Basic life support: Awareness, attitude, and knowledge among junior doctors, physiotherapists, and nursing staffs in a tertiary care center of Sikkim

Background: Basic life support (BLS) is a lifesaving skill which every health-care personnel must know. It has been added to the curriculum but still studies have shown poor knowledge and skill among them in India. Aims and Objectives: The aim of our study was to assess attitude and knowledge of BLS among healthcare personnel in a tertiary care center of Sikkim and to recommend training of BLS according to the finding of our study. Materials and Methods: A questionnaire based cross-sectional study was done among junior doctors, physiotherapists, and nursing staffs, who were willing to participate. The questionnaire collected data under the heading of demographics, attitude, awareness, and knowledge about various domains of BLS. Analysis was done with standard statistical software. Results: Among 208 completed surveys, 24 (11.5%) were males and 184 (88.5%) were females, majority of them (76.4%) were nursing staff and belonged to 20�-year age group (76%). Mean score of the participants were 13.43 � 3.725 with a range from 2 to 21. The necessity of BLS training and the requirement of mandatory renewal was strongly agreed by 77.4% and 33.2% participants respectively. Conclusion: We conclude that they all need the trainings at frequent interval to know about the importance of BLS, to gain confidence and to improve their skill which will help them in timely saving of many lives in as well as outside the hospital. This can be achieved if institutes help in conducting the BLS session regularly despite being already in curriculum.

Retenção da aprendizagem após treinamento em suporte básico de vida com uso de simulação de baixa fidelidade em uma unidade hospitalar odontológica / Retention of learning after training in basic life support using low fidelity simulation in a dental hospital unit

OBJETIVOS: Avaliar a retenção de aprendizagem dos participantes de um curso de Suporte Básico de Vida em uma unidade odontológica de um hospital universitário. MÉTODOS: Este estudo combinou métodos quantitativos e qualitativos em um delineamento quasi-experimental, em que foram comparados os mesmos sujeitos, antes e em dois momentos após uma intervenção, a qual consistiu em um curso de treinamento em Suporte Básico de Vida. Os participantes eram servidores da Unidade de Saúde Bucal do Hospital Universitário de Brasília. Foram realizadas três avaliações: pré-teste, pós-teste e pós-teste tardio, para aferir a retenção de aprendizagem dos participantes. Em uma segunda etapa da pesquisa, foram realizadas entrevistas com os participantes aprovados no teste de retenção de aprendizado. RESULTADOS: Ao todo, 66 profissionais participaram do curso e realizaram o pré-teste teórico e o pós-teste teórico e prático. Após um ano e cinco meses da realização do curso, 10 participantes foram submetidos ao pós-teste tardio, também teórico e prático. Em relação aos conhecimentos teóricos, a média foi 6,3±2,31 pontos no pré-teste, 8,3±1,25 pontos no pós-teste e 5,1±1,44 pontos no pós-teste tardio. Os resultados do pós-teste tardio revelaram também que 70% dos participantes cumpriram com o requisito mínimo em conhecimentos teóricos para aprovação no curso (5 de 10 pontos), mas apenas 20% foram aprovados na avaliação de retenção prática. Os dois participantes que foram aprovados na avaliação prática haviam repetido os treinamentos posteriormente ao curso inicial. CONCLUSÕES: O curso de Suporte Básico de Vida baseado em simulação resultou em aprendizagem prática e teórica sobre ressuscitação cardiopulmonar. Entretanto, o efeito não se manteve após um ano e cinco meses, exceto em participantes que repetiram o treinamento nesse período, indicando que a retenção a longo prazo dessa aprendizagem exige mais oportunidades de treino ou prática. São necessários mais estudos para investigar a carga horária ideal, o número de repetições necessárias durante o treinamento e a frequência adequada dos treinamentos, bem como obter informações sobre a influência do conhecimento prévio dos participantes e da prática após o treinamento na retenção das habilidades.

