or supplementary teaching tool for first-time learners and refreshers, especially in a group setting when teaching materials are limited.

Undergraduate Medical Students' Perceptions of an Online Audio-Visual-Based Module for Teaching Musculoskeletal Physical Examination Skills

INTRODUCTION

Video-based learning has gained prominence in medical education and, more recently, in musculoskeletal teaching. This study investigated medical students' perceptions of the effectiveness of online video-based learning for musculoskeletal physical examination skills.

METHODS

For one academic year, undergraduate medical students were instructed online through video-based learning before bedside teaching about the physical examination of knee and shoulder joints. At the end of the course, the students participated in a survey to assess their perceptions of the online video-based learning module using a pre-validated questionnaire. The questionnaire consisted of closed-ended and open-ended questions. The closed-ended question responses were assessed using a Likert scale; the open-ended responses were analyzed qualitatively.

RESULTS

In total, 242 out of 310 students who participated in the online video-based learning responded to the survey. Most students found the teaching approach to be satisfactory and preferable to traditional teaching methods. However, they also felt that these modules could not replace hands-on practice. The most helpful aspects of the training modules were a better understanding of the specific tests, technique, and sequence of administering the physical examination. Perceived limitations included the inadequately addressed theoretical basis of the physical examination and the special tests, the need for more time to explain clinical anatomy, and the practical implications of the positive special tests.

CONCLUSION

Undergraduate medical students perceive VBL as helpful for MPES learning. The positive aspects of the VBL approach in teaching MPES are that it is comprehensive, easily accessible, offers standardized teaching, save times, and it includes demonstrations of special tests, examination techniques, and the sequence and organization of the clinical examination. The main perceived limitations were lack of content regarding clinical reasoning and the anatomical basis of the clinical tests.

Teaching Infant Cardiopulmonary Resuscitation to Caregivers in the Emergency Department

OBJECTIVES

Infant cardiopulmonary resuscitation (CPR) has been taught to caregivers of infants in inpatient settings. There are no studies to date that look at teaching infant CPR in the emergency department (ED). Using a framework of cognitive load theory, we compared teaching infant CPR to caregivers in a pediatric ED versus an inpatient setting.

METHODS

Knowledge tests, 1-minute infant CPR performances on a Resusci Baby QCPR (Laerdal) manikin, and self-reported questionnaires were completed before and after caregivers were self-taught infant CPR using Infant CPR Anytime kits. The proportions of chest compression depth and rate that met quality standards from the American Heart Association's Basic Life Support program were measured.

RESULTS

Seventy-four caregivers participated. Mean knowledge scores (out of a total score of 15) increased in both settings (ED preintervention: Mean (M) = 4.53 [SD = 1.97]; ED postintervention: M = 10.47 [SD = 2.90], P < 0.001; inpatient preintervention: M = 4.83 (SD = 2.08); inpatient postintervention: M = 10.61 [SD = 2.79], P < 0.001). Improvement in the proportion of chest compression that met high quality standards for depth increased in the inpatient group only. Neither groups had improvements in compression rates. There were no statistically significant differences in the difficulty of learning CPR, frequency of interruptions/distractions, or difficulty staying concentrated in learning CPR between the 2 settings.

CONCLUSIONS

Caregivers in the ED and inpatient settings after a self-instructional infant CPR kit did not demonstrate adequate infant CPR performance. However, both groups gained infant CPR knowledge. Differences in cognitive loads between the 2 settings were not significant.

2021 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations: Summary From the Basic Life Support; Advanced Life Support; Neonatal Life Support; Education, Implementation, and Teams; First Aid Task Forces; and the COVID-19 Working Group

The International Liaison Committee on Resuscitation initiated a continuous review of new, peer-reviewed published cardiopulmonary resuscitation science. This is the fifth annual summary of the International Liaison Committee on Resuscitation International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations; a more comprehensive review was done in 2020. This latest summary addresses the most recently published resuscitation evidence reviewed by International Liaison Committee on Resuscitation task force science experts. Topics covered by systematic reviews in this summary include resuscitation topics of video-based dispatch systems; head-up cardiopulmonary resuscitation; early coronary angiography after return of spontaneous circulation; cardiopulmonary resuscitation in the prone patient; cord management at birth for preterm and term infants; devices for administering positive-pressure ventilation at birth; family presence during neonatal resuscitation; self-directed, digitally based basic life support education and training in adults and children; coronavirus disease 2019 infection risk to rescuers from patients in cardiac arrest; and first aid topics, including cooling with water for thermal burns, oral rehydration for exertional dehydration, pediatric tourniquet use, and methods of tick removal. Members from 6 International Liaison Committee on Resuscitation task forces have assessed, discussed, and debated the quality of the evidence, according to the Grading of Recommendations Assessment, Development, and Evaluation criteria, and their statements include consensus treatment recommendations or good practice statements. Insights into the deliberations of the task forces are provided in Justification and Evidence-to-Decision Framework Highlights sections. In addition, the task forces listed priority knowledge gaps for further research.

