Implementation of basic life support education for the lay public in China: barriers, enablers, and possible solutions.

Background: Education for the lay public in basic life support (BLS) is critical for increasing bystander cardiopulmonary resuscitation (CPR) rates and improving survival from out-of-hospital cardiac arrest (OHCA). Despite years of implementation, the BLS training rate in China has remained modest. The aim of this study was to investigate the factors influencing the implementation of BLS training programs in emergency medical service (EMS) centers in China and to identify specific barriers and enablers. Methods: Qualitative interviews were conducted with key informants from 40 EMS centers in Chinese cities. The participants included 11 directors/deputy directors, 24 training department leaders, and 5 senior trainers. The interview guide was based on the Exploration, Preparation, Implementation, Sustainment (EPIS) framework. Thematic content analysis was used to identify themes and patterns across the interviews. Results: We identified 16 factors influencing the implementation of BLS training programs encompassing the outer content, inner context, innovation and bridging factors. Some factors acted as either barriers or enablers at different EPIS stages. The main implementation barriers included limited external leadership, insufficient government investment, low public awareness, a shortage of trainers, an absence of incentives, an absence of authoritative courses and guidelines, a lack of qualification to issue certificates, limited academic involvement, and insufficient publicity. The main enablers were found to be supportive government leaders, strong public demand, adequate resources, program champions, available high-quality courses of high fitness within the local context, the involvement of diverse institutions, and effective publicity and promotion. Conclusion: Our findings emphasize the diversity of stakeholders, the complexity of implementation, and the need for localization and co-construction when conducting BLS training for lay public in city EMS centers. Improvements can be made at the national level, city level, and EMS institutional level to boost priority and awareness, promote legislation and policies, raise sustainable resources, and enhance the technology of BLS courses.

Do laypersons need App-linked real-time feedback devices for effective resuscitation? - Results of a prospective, randomised simulation trial.

Background: App-linked real-time feedback-devices for cardiopulmonary resuscitation (CPR) aim to improve laypersons' resuscitation quality. Resuscitation guidelines recommend these technologies in training settings. This is the first study comparing resuscitation quality of all App-linked feedback-devices currently on market. Methods: A prospective randomised simulation study was performed. After standardised instructions, participants performed 2-minutes compression-only CPR on a manikin without feedback (baseline). Afterwards, participants performed 4 × 2 min CPR with four different feedback devices in randomised order (CorPatch® Trainer, CPRBAND AIO Training, SimCPR®ProTrainer, Relay Response™) (intervention). CPR metrics (chest compression depth (CD), chest compression rate (CR), percentage of correct CD/CR (%), correct hand position, correct chest recoil, and technical preparation-time) were assessed. Devices data were compared to the baseline group using Wilcoxon testing with IBM SPSS (primary outcome). Differences between devices were analysed with ANOVA testing (secondary outcome). Normally distributed data were described as mean ± standard deviation (SD) and non-normally distributed data as Median [Interquartile range (IQR). CPR self-confidence was measured by means of questionnaire before and after feedback devices' use. Comparison was performed by students t-test. Results: Forty participants were involved. SimCPR®ProTrainer was the only device, which resulted in guideline-compliant chest compressions (Mean ± SD:5.37 ± 0.76) with improved chest compression depth (p < 0.001), and percentage of correct chest compression depth (p < 0.001) compared to unassisted CPR (baseline). CorPatch® Trainer as the only device with audio-visual recoil instructions resulted in improved chest recoil (Mean ± SD:72.25 ± 24.89) compared to baseline (Mean ± SD:49.00 ± 42.20; p < 0.01), while the other three devices resulted in significantly lower chest recoil rates (CPRBAND AIO Training: 37.03 ± 39.90; p < 0.01, SimCPR®ProTrainer: Mean ± SD:39.88 ± 36.50; p = 0.03, Relay Response™: Mean ± SD:36.88 ± 37.73; p = 0.02). CPR quality when using the different feedback devices differ in chest compression depth (p = 0.02), chest compression rate (p < 0.001), percentage of correct chest compression depth/rate (p = 0.03/p = 0.04), and technical preparation-time (p < 0.001). Feedback-devices' use increased participant's CPR self-confidence (p < 0.001). Conclusion: Although, CPR feedback devices show improved CPR performance in layperson in some metrics, none of the tested CPR feedback devices supported layperson in overall adequate CPR performance. More and better technical functionality is necessary, to fully utilise the potential of CPR feedback devices and to prevent a worsening of CPR performance when layperson use this technology.

Awareness, Knowledge, and Attitudes Regarding Basic Life Support Among the General Population in the Al-Majma'ah Region, Saudi Arabia.

