Automated external defibrillators in schools?

OBJECTIVE: Automated external defibrillators (AEDs) placed in public locations can save lives of cardiac arrest victims. In this paper, we try to estimate the cost-effectiveness of AED placement in Belgian schools. This would allow school policy makers to make an evidence-based decision about an on-site AED project. METHODS AND RESULTS: We developed a simple mathematical model containing literature data on the incidence of cardiac arrest with a shockable rhythm; the feasibility and effectiveness of defibrillation by on-site AEDs and the survival benefit. This was coupled to a rough estimation of the minimal costs to initiate an AED project. According to the model described above, AED projects in all Belgian schools may save 5 patients annually. A rough estimate of the minimal costs to initiate an AED project is 660 EUR per year. As there are about 6000 schools in Belgium, a national AED project in all schools would imply an annual cost of at least 3960 000 EUR, resulting in 5 lives saved. CONCLUSIONS: As our literature survey shows that AED use in schools is feasible and effective, the placement of these devices in all Belgian schools is undoubtedly to be considered. The major counter-arguments are the very low incidence and the high costs to set up a school-based AED programme. Our review may fuel the discussion about Whether or not school-based AED projects represent good value for money and should be preferred above other health care interventions.

Assessing basic life support skills without an instructor: is it possible?

BACKGROUND: Current methods to assess Basic Life Support skills (BLS; chest compressions and ventilations) require the presence of an instructor. This is time-consuming and comports instructor bias. Since BLS skills testing is a routine activity, it is potentially suitable for automation. We developed a fully automated BLS testing station without instructor by using innovative software linked to a training manikin. The goal of our study was to investigate the feasibility of adequate testing (effectiveness) within the shortest period of time (efficiency). METHODS: As part of a randomised controlled trial investigating different compression depth training strategies, 184 medicine students received an individual appointment for a retention test six months after training. An interactive FlashTM (Adobe Systems Inc., USA) user interface was developed, to guide the students through the testing procedure after login, while Skills StationTM software (Laerdal Medical, Norway) automatically recorded compressions and ventilations and their duration ("time on task"). In a subgroup of 29 students the room entrance and exit time was registered to assess efficiency. To obtain a qualitative insight of the effectiveness, student's perceptions about the instructional organisation and about the usability of the fully automated testing station were surveyed. RESULTS: During testing there was incomplete data registration in two students and one student performed compressions only. The average time on task for the remaining 181 students was three minutes (SD 0.5). In the subgroup, the average overall time spent in the testing station was 7.5 minutes (SD 1.4). Mean scores were 5.3/6 (SD 0.5, range 4.0-6.0) for instructional organisation and 5.0/6 (SD 0.61, range 3.1-6.0) for usability. Students highly appreciated the automated testing procedure. CONCLUSIONS: Our automated testing station was an effective and efficient method to assess BLS skills in medicine students. Instructional organisation and usability were judged to be very good. This method enables future formative assessment and certification procedures to be carried out without instructor involvement. TRIAL REGISTRATION: B67020097543.

Effect of a backboard on chest compression quality during in-hospital adult cardiopulmonary resuscitation: A randomised, single-blind, controlled trial using a manikin model.

INTRODUCTION: Chest compression quality during in-hospital resuscitation is often suboptimal on a soft surface. Scientific evidence regarding the effectiveness of a backboard is scarce. This single-blinded manikin study evaluated the effect of a backboard on compression depth, rate and chest recoil performed by nurses. Sex, BMI, age and clinical department were considered as potential predictors. METHODS: Using self-learning, nurses were retrained to achieve a minimal combined compression score at baseline. This combined score consisted of ≥70% compressions with depth 50-60 mm, ≥70% compressions with complete release (≤5mm) and a mean compression rate of 100-120 bpm. Subsequently, nurses were allocated to a backboard or control group and performed a two-minute cardiopulmonary resuscitation test. The main outcome measure was the difference in proportion of participants achieving a combined compression score of ≥70%. RESULTS: In total 278 nurses were retrained, 158 nurses dropped out and 120 were allocated to the backboard (n = 61) or control group (n = 59). The proportion of participants achieving a combined compression score of ≥70% was not significantly different (p = 0.475) and suboptimal in both groups: backboard group 47.5% (backboard) versus 41.0% (control). Older age (≥51 years) was associated with a lower probability of achieving a combined compression score >70% [OR = 0.133; 95% confidence interval (CI), 0.037-0.479; p = 0.002]. CONCLUSION: Using a backboard did not significantly improve compression quality in our study. Important decay of compression skills was observed in both groups, highlighting the importance of frequent retraining, particularly in some age groups.