2021 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations

The International Liaison Committee on Resuscitation initiated a continuous review of new, peer-reviewed published cardiopulmonary resuscitation science. This is the fifth annual summary of the International Liaison Committee on Resuscitation International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations; a more comprehensive review was done in 2020. This latest summary addresses the most recently published resuscitation evidence reviewed by International Liaison Committee on Resuscitation task force science experts. Topics covered by systematic reviews in this summary include resuscitation topics of video-based dispatch systems; head-up cardiopulmonary resuscitation; early coronary angiography after return of spontaneous circulation; cardiopulmonary resuscitation in the prone patient; cord management at birth for preterm and term infants; devices for administering positive-pressure ventilation at birth; family presence during neonatal resuscitation; self-directed, digitally based basic life support education and training in adults and children; coronavirus disease 2019 infection risk to rescuers from patients in cardiac arrest; and first aid topics, including cooling with water for thermal burns, oral rehydration for exertional dehydration, pediatric tourniquet use, and methods of tick removal. Members from 6 International Liaison Committee on Resuscitation task forces have assessed, discussed, and debated the quality of the evidence, according to the Grading of Recommendations Assessment, Development, and Evaluation criteria, and their statements include consensus treatment recommendations or good practice statements. Insights into the deliberations of the task forces are provided in Justification and Evidence-to-Decision Framework Highlights sections. In addition, the task forces listed priority knowledge gaps for further research.

A non-inferiority randomised controlled trial comparing self-instruction with instructor-led method in training of layperson cardiopulmonary resuscitation

Our study aimed to compare the effect of self-instruction with manikin feedback to that of instructor-led method on cardiopulmonary resuscitation (CPR) and automated external defibrillator (AED) skill performance. In our randomized non-inferiority trial, 64 non-healthcare providers were randomly allocated into self-instruction and instructor-led groups. Both groups watched a 27-min standardized teaching video. Participants in the self-instruction group then performed hands-on practice on the Resusci Anne QCPR with a device-driven feedback, while those in the instructor-led group practiced manikins; feedback was provided and student's questions were answered by instructors. Outcomes were measured by blinded evaluators and SkillReporter software. The primary outcome was the pass rate. Secondary outcomes were scores of the knowledge test and items of individual skill performance. The baseline characteristics of the two groups were similar. The pass rates were 93.8% in both group (absolute difference 0%, p = 0.049 for noninferiority). The knowledge test scores were not significantly different. However, the self-instruction group performed better in some chest compression and ventilation skills, but performed worse in confirming environmental safety and checking normal breathing. There was no difference in AED skills between the two groups. Our results showed the self-instruction method is not inferior to the instructor-led method.

Medical professionalism videos on YouTube: Content exploration and appraisal of user engagement

Background

Social media has become the fastest growing platform for sharing and retrieving information and knowledge, and YouTube is one of the most popular and growing sources of health and educational information video-sharing website. But, videos on this open platform are not peer-assessed, therefore, the accessible data should be adequately assessed. Till date, no exploration and analysis for assessing the credibility and usefulness of Medical professionalism videos available on YouTube are conducted.

Objective

To analyze the video sources, contents and quality of YouTube videos about the topic of medical professionalism.

Methods

A systematic search was accomplished on YouTube videos during the period between March 1, 2020 and March 27, 2020. The phrases as significant words used throughout YouTube web search were ‘Professionalism in Medical Education’, Professionalism in medicine’, ‘Professionalism of medical students’, ‘Professionalism in healthcare’. ‘Teaching professionalism’, ‘Attributes of professionalism’. The basic information collected for each video included author’s/publisher’s name, total number of watchers, likes, dislikes and positive and undesirable remarks. The videos were categorized into educationally useful and useless established on the content, correctness of the knowledge and the advices. Different variables were measured and correlated for the data analysis.

YouTube website was searched the using keywords ‘Professionalism in Medical Education’, Professionalism in medicine’, ‘Professionalism of medical students’, ‘Professionalism in healthcare’. ‘Teaching professionalism’, and ‘Attributes of professionalism’.

Results

After 2 rounds of screening by the subject experts and critical analysis of all the 137 YouTube videos, only 41 (29.92%) were identified as pertinent to the subject matter, i.e., educational type. After on expert viewing these 41 videos established upon our pre-set inclusion/exclusion criteria, only 17 (41.46%) videos were found to be academically valuable in nature.

Conclusion

Medical professionalism multimedia videos uploaded by the healthcare specialists or organizations on YouTube provided reliable information for medical students, healthcare workers and other professional. We conclude that YouTube is a leading and free online source of videos meant for students or other healthcare workers yet the viewers need to be aware of the source prior to using it for training learning.