AIMS: To evaluate the learning retention of participants of a Basic Life Support course in a dental unit of a university hospital. METHODS: This study combined quantitative and qualitative methods in a quasi-experimental design, in which the same subjects were compared before and at two moments after an intervention, which consisted of a training course in Basic Life Support. The participants were employees of the Oral Health Unit of the University Hospital of Brasília. Three evaluations were performed: pre-test, post-test and late post-test, in order to assess participants' learning retention. In a second stage of the research, interviews were conducted with the participants approved in the retention learning test. RESULTS: At all, 66 professionals participated in the course and carried out the theoretical pre-test and the theoretical and practical post-test. One year and five months after the course, 10 participants were submitted to the late post-test, also theoretical and practical. Regarding the theoretical knowledge, the mean was 6.3±2.31 points in the pre-test, 8.3±1.25 points in the post-test and 5.1±1.44 points in the late post-test. Late post-test results revealed also that 70% of participants met the minimum theoretical knowledge requirement for approval (5 of 10 points) but only 20% passed the practical retention assessment. The two participants who passed the practical evaluation had repeated the training after the initial course. CONCLUSIONS: Basic Life Support training based on simulation resulted in practical and theoretical learning in cardiopulmonary resuscitation. However, the effect did not persist after one year and five months, except for participants who repeated the training during this period, indicating that the long term retention of this learning requires more opportunities for training or practice. Further studies are needed to investigate the ideal workload, the number of repetitions required during training and the appropriate frequency of training, as well as to obtain information about the influence of prior knowledge of the participants and the practice after training in retention of skills.

Basic life support: evaluation of learning using simulation and immediate feedback devices / Suporte básico de vida: avaliação da aprendizagem com uso de simulação e dispositivos de feedback imediato / Soporte vital básico: evaluación del aprendizaje con uso de simulación y dispositivos de retroalimentación inmediata

ABSTRACT Objective: to evaluate students' learning in an online course on basic life support with immediate feedback devices, during a simulation of care during cardiorespiratory arrest. Method: a quasi-experimental study, using a before-and-after design. An online course on basic life support was developed and administered to participants, as an educational intervention. Theoretical learning was evaluated by means of a pre- and post-test and, to verify the practice, simulation with immediate feedback devices was used. Results: there were 62 participants, 87% female, 90% in the first and second year of college, with a mean age of 21.47 (standard deviation 2.39). With a 95% confidence level, the mean scores in the pre-test were 6.4 (standard deviation 1.61), and 9.3 in the post-test (standard deviation 0.82, p <0.001); in practice, 9.1 (standard deviation 0.95) with performance equivalent to basic cardiopulmonary resuscitation, according to the feedback device; 43.7 (standard deviation 26.86) mean duration of the compression cycle by second of 20.5 (standard deviation 9.47); number of compressions 167.2 (standard deviation 57.06); depth of compressions of 48.1 millimeter (standard deviation 10.49); volume of ventilation 742.7 (standard deviation 301.12); flow fraction percentage of 40.3 (standard deviation 10.03). Conclusion: the online course contributed to learning of basic life support. In view of the need for technological innovations in teaching and systematization of cardiopulmonary resuscitation, simulation and feedback devices are resources that favor learning and performance awareness in performing the maneuvers.

RESUMO Objetivo: avaliar o aprendizado de estudantes no curso online sobre suporte básico de vida com dispositivos de retroalimentação imediata, em simulação de atendimento em parada cardiorrespiratória. Método: pesquisa quase-experimental, do tipo antes-depois. Foi desenvolvido curso online sobre suporte básico e aplicado aos participantes, como intervenção educacional. O aprendizado teórico foi avaliado por meio de pré e pós-teste e, para verificar a prática, utilizou-se simulação com dispositivos de retroalimentação imediata. Resultados: 62 concluintes, sendo 87% mulheres, 90% do primeiro e segundo ano de faculdade, idade média de 21,47 (desvio-padrão 2,39). Com índice de confiabilidade de 95%, a média das notas no pré-teste foi 6,4 (desvio-padrão 1,61) e, no pós-teste, 9,3 (desvio-padrão 0,82), p<0,001; na prática, 9,1 (desvio-padrão 0,95) e, de acordo com o dispositivo de feedback com desempenho equivalente à reanimação cardiopulmonar básica, 43,7 (desvio-padrão 26,86), médias de duração do ciclo de compressões por segundo de 20,5 (desvio-padrão 9,47), número de compressões de 167,2 (desvio-padrão 57,06), profundidade de compressões por milímetro de 48,1 (desvio-padrão 10,49), volume de ventilação de 742,7 (desvio-padrão 301,12), percentual de fração de fluxo de 40,3 (desvio-padrão 10,03). Conclusão: com o curso online houve contribuição para o aprendizado do suporte básico de vida. Em face da necessidade de inovações tecnológicas no ensino e na sistematização da reanimação cardiopulmonar, simulação e dispositivos de retroalimentação são recursos que favorecem o aprendizado e a consciência da performance na realização das manobras.