Impact of perceived inappropiate cardiopulmonary resuscitation on emergency clinicians' intention to leave the job: Results from a cross-sectional survey in 288 centres across 24 countries.

INTRODUCTION: Cardiopulmonary resuscitation (CPR) in patients with a poor prognosis increases the risk of perception of inappropriate care leading to moral distress in clinicians. We evaluated whether perception of inappropriate CPR is associated with intention to leave the job among emergency clinicians. METHODS: A cross-sectional multi-centre survey was conducted in 24 countries. Factors associated with intention to leave the job were analysed by conditional logistic regression models. Results are expressed as odds ratios with 95% confidence intervals. RESULTS: Of 5099 surveyed emergency clinicians, 1836 (36.0%) were physicians, 1313 (25.7%) nurses, 1950 (38.2%) emergency medical technicians. Intention to leave the job was expressed by 1721 (33.8%) clinicians, 3403 (66.7%) often wondered about the appropriateness of a resuscitation attempt, 2955 (58.0%) reported moral distress caused by inappropriate CPR. After adjustment for other covariates, the risk of intention to leave the job was higher in clinicians often wondering about the appropriateness of a resuscitation attempt (1.43 [1.23-1.67]), experiencing associated moral distress (1.44 [1.24-1.66]) and who were between 30-44 years old (1.53 [1.21-1.92] compared to <30 years). The risk was lower when the clinician felt valued by the team (0.53 [0.42-0.66]), when the team leader acknowledged the efforts delivered by the team (0.61 [0.49-0.75]) and in teams that took time for debriefing (0.70 [0.60-0.80]). CONCLUSION: Resuscitation attempts perceived as inappropriate by clinicians, and the accompanying moral distress, were associated with an increased likelihood of intention to leave the job. Interprofessional collaboration, teamwork, and regular interdisciplinary debriefing were associated with a lower risk of intention to leave the job. ClinicalTrials.gov; No.: NCT02356029.

Cardiopulmonary Resuscitation in Adults Over 80: Outcome and the Perception of Appropriateness by Clinicians.

OBJECTIVES: To determine the prevalence of clinician perception of inappropriate cardiopulmonary resuscitation (CPR) regarding the last out-of-hospital cardiac arrest (OHCA) encountered in an adult 80 years or older and its relationship to patient outcome. DESIGN: Subanalysis of an international multicenter cross-sectional survey (REAPPROPRIATE). SETTING: Out-of-hospital CPR attempts registered in Europe, Israel, Japan, and the United States in adults 80 years or older. PARTICIPANTS: A total of 611 clinicians of whom 176 (28.8%) were doctors, 123 (20.1%) were nurses, and 312 (51.1%) were emergency medical technicians/paramedics. RESULTS AND MEASUREMENTS: The last CPR attempt among patients 80 years or older was perceived as appropriate by 320 (52.4%) of the clinicians; 178 (29.1%) were uncertain about the appropriateness, and 113 (18.5%) perceived the CPR attempt as inappropriate. The survival to hospital discharge for the "appropriate" subgroup was 8 of 265 (3.0%), 1 of 164 (.6%) in the "uncertain" subgroup, and 2 of 107 (1.9%) in the "inappropriate" subgroup (P = .23); 503 of 564 (89.2%) CPR attempts involved non-shockable rhythms. CPR attempts in nursing homes accounted for 124 of 590 (21.0%) of the patients and were perceived as appropriate by 44 (35.5%) of the clinicians; 45 (36.3%) were uncertain about the appropriateness; and 35 (28.2%) perceived the CPR attempt as inappropriate. The survival to hospital discharge for the nursing home patients was 0 of 107 (0%); 104 of 111 (93.7%) CPR attempts involved non-shockable rhythms. Overall, 36 of 543 (6.6%) CPR attempts were undertaken despite a known written do not attempt resuscitation decision; 14 of 36 (38.9%) clinicians considered this appropriate, 9 of 36 (25.0%) were uncertain about its appropriateness, and 13 of 36 (36.1%) considered this inappropriate. CONCLUSION: Our findings show that despite generally poor outcomes for older patients undergoing CPR, many emergency clinicians do not consider these attempts at resuscitation to be inappropriate. A professional and societal debate is urgently needed to ensure that first we do not harm older patients by futile CPR attempts. J Am Geriatr Soc 68:39-45, 2019.