App-based learning as an alternative for instructors in teaching basic life support to school children: a randomized control trial

Background: The importance of early cardiopulmonary resuscitation (CPR) during an out-of-hospital cardiac arrest (OHCA) cannot be emphasized enough and has a major impact on survival. Unfortunately, CPR education in schools is often inadequate or non-existing due to lack of educators and financial resources. The introduction of application-based teaching could facilitate education as no instructor is needed. The aim of present study is to compare app-based self-teaching (intervention group) with a traditional instructor-led course (control group). This trial is in line with the endorsement of training school children by the World Health Organization (WHO). Methods: This randomized controlled trial contains 165 participants between 16 and 18 years. The control group followed an instructor-led course, while the intervention group used a tablet application to complete a self-education course.Both groups were taught in separated classes during 40 min and used manikins and automated external defibrillator (AED) trainer kits. Before and after training, both groups were evaluated in a practical test to examine their skills (an overall score and sub-scores on different sections were obtained, following ERC 2015 guidelines). Results: No significant difference (p = 0.304) in overall teaching effectiveness was found between both groups. Although, in a sub-analysis, we found significantly better results for the instructor group for checking airway (p = 0.018), asking for an AED (p < 0.01) and shocking the patient (p = 0.002). Conclusions: App-based teaching can be a valuable alternative for classic instructor-based education. Yet new apps have to be evaluated before being implemented in CPR education.

Deploying Clinical Process Improvement Strategies to Reduce Motion Artifacts and Expiratory Phase Scanning in Chest CT

We hypothesized that clinical process improvement strategies can reduce frequency of motion artifacts and expiratory phase scanning in chest CT. We reviewed 826 chest CT to establish the baseline frequency. Per clinical process improvement guidelines, we brainstormed corrective measures and priority-pay-off matrix. The first intervention involved education of CT technologists, following which 795 chest CT were reviewed. For the second intervention, instructional videos on optimal breath-hold were shown to 245 adult patients just before their chest CT. Presence of motion artifacts and expiratory phase scanning was assessed. We also reviewed 311 chest CT scans belonging to a control group of patients who did not see the instructional videos. Pareto and percentage run charts were created for baseline and post-intervention data. Baseline incidence of motion artifacts and expiratory phase scanning in chest CT was 35% (292/826). There was no change in the corresponding incidence following the first intervention (36%; 283/795). Respiratory motion and expiratory phase chest CT with the second intervention decreased (8%, 20/245 patients). Instructional videos for patients (and not education and training of CT technologists) reduce the frequency of motion artifacts and expiratory phase scanning in chest CT.

A critical review of obstetric and gynecological physical examination videos available on YouTube: Content analysis and user engagement evaluation

BACKGROUND

Video-sharing website "YouTube" is a growing source of healthcare information. But, the videos uploaded on this open platform are not peer reviewed, therefore, the information available needs to be sufficiently evaluated. No studies have been conducted to evaluate the authenticity and utility of obstetrics and gynecology (Obs/Gyne) physical examination YouTube videos. This study was performed to analyze the sources, contents, and quality of videos about the Obs/Gyne clinical examination available on YouTube.

METHODS

A systematic search was performed on YouTube website using the following key words: "OBSTETRIC," "GYNECOLOGICAL," "SPECULUM OBSTETRIC," "OBSTETRIC CLINICAL," "BIMANUAL PELVIC," and "EXAMINATION" to analyze the sources, contents, and the quality of YouTube videos about the Obs/Gyne clinical examination during the period between November 2015 and March 2017. The videos were classified into educationally useful and useless based on the content, accuracy of the knowledge, and the demonstration.

RESULTS

Out of total 457 screened videos, 176 (38.51%) videos met the pre-set inclusion criteria. After review, out of 176 pertinent videos, 84 (47.7%) videos were found educationally useful, and out of these 84 useful videos, only 29 (34.5%) were highly educational in nature.

CONCLUSION

YouTube videos showed variable educational value. Only, a small number of videos were identified as useful and can be used by the medical students for self-directed learning and by the clinical teachers for educational purposes or other academic activities.

Use of Selected Telemedicine Tools in Monitoring Quality of In-Hospital Cardiopulmonary Resuscitation: A Prospective Observational Pilot Simulation Study

Background

The aim of this study was to assess the quality of in-hospital cardiopulmonary resuscitation components performed by nurses under simulated conditions, with the use of selected telemedicine tools.

Material/Methods

This prospective observational pilot simulation study was carried out with a group of 48 nurses working in hospital wards specializing in conservative treatment (HOS/C=22; mean age of 30.27 years; SD 9.30) or interventional therapy (HOS/I=26 nurses; mean age of 30.35 years; SD 9.77). Each nurse performed CPR for two minutes (a sequence of 30 compressions: 2 breaths) on a Laerdal Resusci-Anne manikin that was positioned on an examination couch using a self-inflating bag and face mask in accordance with their knowledge of and skills related to in-hospital resuscitation. The study was conducted in two stages, separated with an intervention (refresh online training by using Polycom RealPresence Group Devices). Analyses of selected chest compression and relaxation parameters were performed with the use of the TrueCPR Coaching Device.

Results

The finding showed improved compression depth (HOS/C: 46.68 mm vs. 51.50 mm; HOS/I: 46.92 mm vs. 50.57 mm), improved full recoil (HOS/C: 81.68% vs. 94.67%; HOS/I: 75.92% vs. 82.13%), and sustained standard compression rate (HOS/C: 115.23/min vs. 105.11/min; HOS/I: 113.65/min vs. 111.04/min) in the study group, 2 months after the intervention. A significant difference between the groups was observed in the rate of chest compressions with complete recoil (HOS/C: 94.67% vs. HOS/I: 82.13%; p<0.042).

