Training and educational paperPublic access resuscitation program including defibrillator training for laypersons: A randomized trial to evaluate the impact of training course duration☆,☆☆
Introduction
Sudden out-of-hospital cardiac arrest remains a leading cause of death worldwide. It is estimated that in Western populations, 0.5–1/1000 adults die each year from sudden cardiac death outside the hospital setting.1, 2 The “chain of survival” outlines opportunities to improve outcome through prompt activation of the local Emergency Medical System (EMS), through early cardiopulmonary resuscitation (CPR), defibrillation and timely advanced life support.3 For several years, the American Heart Association (AHA) and the European Resuscitation Council (ERC) have prompted the development of lay rescuer programs including training in the use of the automated external defibrillator (AED) in order to improve survival of sudden cardiac arrest victims.4 It has been demonstrated that trained laypersons can use the AED safely and effectively in a variety of public settings.5
In this study, we investigated the relation between training course duration and retention of attained skills, to provide a basis for recommendations on the optimal training programs for volunteers in basic life support (BLS) including AED use.
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Participants
The study was conducted between October 2002 and November 2005. Out of 1095 lay volunteers, 132 training groups averaging 8 participants were randomly assigned to receive 2, 4 or 7 h of theoretical and practical instruction. The volunteers were recruited from 23 different companies and agencies in Berlin (Table 1). All participants were trained in CPR (precordial compression and mouth-to-mouth ventilation) and the use of the AED in accordance with the guidelines for cardiopulmonary resuscitation
Participants
Among 1095 volunteers, 375, 378 and 342 were assigned to 2-, 4-, or 7-h classes. The demographic data for the three groups are summarized in Table 1.
Immediate test
Among the randomized volunteers, 1066 trainees (97.3%) completed the test immediately after training. In the 7-h group, the rate of correct overall responses was slightly higher (7-h group: 96.3%, 4-h group: 93.9%, 2-h group: 91.5%) (p < 0.001) (Figure 1).
Discussion
This is the first randomized trial comparing the effectiveness of a 2-, 4- and 7-h AED/CPR course on resuscitation skills of laypersons.
Earlier studies defined the duration of CPR/AED classes arbitrarily.6, 7, 8 While a standard 8-h curriculum used to be quite common for classes offered by rescue organizations, more recent studies on lay resuscitation often report on 4-h classes.6, 8 Other authors believe, however, that 4 h may still be too long and present an obstacle to widespread CPR training.
Conflict of interest statement
Disclosures: DA, HRA and SH have received speaking fees from Medtronic. The other authors report no disclosures.
Acknowledgments
The authors wish to thank Dr. Peter Rauh for his assistance with the statistical analysis and Mrs Angelika Mathes for her secretarial assistance.
Statement of responsibility: The authors had full access to the data and take responsibility for its integrity. All authors have read and agree to the manuscript as written.
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A Spanish translated version of the summary of this article appears as Appendix in the final online version at 10.1016/j.resuscitation.2007.08.019.
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Clinical Trial Registration: This study represents results from a clinical trial. The trial was started September 2002.