Awareness and willingness to perform CPR: a survey amongst Flemish schoolchildren, teachers and principals.

OBJECTIVES: Training children in cardiopulmonary resuscitation (CPR) is one of the strategies to increase bystander CPR in society. Reinforcing knowledge and awareness and increasing willingness to perform bystander CPR contributes to a better outcome after cardiac arrest. We questioned schoolchildren, teachers and principals about their awareness of the importance of CPR and about their willingness to perform CPR. METHODS: During a four-month period, Flemish schoolchildren aged 10-18 years, teachers and principals were invited to complete a survey consisting of three parts: (1) demographics, (2) CPR (training) experience and (3) attitude towards CPR teaching and training. RESULT: In total, 390 schoolchildren, 439 teachers and 100 principals completed the survey. Previous CPR training was reported by 33% of the schoolchildren (in 82% as part of the curriculum) and by 81% teachers and 82% principals. Willingness to participate in CPR training was 77% in schoolchildren, 79% in teachers and 86% in principals with 88% of the principals convinced that schoolchildren should learn how to perform CPR. Willingness to perform CPR in a real-life situation was 68% in schoolchildren, 84% in teachers and 92% in principals. CONCLUSION: Schoolchildren are well aware of the importance of CPR and are willing to acquire the related knowledge and skills. Noteworthy is the larger awareness among principals and teachers, establishing a strong base for increasing implementation of CPR training in schools. However, a majority of children indicated a lack of training opportunities, highlighting the need for a stronger implementation.

Perception of inappropriate cardiopulmonary resuscitation by clinicians working in emergency departments and ambulance services: The REAPPROPRIATE international, multi-centre, cross sectional survey.

INTRODUCTION: Cardiopulmonary resuscitation (CPR) is often started irrespective of comorbidity or cause of arrest. We aimed to determine the prevalence of perception of inappropriate CPR of the last cardiac arrest encountered by clinicians working in emergency departments and out-of-hospital, factors associated with perception, and its relation to patient outcome. METHODS: A cross-sectional survey was conducted in 288 centres in 24 countries. Factors associated with perception of CPR and outcome were analyzed by Cochran-Mantel-Haenszel tests and conditional logistic models. RESULTS: Of the 4018 participating clinicians, 3150 (78.4%) perceived their last CPR attempt as appropriate, 548 (13.6%) were uncertain about its appropriateness and 320 (8.0%) perceived inappropriateness; survival to hospital discharge was 370/2412 (15.3%), 8/481 (1.7%) and 8/294 (2.7%) respectively. After adjusting for country, team and clinician's characteristics, the prevalence of perception of inappropriate CPR was higher for a non-shockable initial rhythm (OR 3.76 [2.13-6.64]; P < .0001), a non-witnessed arrest (2.68 [1.89-3.79]; P < .0001), in older patients (2.94 [2.18-3.96]; P < .0001, for patients >79 years) and in case of a "poor" first physical impression of the patient (3.45 [2.36-5.05]; P < .0001). In accordance, non-shockable and non-witnessed arrests were both associated with lower survival to hospital discharge (0.33 [0.26-0.41]; P < 0.0001 and 0.25 [0.15-0.41]; P < 0.0001, respectively), as were older patient age (0.25 [0.14-0.44]; P < 0.0001 for patients >79 years) and a "poor" first physical impression (0.26 [0.19-0.35]; P < 0.0001). CONCLUSIONS: The perception of inappropriate CPR increased when objective indicators of poor prognosis were present and was associated with a low survival to hospital discharge. Factoring clinical judgment into the decision to (not) attempt CPR may reduce harm inflicted by excessive resuscitation attempts.