Conclusions

The use of selected telemedicine tools leads to improved chest compression and relaxation parameters during in-hospital sudden cardiac arrest.

The effectiveness of teaching chest compression first in a standardized public cardiopulmonary resuscitation training program

Effectiveness of bystander cardiopulmonary resuscitation (CPR) is known to provide emergency medical services which reduce the number of deaths in patients with out-of-hospital cardiac arrest. The survival at these patients is affected by the training level of the bystander, but the best format of CPR training is unclear. In this pilot study, we aimed to examine whether the sequence of CPR instruction improves learning retention on the course materials.A total of 95 participants were recruited and divided into 2 groups; Group 1: 49 participants were taught firstly how to recognize a cardiac arrest and activate the emergency response system, and Group 2: 46 participants were taught chest compression first. The performance of participants was observed and evaluated, the results from 1 pre-test and 2 post-tests between 2 groups were then compared.There was a significantly better improvement of participants in Group 2 regarding the recognition of a cardiac arrest and the activation of the emergency response system than of those in Group 1. At the post-test, participants in Group 2 had an improvement in chest compression compared to those in Group 1, but the difference was not statistically significant.Our study had revealed that teaching CPR first in a standardized public education program had improved the ability of participants to recognize cardiac arrest and to activate the emergency response system.

Animation and interactivity facilitate acquisition of pediatric life support skills: a randomized controlled trial using virtual patients versus video instruction

BACKGROUND

Several promising studies suggest a positive impact of interactive and media-enriched e-learning resources such as virtual patients (VP) on skill acquisition in pediatric basic life support (PBLS). This study investigates which immanent VP components account for this effect.

METHODS

N = 103 medical students in their 5th year were assigned to one of three groups: a video group prepared with self-instructional videos on PBLS (N = 37); an animation-enriched VP group with VP containing interactive questions (N = 35), static and animated media, and a static VP group with VP containing interactive questions and only static media (N = 31). Subsequent PBLS demonstrations were video-documented and scored for adherence to guideline-based algorithm, temporal demands (such as correct pace of rescue breaths and chest compressions), and quality of procedural steps (e.g., correct head positioning), as well as overall competency by two group-blinded, independent pediatricians.

RESULTS

Groups did not differ with regard to adherence to correct algorithm (88.7 ± 10.3, 93.3 ± 6.7 and 90.3 ± 10.5, respectively). Self-instruction with animated media - through videos or animation-enriched VP - resulted in a better adherence to temporal demands, as compared with training with static VP (64.5 ± 26.3 and 50.7 ± 25.7, respectively, vs. 23.8 ± 21.0). Procedural quality by the video group was slightly inferior compared with the animation-enriched VP group (79.5 ± 12.3 vs. 82.0 ± 11.9), and distinct inferior in overall 'competent' ratings (43.2% vs. 65.7%). The static VP group performed considerably most poorly of all three groups (temporal adherence 73.2 ± 11.9 and 19.4% 'competent' ratings).

CONCLUSIONS

VP can feasibly enhance PBLS skill acquisition. Thoughtful design of animations and interactivity of the VP further improves such skill acquisition, both in quality of performance and in adherence to temporal demands.

Bystander Assistance for Trauma Victims in Low- and Middle-Income Countries: A Systematic Review of Prevalence and Training Interventions

OBJECTIVE

Lack of organized prehospital care may contribute to the disproportionate burden of trauma-related deaths in low- and middle-income countries (LMICs). The World Health Organization (WHO) recommends bystander training in basic principles of first aid and victim transport; however, prevalence of bystander or layperson assistance to trauma victims in LMICs has not been well-described, and organized reviews of existing evidence for bystander training are lacking. This systematic review aims to 1) describe the prevalence of bystander or layperson aid or transport for trauma victims in the prehospital setting in LMICs and 2) ascertain impacts of bystander training interventions in these settings.

METHODS

A systematic search of OVID Medline, Cochrane Library, and relevant gray literature was conducted. We included 1) all studies detailing prevalence of bystander-administered aid or transport for trauma victims in LMICs and 2) all randomized controlled trials and observational studies evaluating bystander training interventions. We extracted study characteristics, interventions, and outcomes data. Study quality was assessed using Grading of Recommendations Assessment, Development and Evaluation (GRADE) criteria.

RESULTS

Sixty-two studies detailed prevalence of bystander transport and aid. Family members, police, and bus or taxi drivers commonly transported patients; a majority of patients, up to >94%, received aid from bystanders. Twenty-four studies examined impacts of training interventions. Only one study looked at transport interventions; the remainder addressed first aid training. Interventions varied in content, duration, and target learners. Evidence was generally of low quality, but all studies demonstrated improvements in layperson knowledge and skills. Five studies reported a mortality reduction.

CONCLUSIONS

Heterogeneity in data reporting and outcomes limited formal meta-analysis. However, this review shows high rates of bystander involvement in prehospital trauma care and transport in LMICs and highlights the need for bystander training. Bystander training in these settings is feasible and may have an important impact on meaningful outcomes such as mortality. Categories of involved bystanders varied by region and training interventions should be targeted at relevant groups. "Train the trainer" models appear promising in securing community engagement and maximizing participation. Further research is needed to examine the value of bystander transport networks in trauma.

