ABC of resuscitation. The automated external defibrillator.
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Arrhythmias, Cardiac↗
Biomedical subjects
Anthony J Handley
Publications and source records attributed to Anthony J Handley.
Improving CPR performance using an audible feedback system suitable for incorporation into an automated external defibrillator.
BACKGROUND: It has been shown that a computer-based audible feedback system can improve acquisition and retention of basic life support (BLS) skills. This system is being developed to work in association with an automated external defibrillator (AED). AIM: To determine if such a feedback system is likely to improve the quality of CPR performed by trained nurses whilst using an AED. METHOD: Thirty-six general nurses performed 3 min of BLS on a manikin connected to a laptop computer running an experimental software program. After initial testing they were randomly allocated to control or 'feedback' groups. Both groups then performed a further 3 min of BLS, but those in the feedback group received audible corrective instructions from the computer when errors of technique were detected. RESULTS: The group receiving feedback were significantly better than the control group at performing inflations (P=0.004) and achieving the correct depth of chest compression (P<0.0005). CONCLUSIONS: The results suggest that if the feedback system were to be incorporated into an AED, it could lead to better performance of CPR during a resuscitation attempt.
Adult↗
Time for change?
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Cardiopulmonary Resuscitation↗
Teaching hand placement for chest compression--a simpler technique.
BACKGROUND: Simplification of the techniques and teaching of resuscitation are advocated as ways of improving skill acquisition and retention. A simple method for teaching hand placement for chest compression has been described but not validated. OBJECTIVE: The objective of this study was to determine if instructing trainees simply to place their hands in the centre of the chest results in better initial and retained accuracy of hand placement than the usual method of first identifying anatomical landmarks. METHODS: Volunteers received instruction in basic CPR, being taught hand placement either by the standard method (33 subjects) or the simplified method (32 subjects). They were tested for accuracy of hand position before training, immediately afterwards and 6 weeks later. RESULTS: After training both groups showed an improvement in accuracy of hand placement but there was no significant difference in the degree of improvement between the groups (P=0.345), nor in the level of accuracy achieved (P=0.178). Six weeks after training, the Standard Group demonstrated a statistically significant deterioration in accuracy (P=0.001), whereas the Simple Group did not (P=0.561). By this time, however, there was no longer any difference in accuracy of hand placement for either group compared with before training (Standard Group P=0.912; Simple Group P=0.140). On the positive side, the Simple Group took significantly less time (2.90 s) than the Standard Group (4.43 s) to change from ventilation to chest compression (P=0.000003). CONCLUSIONS: Simplifying the teaching of correct hand placement for chest compression does not appear to lead to improvement in acquisition or retention of the skill. However, it does result in a significant reduction in the length of the pauses between ventilation and chest compression.
Adult↗
Trials of teaching methods in basic life support (3): comparison of simulated CPR performance after first training and at 6 months, with a note on the value of re-training.
A randomised controlled trial comparing staged teaching of cardiopulmonary resuscitation (CPR) with conventional training provided the additional opportunity to investigate skill acquisition and retention in those attending conventional CPR classes. All subjects were tested immediately after their first instruction period and again at 6-9 months at an unheralded home visit. We were able to assess how far performance was related to poor acquisition of skills and how far it was related to skill decay. Out of 262 subjects who were randomised to receive conventional CPR instruction, 166 were available for home testing at 6-9 months. An invitation to attend for re-training had been accepted by 39 of them. The remaining 127 who attended only a single class comprise the principal study group, with additional comparative observations on the smaller re-trained cohort. Important failings were observed in the acquisition of skills in all modalities tested after the initial instruction. These were particularly marked in skills related to ventilation. Immediately after a class, 68% of trainees performed an effective check of breathing, but only 33% opened the airway as taught and no more than 18% provided an ideal ventilation volume. The technique of chest compression was also less than ideal. Although 80% of subjects placed their hands in an acceptable position, compression to an adequate depth and an adequate rate of compression were achieved by 54 and 63%, respectively. Seventy-eight percent demonstrated a careful approach, and 46% remembered to call for help. A carotid pulse check was simulated by 61% of trainees. When tested 6-9 months later, skill deterioration from this baseline was observed in all modalities tested except for the ventilation volume. The skill decay was significant (P<0.05) for the careful approach, performing an effective breathing check, the carotid pulse check, placing the hands in an acceptable position for chest compression, and compressing at an optimal rate. The minority who attended for re-training showed a trend to protection against skill decay for seven of the ten variables, compared with those who had attended only one training session. This improvement was significant for only two of them, but all were relatively small with limited practical value. Many who attend conventional CPR classes fail to acquire the necessary skills, and the skills that are acquired decline appreciably over the subsequent 6-9 months. The value of conventional re-training was modest in this study of community volunteers.
Adult↗