Children saving lives: Training towards CPR excellence levels in chest compression based on age and physical characteristics.

BACKGROUND: The World Health Organization's endorsement of the "Kids save lives" statement fosters the implementation of cardiopulmonary resuscitation (CPR) training for school children worldwide. However, not every child achieves and maintains the recommended chest compression depth of 5-6cm. PURPOSE: To investigate the variability in compression depth for three age groups (grade 1: 12-14; grade 2: 14-16; grade 3: 16-18 years) as a function of physical characteristics and to define minimal compression excellence levels for training. METHODS: Compression depth of 265 subjects (111 girls, 154 boys) aged 12-18 years from one secondary school was individually assessed and reported in percentiles per age group. Pearson correlations between physical characteristics and CPR variables were calculated. Excellence level was defined as the percentage compressions with depth 5-6cm. RESULTS: In grade 1 (12-14 years), achieved excellence levels were 1% for girls and 23% for boys at the 75th percentile. In grade 2 (14-16 years), it increased to 24% for girls and 80% for boys. In grade 3 (16-18 years) finally, it was 59% for girls and 87% for boys. Significant positive correlations were found between CPR and physical variables (p<0.05), especially weight >50kg (p<0.01). CONCLUSION: A minimal excellence level of 25% is achievable by boys 12-14year and girls 14-16year and can be gradually improved to 60% and 90% according to age and gender. This might necessitate more exertion and training for some younger children, especially girls, and will probably be more easily achieved for children weighing >50kg.

Inaccurate treatment decisions of automated external defibrillators used by emergency medical services personnel: incidence, cause and impact on outcome.

BACKGROUND: The rhythm analysis algorithm (RAA) of automated external defibrillators (AEDs) may be deceived by many factors. In this observational study we assessed RAA accuracy in prehospital interventions. For every rhythm analysis judged to be inaccurate, we looked for causal factors and estimated the impact on outcome. METHODS: In 135 consecutive patients, two physicians reviewed 837 rhythm analyses independently. When they disagreed, a third physician made the final decision. RESULTS: Among 148 shockable episodes, 23 (16%) were not recognized by the RAA due to external artifacts (n=7), fine ventricular fibrillation (VF; n=7), RAA error without external artifacts (n=4) or a combination of factors (n=5). In six cases the omitted/delayed shock was judged to be of clinical relevance: survival with some neurological deficit (n=4), death without regaining consciousness (n=1) and no restoration of spontaneous circulation (n=1). In 689 non-shockable episodes, the RAA decided "shockable" 25 times (4%). This wrongful decision was due to external artifacts (n=9), a concurrent shock of an internal cardioverter defibrillator (n=1), RAA error without external artifacts (n=13) or a combination of factors (n=2). Fifteen spurious shocks were delivered. As these non-shockable rhythms did not deteriorate after the shock, we assumed that no significant harm was done. CONCLUSIONS: Up to 16% of shockable rhythms were not detected and 4% of non-shockable rhythms were interpreted as shockable. Therefore, all AED interventions should be reviewed. Feedback to caregivers may avoid future deleterious interactions with the AED, whereas AED manufacturers may use this information to improve RAA accuracy. This approach may improve the outcome of some VF patients.