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

Objective

This study aims to determine whether or not cardiopulmonary resuscitation (CPR) skills differ according to different instructional models for CPR education and training for junior and senior high school students.

Methods

This was a prospective and randomised study including 519 junior and senior high school students. After the lecture on CPR, students practiced the skill on the manikin. Group 1 used model 1 and Group 2 used model 2 for practical training and practical skills and CPR performance quality were evaluated.

Results

Data from skill tests were analysed in 229 students in group 1 and 210 students in group 2. The total score of sequence skill tests was 17.8±2.0 points. During 2 cycles, no chest elevation was observed in 33.3% and was significantly lower in group 1. There were no significant differences in the frequency of proper ventilation and in ventilation volume between the 2 groups. Excessive ventilation was more frequently observed in group 1 and insufficient ventilation was observed more frequently in group 2. The percentage of the frequency of a proper chest compression rate was 80.5±31.2% and there were no significant differences in proper and insufficient depths, mean rate and recoil of the chest in chest compression between the 2 groups.

Conclusions

There were differences in CPR skills according to different CPR training manikins. Therefore, certain conditions seem to be considered in selection of instructional models for CPR psychomotor skills. (Hong Kong j.emerg.med. 2011;18:375-382)

Effectiveness of hands-on cardiopulmonary resuscitation practice with self-debriefing for healthcare providers: A simulation-based controlled trial

Introduction:

The psychomotor skill of cardiopulmonary resuscitation emphasized the importance of high-quality chest compression. This investigation examined the effect of self-debriefing and the different materials of debriefing during hands-on cardiopulmonary resuscitation practice for healthcare providers.

Methods:

This was a randomized controlled trial of a cardiopulmonary resuscitation training program involving emergency medical technicians in northern Taiwan. Participants were blinded to the study purpose and were allocated randomly using the black envelope method. All participants completed a 2-min pre-test of hands-only cardiopulmonary resuscitation using a manikin. Those who were allocated to the control group received self-debriefing with knowledge of pre-test result. Those who were allocated to the experimental group received self-debriefing with an additional biomechanical information of performance of chest compression. A post-test was performed 30 min after the pre-test.

Results:

A total of 88 participants were enrolled with 44 in each group. There was significant difference of cardiopulmonary resuscitation quality after self-debriefing among all participants (pre- vs post-test adequate rate, 54.7% vs 67.5%, p = 0.028; adequate depth, 41.2% vs 69.5%, p < 0.001; full recoil, 35.9% vs 54.5%, p = 0.001). The analysis of effects of self-debriefing with additional knowledge of performance revealed no significant difference in any of the measurements (improvement in adequate rate, 11.3% vs 14.2%, p = 0.767; adequate depth, 29.6% vs 27.0%, p = 0.784; full recoil, 23.0% vs 14.1%, p = 0.275).

Conclusion:

Self-debriefing improved hands-only cardiopulmonary resuscitation quality whether or not biomechanical information of performance of chest compression was given.

The International Liaison Committee on Resuscitation-Review of the last 25 years and vision for the future

2017 marks the 25th anniversary of the International Liaison Committee on Resuscitation (ILCOR). ILCOR was formed in 1992 to create a forum for collaboration among principal resuscitation councils worldwide. Since then, ILCOR has established and distinguished itself for its pioneering vision and leadership in resuscitation science. By systematically assessing the evidence for resuscitation standards and guidelines and by identifying national and regional differences, ILCOR reached consensus on international resuscitation guidelines in 2000, and on international science and treatment recommendations in 2005, 2010 and 2015. However, local variation and contextualization of guidelines are evident by subtle differences in regional and national resuscitation guidelines. ILCOR's efforts to date have enhanced international cooperation, and progressively more transparent and systematic collection and analysis of pertinent scientific evidence. Going forward, this sets the stage for ILCOR to pursue its vision to save more lives globally through resuscitation.

A comparison of pediatric basic life support self-led and instructor-led training among nurses

OBJECTIVE

Pediatric cardiac arrest carries a poor prognosis. Basic life support improves survival. Studies on pediatric basic life support (PBLS) training are sparse. The aim of our study was to investigate the effect of self-training in PBLS.

PARTICIPANTS AND METHODS

We conducted a prospective controlled trial enrolling nurses from pediatric and maternity wards (n=29 in each group). Self-training, including a manikin and access to a web-based video on PBLS, was compared with a 2-h instructor-led course. Two weeks after training, all participants were tested in a mock scenario of pediatric cardiac arrest. Fifteen parameters equivalent to the steps in the PBLS algorithm - for example, effective ventilations, effective chest compressions, calling for help, and correct sequence of actions, were evaluated and rated dichotomously (1=approved or 0=not approved).

RESULTS

No difference was observed in the baseline demographics between the self-training group and the instructor-led group. The participants in the self-training group accessed the website 2±1.5 times (mean±SD) and spent 41±25 min on the site. There was no significant difference between the two groups in the overall average score (10.5 in the self-training group vs. 10.0 in the instructor-led group, P=0.51) or in any of the 15 parameters. After the study, all participants felt that they had improved their skills and felt capable of performing PBLS.

