Original Contribution
Very brief training for laypeople in hands-only cardiopulmonary resuscitation. Effect of real-time feedback

https://doi.org/10.1016/j.ajem.2016.02.047Get rights and content

Abstract

Background

Bystander cardiopulmonary resuscitation (CPR) improves survival from out-of-hospital cardiac arrest, but rates and performance quality remain low. Although training laypeople is a primary educational goal, the optimal strategy is not well defined. This study aimed to determine whether a short training with real-time feedback was able to improve hands-only CPR among untrained citizens.

Methods

On the occasion of the 2015 World Heart Day and the European Restart a Heart Day, a pilot study involving 155 participants (81 laypeople, 74 health care professionals) was conducted. Participants were invited to briefly practice hands-only CPR on a manikin and were after evaluated during a 2-minute chest compression (CC) test. During training brief instructions regarding hand position, compression rate and depth according to the current guidelines were given and real-time feedback was provided by a Laerdal SkillReporting System.

Results

Mean CC rate was significantly higher among health care professionals than among laypeople (119.07 ± 12.85 vs 113.02 ± 13.90 min 1; P = .006), although both met the 100-120 CC min 1 criterion. Laypeople achieved noninferior results regarding % of CC at adequate rate (51.46% ± 35.32% vs health care staff (55.97% ± 36.36%; P = .43) and depth (49.88% ± 38.58% vs 50.46% ± 37.17%; P = .92), % of CC with full-chest recoil (92.77% ± 17.17% vs 0.91% ± 18.84; P = .52), and adequate hand position (96.94% ± 14.78% vs 99.74 ± 1.98%; P = .11). The overall quality performance was greater than 70%, noninferior for citizens (81.23% ± 20.10%) vs health care staff (85.95% ± 14.78%; P = .10).

Conclusion

With a very brief training supported by hands-on instructor-led advice and visual feedback, naïve laypeople are able to perform good-quality CC-CPR. Simple instructions, feedback, and motivation were the key elements of this strategy, which could make feasible to train big numbers of citizens.

Introduction

Sudden cardiac death is for many individuals the first manifestation of cardiovascular disease (CVD), usually on the presence of an ischemic substrate [1], [2]. At least half of out-of-hospital cardiac arrests (OHCAs) are witnessed [3], [4], [5], [6]. Although bystander initiation of cardiopulmonary resuscitation (CPR) and early defibrillation significantly increase survival compared with no CPR [3], [6], [7], [8], [9], [10], rates of bystander initiated CPR remain worryingly low [11], [12]. Therefore, training general population in basic CPR skills is a primary educational goal, as expressly noted in the current resuscitation guidelines [13], [14].

Prompt delivery of high-quality chest compression–CPR (CC-CPR) provides critical perfusion to the heart and brain and may prevent defibrillable rhythm from degenerating into asystole [15]. It has been proven to be at least as effective as conventional CPR in the out-of-hospital setting and easier to perform for untrained lay rescuers [16], [17], [18], [19], [20]. “Hands-only” CPR should be thus taught to all citizens as a minimum requirement [13] and it may be a good approach when presented in public campaigns or mass events, where information should be focused and clear.

Despite previous studies comparing a wide range of educational CPR strategies, the optimal training method is still to be defined. Overall financial, time, or motivational reasons are obstacles that limit citizens' access to standard CPR courses [13], [21], and new cost-effective approaches are needed to reach general population. Recent studies have explored the usefulness of short training strategies, which have been suggested to be as effective as the former. Feedback [22], [23], [24], self-instructed learning [25], [26], and competition [24], [27] appear to be useful tools to strengthen CPR learning, although further research is needed to assess their impact on a real scenario.

In this study, we aimed to assess the usefulness of very brief practical training (< 5 minutes) on a manikin to improve CC-CPR skills among naïve citizens. Simple instructions, real-time feedback, and motivation may have been the core elements of the proposed strategy.

Section snippets

Study design

The World Heart Day (29th September) and the European Restart Heart Day (16th October) are initiatives that aim to increase general awareness of the importance of cardiovascular prevention and cardiac resuscitation [28], [29]. As part of these events in 2015, a number of activities to promote cardiovascular health and health education were organized at our hospital, targeted at both health care staff and general population. One of these was a CPR learning station organized at the hospital hall.

Results

From the 159 recruited, 2 laypeople younger than 18 years as well as 1 participant in each group who had not completed the 2-minute test were excluded. The final sample included 74 health care professionals and 81 laypeople. Fig. 2 illustrates the flow diagram for our study. Participants' age and results of CPR quality metrics for both groups are shown in Table 1.

During the 2-minute test, both groups met the CC rate criterion of 100 to 120 min 1, although the rate was higher among health care

Discussion

Cardiac arrest is a leading cause of death worldwide. Cardiovascular disease is the most frequent underlying condition, with coronary ischemia accounting for approximately 80% of cases, which mainly occur in the out-of-hospital setting [4], [6]. Because the burden of CVD parallels that of cardiac arrest, interventions performed to tackle CVD will carry an inherent reduction in the incidence of sudden cardiac death [1].

Cardiovascular prevention plays a central role in this regard. Efforts must

Conclusion

After a very brief training supported by a real-time CC quality feedback and hands-on instructor led advice, naïve laypeople are able to perform good-quality hands-only CPR on a manikin. Simple instructions, real-time feedback, and motivation might have been the key elements of this training strategy, which could make feasible to train big numbers of citizens. We suggest that CPR training should be adjusted to citizens' real availability and circumstances. Selected initiatives, carried out in

Conflict of interest

The authors report no relationships that could be construed as a conflict of interest.

Acknowledgments

We would like to thank all collaborators among nursery students from Universidade de Santiago de Compostela involved in this study, as well as staff from the Cardiology Department and the Acute Care Unit, who helped to organize and carry out the project. Special mention should be made to instructors from the Faculty of Education and Sport Sciences from Universidade de Vigo for their contribution and material support.

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