RESUMEN Objetivo: evaluar el aprendizaje de estudiantes en curso online sobre soporte vital básico de vida con dispositivos de retroalimentación inmediata, en simulación de asistencia en paro cardiorrespiratorio. Método: investigación casi-experimental, del tipo antes-después. Se desarrolló un curso online sobre soporte básico y aplicado a los participantes, como intervención educacional. El aprendizaje teórico fue evaluado por medio de pre y pos-test y, para verificar la práctica, se utilizó una simulación con dispositivos de retroalimentación inmediata. Resultados: 62 graduados, el 87% mujeres, el 90% del primero y segundo año de facultad, edad media de 21.47 (desviación estándar 2.39). Con índice de confiabilidad del 95%, la media de las notas en pre-test fue de 6.4 (desviación estándar1.61) y, en pos-test, 9.3 (desviación estándar 0.82), p<0.001; en la práctica, 9.1 (desviación estándar 0.95) y, de acuerdo con el dispositivo de retroalimentación con desempeño equivalente a la reanimación cardiopulmonar básica, 43.7 (desviación estándar 26.86), medias de duración del ciclo de compresiones por segundo de 20.5 (desviación estándar 9.47), número de compresiones de 1672 (desviación estándar 57.06), profundidad de compresiones por milímetro de 48.1 (desviación estándar 10.49), volumen de ventilación de 742.7 (desviación estándar 301.12), porcentual de fracción de flujo de 40.3 (desviación estándar 10.03). Conclusión: con el curso online hubo contribución al aprendizaje del soporte vital básico. En vista de la necesidad de innovaciones tecnológicas en la enseñanza y en la sistematización de la reanimación cardiopulmonar, simulación y dispositivos de retroalimentación son recursos que favorecen el aprendizaje y la consciencia del desempeño en la realización de las maniobras.

Cursos de reanimación cardiopulmonar básicos para padres de recién nacidos y lactantes / Basic cardiopulmonary resuscitation courses for parents of newborns and infants

Los cursos de reanimación cardiopulmonar (RCP), cumplen todas las definiciones de una actividad educativa dirigida hacia la prevención, por parte de los padres, de la muerte por paro cardiorrespiratorio de pacientes de riesgo y/o población general. Su finalidad es principalmente la de mejorar el cuidado hogareño de los pacientes y brindar confianza antes del alta de los sectores de internación, sobre todo de cuidados intensivos. En la actualidad, forman parte del protocolo de alta de muchos servicios de neonatología, aunque hay propuestas que superan este objetivo y se extienden a otras áreas, tales como los distintos ámbitos educativos y cuidadores. A nivel local, se destaca la experiencia del grupo de RCP neonatal de la Sociedad Argentina de Pediatría en sus funciones de dictado regular de cursos a grupos familiares de pacientes de alto riesgo, así como también en la creación y difusión de contenidos.