CONCLUSION

Self-training is not statistically different to instructor-led training in teaching PBLS. Self-evaluated confidence improved, but showed no difference between groups. PBLS may be disseminated through self-training.

Cardiopulmonary Resuscitation Training by Avatars: A Qualitative Study of Medical Students' Experiences Using a Multiplayer Virtual World

Background

Emergency medical practices are often team efforts. Training for various tasks and collaborations may be carried out in virtual environments. Although promising results exist from studies of serious games, little is known about the subjective reactions of learners when using multiplayer virtual world (MVW) training in medicine.

Objective

The objective of this study was to reach a better understanding of the learners’ reactions and experiences when using an MVW for team training of cardiopulmonary resuscitation (CPR).

Methods

Twelve Swedish medical students participated in semistructured focus group discussions after CPR training in an MVW with partially preset options. The students’ perceptions and feelings related to use of this educational tool were investigated. Using qualitative methodology, discussions were analyzed by a phenomenological data-driven approach. Quality measures included negotiations, back-and-forth reading, triangulation, and validation with the informants.

Results

Four categories characterizing the students’ experiences could be defined: (1) Focused Mental Training, (2) Interface Diverting Focus From Training, (3) Benefits of Practicing in a Group, and (4) Easy Loss of Focus When Passive. We interpreted the results, compared them to findings of others, and propose advantages and risks of using virtual worlds for learning.

Conclusions

Beneficial aspects of learning CPR in a virtual world were confirmed. To achieve high participant engagement and create good conditions for training, well-established procedures should be practiced. Furthermore, students should be kept in an active mode and frequent feedback should be utilized. It cannot be completely ruled out that the use of virtual training may contribute to erroneous self-beliefs that can affect later clinical performance.

Improving Pediatric Basic Life Support Performance Through Blended Learning With Web-Based Virtual Patients: Randomized Controlled Trial

BACKGROUND

E-learning and blended learning approaches gain more and more popularity in emergency medicine curricula. So far, little data is available on the impact of such approaches on procedural learning and skill acquisition and their comparison with traditional approaches.

OBJECTIVE

This study investigated the impact of a blended learning approach, including Web-based virtual patients (VPs) and standard pediatric basic life support (PBLS) training, on procedural knowledge, objective performance, and self-assessment.

METHODS

A total of 57 medical students were randomly assigned to an intervention group (n=30) and a control group (n=27). Both groups received paper handouts in preparation of simulation-based PBLS training. The intervention group additionally completed two Web-based VPs with embedded video clips. Measurements were taken at randomization (t0), after the preparation period (t1), and after hands-on training (t2). Clinical decision-making skills and procedural knowledge were assessed at t0 and t1. PBLS performance was scored regarding adherence to the correct algorithm, conformance to temporal demands, and the quality of procedural steps at t1 and t2. Participants' self-assessments were recorded in all three measurements.

RESULTS

Procedural knowledge of the intervention group was significantly superior to that of the control group at t1. At t2, the intervention group showed significantly better adherence to the algorithm and temporal demands, and better procedural quality of PBLS in objective measures than did the control group. These aspects differed between the groups even at t1 (after VPs, prior to practical training). Self-assessments differed significantly only at t1 in favor of the intervention group.

CONCLUSIONS

Training with VPs combined with hands-on training improves PBLS performance as judged by objective measures.

Cardiopulmonary resuscitation and automatic external defibrillator training in schools: "is anyone learning how to save a life?"

OBJECTIVES

Bystander resuscitation efforts, such as cardiopulmonary resuscitation (CPR) and use of an automatic external defibrillator (AED), save lives in cardiac arrest cases. School training in CPR and AED use may increase the currently low community rates of bystander resuscitation. The study objective was to determine the rates of CPR and AED training in Toronto secondary schools and to identify barriers to training and training techniques.

METHODS

This prospective study consisted of telephone interviews conducted with key school staff knowledgeable about CPR and AED teaching. An encrypted Web-based tool with prespecified variables and built-in logic was employed to standardize data collection.

RESULTS

Of 268 schools contacted, 93% were available for interview and 83% consented to participate. Students and staff were trained in CPR in 51% and 80% of schools, respectively. Private schools had the lowest training rate (39%). Six percent of schools provided AED training to students and 47% provided AED training to staff. Forty-eight percent of schools had at least one AED installed, but 25% were unaware if their AED was registered with emergency services dispatch. Cost (17%), perceived need (11%), and school population size (10%) were common barriers to student training. Frequently employed training techniques were interactive (32%), didactic instruction (30%) and printed material (16%).

CONCLUSIONS

CPR training rates for staff and students were moderate overall and lowest in private schools, whereas training rates in AED use were poor in all schools. Identified barriers to training include cost and student population size (perceived to be too small to be cost-effective or too large to be implemented). Future studies should assess the application of convenient and cost-effective teaching alternatives not presently in use.