Automated testing combined with automated retraining to improve CPR skill level in emergency nurses.

OBJECTIVES: To investigate the effect of automated testing and retraining on the cardiopulmonary resuscitation (CPR) competency level of emergency nurses. METHODS: A software program was developed allowing automated testing followed by computer exercises based on the Resusci Anne Skills Station™ (Laerdal, Norway). Using this system, the CPR competencies of 43 emergency nurses (mean age 37 years, SD 11, 53% female) were assessed. Nurses passed the test if they achieved a combined score consisting of ≥70% compressions with depth ≥50 mm and ≥70% compressions with complete release (<5 mm) and a mean compression rate between 100 and 120/min and ≥70% bag-valve-mask ventilations between 400 and 1000 ml. Nurses failing the test received automated feedback and feedforward on how to improve. They could then either practise with computer exercises or take the test again without additional practise. Nurses were expected to demonstrate competency within two months and they were retested 10 months after baseline. RESULTS: At baseline 35/43 nurses failed the test. Seven of them did not attempt further testing/practise and 7 others did not continue until competency, resulting in 14/43 not competent nurses by the end of the training period. After ten months 39 nurses were retested. Twenty-four nurses failed with as most common reason incomplete release. CONCLUSION: Automated testing with feedback was effective in detecting nurses needing CPR retraining. Automated training and retesting improved skills to a predefined pass level. Since not all nurses trained until success, achieving CPR competence remains an important individual and institutional motivational challenge. Ten months after baseline the combined score showed important decay, highlighting the need for frequent assessments.

Repetitive sessions of formative self-testing to refresh CPR skills: a randomised non-inferiority trial.

OBJECTIVES: To investigate whether repetitive sessions of formative self-testing (RFST) result in an equal cardiopulmonary resuscitation (CPR) skill level compared to repetitive sessions of formative self-testing with additional practice (RFSTAP). METHODS: In a non-inferiority trial, 196 third-year medical students were randomised to an RFST or RFSTAP group. Testing and practising took place in a self-learning station equipped with a manikin connected to a computer. Each cycle of RFST consisted of a 2-min CPR test followed by feedback and feedforward. In the RFSTAP group, additional practice consisted of CPR exercises with a computer voice feedback. To be successful, a combined score consisting of ≥70% compressions with a depth of ≥50 mm and ≥70% compressions with complete release (<5 mm) and a compression rate of 100-120 min(-1) and ≥70% ventilations with a volume of 400-1000 ml had to be achieved within 6 weeks. Skill retention was measured after 6 months. The non-inferiority margin was predefined as a 10% difference in success rate. RESULTS: After six weeks the success rate in both groups was 96%: 99/103 (RFST) and 89/93 (RFSTAP). After 6 months, the success rate in the competent students was 26/96 (27%) for RFST and 32/86 (37%) for RFSTAP (three students dropped out in each group). The difference in the success rate between RFSTAP and RFST was 10% and 90% (CI -2 to 23%), respectively. As the upper bound exceeded 10%, non-inferiority was inconclusive. For each CPR skill separately, RFST was non-inferior for ventilation and complete release, superior for compression depth and inferior for compression rate. CONCLUSIONS: RFST and RFSTAP were equally effective to refresh skills within 6 weeks. After 6 months, non-inferiority was inconclusive for the combined score. Our results indicate the potential of RFST to refresh CPR skills.

Knowledge and willingness to teach cardiopulmonary resuscitation: a survey amongst 4273 teachers.