Cardiopulmonary resuscitation (CPR) courses meet all the definitions of an educational activity for prevention of cardiac arrest death by risk patients' parents and/or the general population. The aim is to improve patients ́ home care and turn parents confident before their children are discharged from hospital, mainly from intensive care units. Currently these courses are part of discharge protocols in many neonatologist services although there are offers that exceed this target, and extend to other areas such as education and caregivers. Locally the experience of neonatal CPR at the Sociedad Argentina de Pediatría stands out in connection with delivering courses to high risk patients ́ parents as well as designing and spreading learning material

Positional Effects on the Quality of Chest Compression: A Simulation Study

PURPOSE: In-hospital cardiopulmonary resuscitation (CPR) is often performed on patients lying on a bed or stretcher, which involves using a step stool. However, as current CPR training uses mannequins placed on a floor, the quality of CPR in simulated cardiac arrest scenarios on a stretcher versus the floor were analyzed. METHODS: This study was performed during the Objective Structured Clinical Examination (OSCE) for sixth grade medical students. The students were trained using Basic Life Support (BLS) guidelines given by the American Heart Association (AHA) in 2010. Simulated CPR was performed in the 1 rescuer-mode (30:2 compression to ventilation ratio) for 5 cycles, while either standing atop a step stool beside the stretcher or kneeling on the floor, and the position order was randomized. The OSCE score and variables related to CPR quality were compared. RESULTS: Among the 59 students enrolled, 47 students were included for analysis. No significant difference in OSCE scores was found between the groups that performed CPR on a stretcher versus the floor (89.4+/-9.1 vs. 88.1+/-8.4, respectively, p=0.610). In addition, variables related to CPR quality did not differ between the groups that performed CPR on a stretcher versus the floor (following results listed respectively): correct compression rate (%) (54.8+/-42.3 vs. 70.0+/-34.9, p=0.185); compression rate (n/min) (127+/-11.3 vs. 126+/-13.3, p=0.792); correct depth (%) (69.8+/-40.6 vs. 78.6+/-33.6, p=0.429); mean compression depth (mm) (51.1+/-7.2 vs. 53.0+/-6.0, p= 0.337); correct release (%) (99.3+/-2.9 vs. 99.1+/-3.0, p=0.875); correct hand position (%) (83.2+/-32.3 vs. 86.7+/-27.5, p=0.694); total hands off time (sec.) (79.9+/-19.5 vs. 70.4+/-15.6, p=0.077). CONCLUSION: Medical students effectively perform CPR on a stretcher or the floor. Thus, current CPR training methods appear adequate and may be maintained.

Cardiopulmonary Resuscitation Training for a Layperson Through Conventional Instructor-led Training and a Self-learning Program Using the CPR Anytime Kit

PURPOSE: We aimed to investigate whether a trained layperson could perform high quality Cardiopulmonary Resuscitation (CPR) after conventional training and a self-learning program using the "CPR Anytime" kit. METHODS: Traditional CPR training for a lay rescuer was conducted two weeks before a CPR contest for high school students. "CPR Anytime" training kits were distributed to the students for their practical training at home or in school. The students were tested in pairs for two-person CPR with rescuer breaths and an automated external defibrillator. The quantitative and qualitative data regarding the quality of CPR, including chest compression and rescuer breaths, were collected using a standardized checklist and a skill reporter. RESULTS: A total of 161 teams with 322 students, including 116 males and 206 females, participated in the CPR contest in pairs. The mean depth and rate for the chest compression were 49.0+/-8.2 mm and 110.2+/-10.2 /min, respectively. The mean tidal volume for the rescue breaths was 604.8+/-208.7 ml. The percentage of participants satisfying the correct chest compression rate of > or =100/min and depth of > or =50 mm was 87.3% and 52.2%, respectively. Only 25.2% of the participants satisfied an optimal tidal volume (between 500 ml and 600 ml). Shallow compression (57.5%) and under-ventilation (44.4%) were the major causes of incorrect compression and ventilation, respectively. CONCLUSION: The quality of CPR with rescuer breaths in the trained lay rescuer was not adequate, especially for mouth-to-mouth rescue breathing. Therefore, the development of teaching methods to improve rescue breathing or omit mouth-to-mouth ventilation in training should be considered.