Understanding and improving low bystander CPR rates: a systematic review of the literature

Objectives:

Cardiopulmonary resuscitation (CPR) is a crucial yet weak link in the chain of survival for out-of-hospital cardiac arrest. We sought to understand the determinants of bystander CPR and the factors associated with successful training.

Methods:

For this systematic review, we searched 11 electronic databases, 1 trial registry and 9 scientific websites. We performed hand searches and contacted 6 content experts. We reviewed without restriction all communications pertaining to who should learn CPR, what should be taught, when to repeat training, where to give CPR instructions and why people lack the motivation to learn and perform CPR. We used standardized forms to review papers for inclusion, quality and data extraction. We grouped publications by category and classified recommendations using a standardized classification system that was based on level of evidence.

Results:

We reviewed 2409 articles and selected 411 for complete evaluation. We included 252 of the 411 papers in this systematic review. Differences in their study design precluded a meta-analysis. We classified 22 recommendations; those with the highest scores were 1) 9-1-1 dispatch-assisted CPR instructions, 2) teaching CPR to family members of cardiac patients, 3) Braslow's self-training video, 4) maximizing time spent using manikins and 5) teaching the concepts of ambiguity and diffusion of responsibility. Recommendations not supported by evidence include mass training events, pulse taking prior to CPR by laymen and CPR using chest compressions alone.

Conclusion:

We evaluated and classified the potential impact of interventions that have been proposed to improve bystander CPR rates. Our results may help communities design interventions to improve their bystander CPR rates.

Evaluation of Teaching Methods in Mass CPCR Training in Different Groups of the Society, an Observational Study

To determine the efficacy of different methods of cardiopulmonary resuscitation (CPCR) training in 3 different groups of the society. In a prospective and observational study of 2000 individuals in 3 different groups including G1, G2, and G3 4 different protocols of CPCR training were applied and their efficacy was compared between the groups. Also, 12 months after the study course, 460 participants from 3 groups were asked to take apart in a theoretical and practical examination to evaluate the long-term efficacy of the 4 protocols. Among 2000 individuals took a parted in the study, 950 (47.5%) were G1, 600 (30%) were G2, and 450 (22.5%) were G3. G1 in 4 groups were 2.37 and 2.65 times more successful in pretest theoretical and 2.61 and 18.20 times more successful in practical examinations compared with G2 and G3 and gained highest improvement in CPCR skills. Other groups also showed significantly improved CPCR skills. Comparison of different methods of CPCR learning showed that the workshop using interactive lecture as well as human model, educational film, and reference CPCR book has the highest efficacy in all groups. This protocol of CPCR training showed more efficacy in long-term postdelayed evaluation. On the contrary, medical students had better long-term outcomes from the course. Although G1 and G2 obtained better results in learning CPCR skills, in G3 also the theoretical and practical knowledge were improved significantly. This course increased confidence for doing CPCR in all groups of the study. Considering that the most of the bystanders at emergency states are general population, training this group of the society and increasing their confidence about performing CPCR can be so effective and lifesaving at emergency states. (Clinical trial. Gov registration: NCT02120573).

Emergency skills learning on video (ESLOV): A single-blinded randomized control trial of teaching common emergency skills using self-instruction video (SIV) versus traditional face-to-face (FTF) methods

BACKGROUND

Self-instruction video (SIV) has been widely explored as a teaching mode for cardiopulmonary resuscitation (CPR) and automated external defibrillation (AED), but not with other basic emergency skills.

AIM

To evaluate the effectiveness of SIV in teaching other basic emergency skill in comparison with traditional face-to-face (FTF) methods.

METHODS

Participants were randomized into SIV and FTF groups. Each group was assigned to learn basic airway management (BAM), cervical collar application (CCA), manual cardiac defibrillation (MCD), and emergency extremity splinting (EES) skills. Confidence level was assessed using questionnaires, and skills performances were assessed using calibrated-blinded assessors through an Objective Structured Clinical Examination (OSCE).

RESULTS

Forty-five participants took part in the assessment exercises. There were no significant differences between both groups, on all four skill categories. The mean OSCE-score of an individual category between the FTF-group vs. the SIV-group were as follows: BAM (10.23 ± 1.04 vs. 10.04 ± 1.49; p = 0.62); CCA (7.86 ± 4.39 vs. 7.13 ± 4.12; p = 0.57); MCD (8.24 ± 0.89 vs. 7.58 ± 1.14; p = 0.39); EES (5.43 ± 2.11 vs. 4.63 ± 2.30; p = 0.23). The composite mean score for the FTF-group was 6.85, and for the SIV-group was 6.20 (p < 0.05). There was no significant different in the level of confidence for both groups.

CONCLUSION

SIV is as effective as FTF in teaching and learning basic emergency skills.

The design of instructional tools affects secondary school students' learning of cardiopulmonary resuscitation (CPR) in reciprocal peer learning: a randomized controlled trial

BACKGROUND

Research investigating design effects of instructional tools for learning Basic Life Support (BLS) is almost non-existent.

AIM

To demonstrate the design of instructional tools matter. The effect of spatial contiguity, a design principle stating that people learn more deeply when words and corresponding pictures are placed close (i.e., integrated) rather than far from each other on a page was investigated on task cards for learning Cardiopulmonary Resuscitation (CPR) during reciprocal peer learning.