INTRODUCTION: Schoolteachers are expected to play a role in teaching cardiopulmonary resuscitation (CPR) to schoolchildren, but little is known about their attitudes, actual knowledge and willingness to do so. We conducted a survey about CPR knowledge, preparedness to perform and teach CPR as well as attitude towards an alternative self-learning strategy amongst Flemish teachers. METHODS: A questionnaire was developed consisting of four distinct parts: (1) Demographics; (2) CPR knowledge and skills level; (3) Attitude towards training and (4) Resuscitation experience. Content experts screened the questionnaire in view of content validity. One hundred and seventy-one students in Educational Sciences were each asked to interview 25 different teachers. RESULTS: A total of 4273 teachers participated in the study (primary school n=856; secondary school n=2562; higher education n=855). Of all respondents, 59% (2539/4273) had received previous CPR training with the highest proportion observed in primary schoolteachers (69%) and in the age group 21-30 years (68%). Mandatory CPR training at school was supported by 41% (1751/4273) of the teachers and only 36% was aware that CPR is now formally included in the secondary education curriculum. Sixty-one percent (2621/4273) did not feel capable and was not willing to teach CPR, mainly because of a perceived lack of knowledge in 50% (2151/2621). In addition 69% (2927/4273) felt incompetent to perform correct CPR and 73% (3137/4273) wished more training. Feeling incompetent and not willing to teach was related to the absence of previous training. Primary schoolteachers and the age group 21-30 years were most willing to teach CPR. CONCLUSIONS: Although many teachers mentioned previous CPR training, only a minority of mostly young and primary schoolteachers felt competent in CPR and was willing to teach it to their students.

Efficiency of short individualised CPR self-learning sessions with automated assessment and feedback.

INTRODUCTION: Regular assessments are recommended to identify individuals requiring additional resuscitation training. We developed a strategy of short CPR self-learning sessions followed by automated assessment with feedback and investigated its efficiency to achieve a pre-defined level of compression skills. METHODS: Four hundred and four students in pharmacy and educational sciences participated. Initial training (max. 40 min) consisted of a 15 min learning-while-watching video followed by manikin exercises with computer voice feedback. At baseline and after training, performance was measured using an automated test. To be judged competent participants had to achieve ≥ 70% compressions with depth ≥ 50 mm and ≥ 70% compressions with complete release (<5mm) and a compression rate between 100 and 120 min(-1) within a two month period. Automated feedback was provided and failed participants had to retrain within two weeks. Retraining (max. 20 min and max. three times) was done with voice feedback exercises. Before retraining, the previous test result was displayed together with feedforward. After five months all participants were invited for a retention test. RESULTS: After one to four sessions, 99% (401/404) of all participants achieved competency. After five months 48% (137/288) of the students participating in the retention test was still competent. The percentage competent participants was 80% (230/288) for compression depth, 97% (279/288) for complete release and 60% (172/288) for mean rate. CONCLUSIONS: One or multiple short self-learning sessions were highly efficient to successfully train 99% of participants. After five months, retention of compression depth and complete release was very high. However, only 48% still achieved a 70% combined score for compression skills, highlighting the importance of regular assessment and retraining.

Retraining basic life support skills using video, voice feedback or both: a randomised controlled trial.

INTRODUCTION: The optimal strategy to retrain basic life support (BLS) skills on a manikin is unknown. We analysed the differential impact of a video (video group, VG), voice feedback (VFG), or a serial combination of both (combined group, CG) on BLS skills in a self-learning (SL) environment. METHODS: Two hundred and thirteen medicine students were randomly assigned to a VG, a VFG and a CG. The VG refreshed the skills with a practice-while-watching video (abbreviated Mini Anne™ video, Laerdal, Norway) and a manikin, the VFG with a computer-guided manikin (Resusci Anne Skills Station™, Laerdal, Norway) and the CG with a serial combination of both. Each student performed two sequences of 60 compressions, 12 ventilations and three complete cycles of BLS (30:2). The proportions of students achieving adequate skills were analysed using generalised estimating equations analysis, taking into account pre-test results and training strategy. RESULTS: Complete datasets were obtained from 192 students (60 VG, 69 VFG and 63 CG). Before and after training, ≥70% of compressions with depth ≥50 mm were achieved by 14/60 (23%) vs. 16/60 (27%) VG, 24/69 (35%) vs. 50/69 (73%) VFG and 19/63 (30%) vs. 41/63 (65%) CG (P<0.001). Compression rate 100-120/min was present in 27/60 (45%) vs. 52/60 (87%) VG, 28/69 (41%) vs. 44/69 (64%) VFG and 27/63 (43%) vs. 42/63 (67%) CG (P=0.05). Achievement of ≥70% ventilations with a volume 400-1000 ml was present in 29/60 (49%) vs. 32/60 (53%) VG, 32/69 (46%) vs. 52/69 (75%) VFG and 25/63 (40%) vs. 51/63 (81%) CG (P=0.001). There was no between-groups difference for complete release. CONCLUSIONS: Voice feedback and a sequential combination of video and voice feedback are both effective strategies to refresh BLS skills in a SL station. Video training alone only improved compression rate. None of the three strategies resulted in an improvement of complete release.