Comparison of the Alternating Rescuer Method between Every Minute and Two Minutes During Continuous Chest Compression in Cardiopulmonary Resuscitation According to the 2010 Guidelines

PURPOSE: To maintain high quality cardiopulmonary resuscitation (CPR), optimal alternating rescuers is important. Stronger and faster chest compression has recently been emphasized in the 2010 guidelines. Therefore, this study compared and evaluated changes in the quality of chest compression in a 2-min scenario group and a 1-min scenario group. METHODS: Among the 88 participants, two-rescuer pairs were randomly allocated. After the training and a one-day break, participants were asked to perform continuous chest compressions for 2 min on a manikin and to take a one-day break, followed by continuous chest compression for 1 min. In all simulated CPRs, the total number of chest compressions and those with appropriate depth were counted. Chest compression quality index was calculated as the proportion of chest compressions with appropriate depth. RESULTS: The mean overall chest compression depth was lower in the 2-min scenario group, compared with the 1-min scenario group. In particular, compression rate (p=0.110), abnormal hand position (p=0.181), and chest recoil (p=0.892) showed no significant difference between the two groups. However, the quality index, mean depth (p=0.018) and too shallow compression depth (p=0.020) 1-min scenario was better than that of the 2-min scenario group. The difference in the CPR quality index reached statistical significance. CONCLUSION: Switching compressors at an interval of 2 min is reasonable for performance of CPR by a lay-bystander. However, alternating rescuers every 1 min may be an alternative method during continuous chest compression.

Analysis of the Layperson Ability to perform Basic Life Support in Public Facilities

PURPOSE: We wanted to evaluate the public's ability to perform basic life support (BLS) in public facilities. METHODS: We collected the information and results of BLS from the public in parks and civil defense education centers. The enrolled subjects performed the CPR sequence and the foreign body airway obstruction (FBAO) sequence on manikins. RESULTS: Three hundred sixty people were enrolled and 186 (52%) of them knew about BLS by the media. Also, 257 (71%) of them answered that the media was important when they were asked about the priority of the education methods for BLS. On the results of the tests, 111 (30%) were not confident performing BLS and as a result, only 9 persons correctly performed the sequence of BLS and 2 persons correctly performed the sequency of FBAO. 189(57%) of them were contacted any cases of resuscitation education just by media and 250(74%) were evaluated in having affinity to media educations. Self-satisfaction was revealed almost at 50~80 points. CONCLUSION: Almost all public persons did not correctly perform the sequence of BLS. We expected that the media will have a large role to teach and effectively spread the techniques of BLS to the public.

How Knowledge-only Reinforcement Can Impact Time-related Changes in Basic Life Support (BLS) Skills of Medical Students on Clinical Clerkship

PURPOSE: Some report that basic life support (BLS) skills decay rapidly, mostly by three months after initial training. Retraining at specific intervals or with more effective methods is necessary to delay this decay. This study was undertaken to determine the effects of the time interval from initial training and to evaluate the impacts of a knowledge-only reinforcement on BLS skills in medical students and interns. METHODS: We tested the single-rescuer BLS performance of 92 medical students and interns with Resusci(R) Anne SkillReporter(TM) and BLS performance criteria. All trainees had been instructed by senior residents in 1~24 months before the test and were assigned into four groups by interval from initial training [group A: 1~3 months (n=21), group B: 4~7 (n=26), group C: 8~15 (n=20), group D: 16~24 (n=25)]. Groups C and D had 1-hour knowledge-only lectures. RESULTS: The performance criteria score of group B was lower than that of group A (p=0.005), but that of group C was higher than that of group B (p=0.025). The percent correct of ventilation (PCV) and compression (PCC) decreased surprisingly during the first three months after initial training. There was no difference in the PCC among the four groups. However, the PCV in group C was lower than that in group A (p=0.047). The PCV and the interval from initial training had a negative correlation (R=-0.273, p=0.009). CONCLUSION: Overall BLS performance of medical students and interns on clinical clerkship, without reinforcement, decreases more significantly after three months compared to the first three months from initial training. The accuracy of the skills decreases rapidly from the time of initial training. A knowledge-only reinforcement could temporally improve overall BLS performance. However, the accuracy of the ventilation skill decays regardless of reinforcement.