METHODS

A randomized controlled trial. A total of 111 students (mean age: 13 years) constituting six intact classes learned BLS through reciprocal learning with task cards. Task cards combine a picture of the skill with written instructions about how to perform it. In each class, students were randomly assigned to the experimental group or the control. In the control, written instructions were placed under the picture on the task cards. In the experimental group, written instructions were placed close to the corresponding part of the picture on the task cards reflecting application of the spatial contiguity principle.

RESULTS

One-way analysis of variance found significantly better performances in the experimental group for ventilation volumes (P=.03, ηp2=.10) and flow rates (P=.02, ηp2=.10). For chest compression depth, compression frequency, compressions with correct hand placement, and duty cycles no significant differences were found.

CONCLUSION

This study shows that the design of instructional tools (i.e., task cards) affects student learning. Research-based design of learning tools can enhance BLS and CPR education.

Training Mothers in Infant Cardiopulmonary Resuscitation With an Instructional DVD and Manikin

Context: Classes in infant cardiopulmonary resuscitation (CPR) can be time consuming and costly.

Objective: To determine whether mothers in an obstetric unit could learn infant CPR by using a 22-minute instructional kit and to assess the value and confidence they gained by learning CPR.

Design: Quasi-experimental study with enrollment between January and December 2008.

Setting: Obstetric unit in Lehigh Valley Hospital, a suburban teaching hospital in Allentown, Pennsylvania.

Participants: Mothers at least 18 years old who had given birth within the previous 24 hours.

Intervention: The experimental group included mothers without prior CPR training who watched a 22-minute instructional DVD and practiced on a manikin. The control group included mothers with prior conventional CPR training.

Main Outcome Measures: In both groups, knowledge and proficiency were assessed with written and practical examinations developed by certified CPR instructors. Participant surveys were conducted at 3 times: immediately before dissemination of course materials, within 24 hours after the mother agreed to participate in the study, and 6 months after initial evaluation.

Results: A total of 126 mothers were enrolled in the study: 79 in the experimental group, 25 in the control group, and 22 who withdrew from the study. Written and practical examinations were used to determine proficiency, and composite scores were generated, with a maximum composite score of 12. The composite scores were statistically significantly higher in the experimental group than in the control group, with median scores of 10 and 7, respectively (P<.001). Twenty-two mothers (21%) had been previously offered CPR training. In the experimental group, 76 mothers (96%) felt more confident as caregivers after learning CPR. Before training in both groups, 84 mothers (81%) stated that learning CPR was extremely important, compared with 100 mothers (96%) after training (P=.001).

Conclusion: Use of an instructional kit is an effective method of teaching CPR to new mothers. Mothers reported that learning CPR is extremely important and that it increases their confidence as caregivers.

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

BACKGROUND

The optimal age to begin CPR training is a matter of debate. This study aims to determine if elementary schoolchildren have the capacity to administer CPR efficiently.

METHODS

This quasi-experimental study took place in a Quebec City school. Eighty-two children 10 to 12 years old received a 6-hour CPR course based on the American Heart Association (AHA) Guidelines. A comparison group of 20 adults who had taken the same CPR course was recruited. After training, participants' performance was evaluated using a Skillreporter manikin. The primary outcome was depth of compressions. The secondary outcomes were compression rate, insufflation volume and adherence to the CPR sequence. Children's performance was primarily evaluated based on the 2005 AHA standards and secondarily compared to the adults' performance.

RESULTS

Schoolchildren did not reach the lower thresholds for depth (28.1 +/- 5.9 vs 38 mm; one-sided p = 1.0). The volume of the recorded insufflations was sufficient (558.6 +/222.8 vs 500 ml; one-sided p = 0.02), but there were a significant number of unsuccessful insufflation attempts not captured by the Skillreporter. The children reached the minimal threshold for rate (113.9 +/-18.3 vs 90/min; one-sided p < 0.001). They did not perform as well as the adults regarding compression depth (p < 0.001), but were comparable for insufflation volume (p = 0.83) and CPR sequence.

CONCLUSIONS

In this study, schoolchildren aged 10-12 years old did not achieve the standards for compression depth, but achieved adequate compression rate and CPR sequence. When attempts were successful at generating airflow in the Skillreporter, insufflation volume was also adequate.

Pneumothorax During CPR Training: Case Report and Review of the CPR Literature

Cardiopulmonary resuscitation is taught widely to both lay persons and health care oworkers. It is a challenging psychomotor skill. Concerns about its safety to the rescuer have centered around the risk of infectious disease exposure. A young nursing assistant developed a minimally symptomatic pneumothorax during CPR training. This case is the first reported example of this complication for a CPR trainee or provider. The literature is reviewed for complications for CPR provider and recipient and the relevant issues regarding the current status and future direction of this intervention.

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

OBJECTIVE

Globally, 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.

METHODS

HCP 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 6 months. 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.

RESULTS

Of 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 6 months (38% vs. 67%, p<0.01), and adult CPR skills were retained to 3 months (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.

CONCLUSIONS

HCP 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.