Acquiring basic life support skills in a self-learning station: video alone is not enough.

OBJECTIVES: To develop a self-learning station combining a video with computer exercises to learn cardiopulmonary resuscitation (CPR) to novices, and to assess the efficacy of these two components on CPR acquisition. METHODS: One hundred and twenty-five pharmacy students were trained using learning-while-watching video instructions followed by exercises with voice feedback. The proportion of students with adequate CPR skills (≥ 70% compressions with depth ≥ 50 mm, ≥ 70% compressions with complete release <5 mm, a compression rate between 100 and 120/min, ≥ 70% ventilations with a volume between 400 and 1000 ml) was measured at baseline, after video training and after subsequent voice-feedback training. RESULTS: Complete datasets were obtained for 104 students. After video training, the 70% cut-off for compression depth was achieved in 29/104 students, for complete release in 75/104, for ventilation volume in 44/104. Mean compression rate 100-120/min was adequate in 77/104 students. Compared with baseline results, only rate (29/104 vs. 77/104) and ventilation volume (6/104 vs. 44/104) improved. After subsequent training with voice feedback the proportions were: compression depth 88/104, compression rate 77/104, ventilation volume 74/104 and complete release 90/104. Compared with the skill level after video training only compression rate did not further improve. A score combining the three compression skills resulted in the following success rates: 6/104 (baseline), 15/104 (after the video), 59/104 (after voice feedback). CONCLUSION: Although in a self-learning station video training can introduce CPR skills to novices, additional voice-feedback exercises were needed to achieve acceptable CPR quality.

Efficacy of a self-learning station for basic life support refresher training in a hospital: a randomized controlled trial.

BACKGROUND: Adult basic life support refresher training using voice feedback manikins has been shown to be feasible, but the superiority of this strategy over instructor-led (IL) refresher training for nurses in a hospital has not been studied in randomized trials. OBJECTIVES: To study if adult basic life support refresher training for nurses in a self-learning (SL) station using a voice feedback manikin is more effective than IL training. METHODS: A Resusci Anne Skills Station (Laerdal, Norway) was installed in a small room. A total of 235 nurses were randomized to SL or IL training. After 1 month and after 7 months, the proportions of nurses achieving a mean compression depth of 38-51 mm, a mean compression rate of 80-120/min, incomplete release of at least 5 mm and a mean ventilation volume of 400-1000 ml were compared between the SL and IL groups. RESULTS: After 1 month, the proportion of nurses with any incomplete release of at least 5 mm was significantly lower in the SL group (23 of 54 nurses, 43%) compared with the IL group (33 of 47 nurses, 70%) (P=0.005). After 7 months, a lower proportion of nurses achieved a depth of 38-51 mm in the SL group (13 of 45 nurses, 29%) compared with the IL group (25 of 45 nurses, 56%) (P=0.01). For the other outcome parameters, no differences between SL and IL training could be demonstrated. CONCLUSIONS: This randomized trial in a real-life setting showed that more nurses achieved adequate compression depth, 7 months after IL refresher training compared with training in a SL station. Further research is needed to improve the efficacy of this SL training strategy.