Resuscitation skills of lay public after recent training.

STUDY OBJECTIVE: To investigate the ability of laypeople to apply basic CPR techniques after recent training. DESIGN: Cross-sectional assessment of practical CPR skills. TYPE OF PARTICIPANTS: 151 laypeople who were trained twice in the preceding 20 to 24 months. MEASUREMENTS AND MAIN RESULTS: Practical skills were tested using six primary recorded variables that describe the quality of CPR techniques in a training situation. A total score on the skills of each participant was computed on the basis of a predefined scoring system. Thirty-three percent of the participants were able to perform adequate CPR. The compression:relaxation ratio, the breathing volume, and the breathing interval were points of concern. CONCLUSION: Practical skills in basic CPR after a 12-month training interval, though better in this study than in many previous studies, are insufficient in the majority of laypeople. The results of this study could be used to design a better tailored (re)instruction program, with an emphasis on regular, frequent refresher courses.

A comparison of resuscitation skills of qualified general nurses and ambulance nurses in The Netherlands.

OBJECTIVE: To investigate the ability of qualified general nurses to perform cardiopulmonary resuscitation and to compare these skills with those of a group of ambulance nurses. DESIGN: Cross-sectional assessment of practical cardiopulmonary resuscitation skills. SUBJECTS: 141 Dutch general nurses. OUTCOME MEASURES: The practical skills were tested with six primary variables that describe the quality of cardiopulmonary resuscitation techniques in a training situation. A total score on the skills was computed based on a predefined scoring system. RESULTS: The percentage of general nurses who were able to achieve a pass score (i.e., the total score did not exceed 15 penalty points) was 6.4 percent. The average score was 37.8 penalty points. Eighty-eight percent of the ambulance nurses achieved a pass score. The average number of penalty points was 10.5. CONCLUSIONS: The practical skills in cardiopulmonary resuscitation are insufficient in the majority of this sample of general nurses in The Netherlands. The findings of this study should be used as a base to design an optimal form and content of an educational re-instruction program. We expect that a considerable improvement could be achieved by more frequent cardiopulmonary resuscitation re-instruction.

Variation in the quality of cardiopulmonary resuscitation.

During instruction in basic cardiopulmonary resuscitation (CPR) skills, cardiac massage and mouth-to-mouth ventilation are applied without interruption for no longer than a few minutes. The aim of this study was to see if the quality of technique during the first 2 min of CPR reflects the resuscitators ability to perform CPR over a 15 min period. Assessments were done with a resuscitation mannequin from which recordings of several variables were made at 2, 5, 10, and 15 min after the start of CPR. 60 lay volunteers who had received CPR training were studied, and six variables that describe the quality of CPR technique were recorded and scored with a predefined scoring system. No deterioration in CPR skills was seen during 15 min. We conclude that the initial 2 min assessment reflects the resuscitators ability to perform CPR over a longer period.

A scoring system for basic cardiac life support skills in training situations.

A valid and reproducible system for determining basic cardiac life support (BCLS) skills can help to evaluate the effect of instruction courses and to estimate the results of educational activities. The aim of this study was to develop and test such a system in accordance with the Standards and Guidelines of the American Heart Association (AHA). Five criteria were defined in advance towards such a system (1) Inadequate techniques must be reflected by a fail score. (2) Skilled persons should achieve a pass score. (3) The effect of training must be reflected by an improvement of the score. (4) Inter- and intra-observer variability must be negligible. (5) The system should be simple to apply. The system was developed, and in order to test the system, the BCLS skills of 40 ambulance nurses were tested once and those of 148 lay people twice. All cardiopulmonary resuscitation (CPR) attempts were performed on a mannequin. The relevant parameters of the attempt were continuously recorded and printed. Penalty points were assigned in a predefined way for aberrations of the techniques advised in the Standards and Guidelines. The system satisfied the five criteria mentioned above. It therefore offers a reliable and reproducible evaluation of BCLS skills.

Cardiopulmonary resuscitation on the general ward: no category of patients should be excluded in advance.

In this study 91 consecutive CPR cases in 90 patients on general wards were evaluated during 18 months. Fifteen patients (16.5%) could be discharged, which is relatively favourable in comparison to the literature. Children proved to have a better chance to leave the hospital alive than adults (6/18 vs. 9/72; P less than 0.05). No factors with negative predictive value before the cardiopulmonary arrest could be isolated. Even oncological patients, often described as a prognostically poor category, with a success rate of 27% (6/22) did not differ from other categories. Patients with isolated respiratory arrest, ventricular tachycardia or ventricular fibrillation at the arrival of the CPR-team had a better chance to be discharged from the hospital. A rapid decrease in survival was noted if a CPR attempt lasted longer than 10 min (P less than 0.001). When there is no return of vital signs within 30 min the CPR attempt can be stopped. During follow-up period (mean 6 month) 2 of the 15 survivors (13.3%) died from a non-cardiopulmonary cause. It is concluded that no category of patients can be excluded from CPR in advance. Although ultimate success rate for CPR in the general wards will rarely exceed 15%, CPR has to be initiated in most cases of cardiopulmonary arrest.