BACKGROUND: Cardiac arrest is a critical medical emergency that can strike individuals of any age or background, often occurring suddenly and unpredictably. The administration of Basic Life Support (BLS) techniques by laypersons in the first few crucial minutes following a cardiac arrest can substantially increase the chances of survival and minimize potential neurological damage. Despite the vital role of BLS in saving lives, there remains a gap in public awareness, knowledge, and attitudes regarding BLS among the general population in many regions worldwide, including Saudi Arabia. In recent years, there has been a growing emphasis on the importance of community-based interventions to enhance cardiac arrest survival rates. Public involvement in the early stages of cardiac arrest management is a key component of the chain of survival, and improving BLS awareness and knowledge among the general population is central to this effort. OBJECTIVE: This study aimed to assess the awareness, knowledge, and attitudes with regard to BLS among the general population in the Al-Majma'ah region, Saudi Arabia. METHODS: This is a descriptive cross-sectional study adopted among the population living in the Al-Majma'ah region of Saudi Arabia. The data was collected by a pre-tested and self-administered questionnaire. Data was analyzed by using IBM SPSS Statistics for Windows, Version 26.0 (Released 2019; IBM Corp., Armonk, New York, United States). The questions included information on social demographic information, awareness and knowledge, and attitudes related to BLS. RESULTS: More than half the participants (n=352; 52.5%) understand that during cardiac arrest, the heart is still beating and pumping blood, but the person is not breathing normally. This is an important understanding for providing proper care during a cardiac arrest situation. On the other hand, the study found that 384 (57.2%) had various reasons for their lack of knowledge about cardiopulmonary resuscitation (CPR). The biggest reason was lack of interest (n=98; 14.6%). This highlights a need for increased awareness and education about the importance of CPR. The findings from the Pearson correlation conducted in this study show that age has a significant influence on the level of awareness and knowledge of cardiac arrest BLS. The p-value obtained for the test was 0.014, indicating that there is a significant relationship between age and awareness and knowledge of BLS. Similarly, the study findings also show that gender has a significant influence on the attitude of cardiac arrest BLS. CONCLUSION: The participants had a decent understanding of BLS, particularly regarding concepts like cardiac arrest and the role of automated external defibrillators (AEDs). However, they showed confusion or gaps in awareness, especially concerning the correct initial steps when encountering a collapsed person. Many participants felt uncomfortable performing Hands-Only CPR in a real-life situation due to a lack of knowledge and skills, which acted as a significant barrier to public CPR performance.

Knowledge and Attitudes of First Aid and Basic Life Support Among Public School Teachers in Qassim, Saudi Arabia.

OBJECTIVE: This study aims to address the knowledge gap in first aid and basic life support (BLS) among teachers, expand the targeted schools to elementary and intermediate schools for boys and girls, and develop clear, focused recommendations. Furthermore, to assess the knowledge, skills, and attitude of BLS among schoolteachers in Qassim, Saudi Arabia. METHODS: This cross-sectional study was conducted in the school year of 2022 to 2023. In Buraidah city and the Uyun AlJiwa and Asyah governorates of Qassim, there are a total of 906 elementary and intermediate schools employing 12,057 teachers (5447 males and 6610 females). A stratified random sampling method was used with a self-administered Arabic questionnaire. This questionnaire included multiple parts (sociodemographic data, previous training status, knowledge and skill of BLS, and assessment of the following: attitude to learn and practice CPR; barriers to performing CPR; the presence or lack of previous resuscitation experience in BLS). Data were analyzed using SPSS Statistics version 25 (IBM Corp., Armonk, NY, USA). Categorical variables were described by frequency and percentage, while continuous variables were described by mean ± SD. A normality test showed that the total knowledge and skills scale was not normally distributed. The Mann-Whitney and Kruskal-Wallis tests were used to compare the mean knowledge and skills scale across variables. The accepted level of significance was below 0.05 (p <0.05). RESULTS: Our study included 482 participants. Only 19.5% (94) had previous CPR training, and 80.9% (76) were trained more than two years prior to this study's data collection. The main reason for participants' fears of applying BLS was the lack of proper knowledge and skills (48.1%). The majority of the teachers, i.e., 71.0% (342), wanted more training in CPR, and 41.1% (198) thought CPR training should be mandatory at school. We found no statistical relationship between attitude toward training and the city or differences in knowledge and skills scores due to the difference in sociodemographic characteristics. Also, we found no statistical relationship between the question 'Did you observe CPR on a collapsed patient?' and the city, meaning that the observation of CPR on collapsed patients is independent of the respondent's school location. Significant differences in skills scores were found between those who had CPR observation and those who did not (p = 0.014), in knowledge scores between those who had previous CPR training and those who did not (p = 0.034), and in skills scores between those who had previous CPR training and those who did not (p <0.001). We found no significant differences in knowledge and skills scores according to the place of previous CPR training (p = 0.163 and p = 0.695, respectively). CONCLUSION: This study reveals that knowledge and skills in BLS among schoolteachers need to be improved. For this reason, we emphasize the inclusion of International Liaison Committee on Resuscitation (ILCOR) recommendations in the curriculum and that they are made periodic and mandatory for teachers. Especially as we found teachers to have a positive attitude and were willing to train and help.

High-Impact Medical Education in Basic Life Support: A Comparative Study of Doctors and Medical Students in a Tertiary Hospital.

INTRODUCTION: Although very crucial in medicine, mastery of cardiopulmonary resuscitation remains poor in many low and-medium income countries (LMICs) due mainly to the lack of readily accessible training facilities and expertise. SUBJECTS AND METHODS: The current study was aimed at evaluating the knowledge of Basic Life Support (BLS) among senior-level medical students and doctors in Nigeria, as well as to evaluate the value of a video teaching method in improving the knowledge base of BLS. It was a two-cohort prospective study carried out over a duration of one month. Each group of participants had an initial assessment of their knowledge of Basic Life Support using a questionnaire. Thereafter, the 45-minute CHEMPIONS-BLS video was projected. On completion of the video session, the same questionnaire was again administered to each group of participants. This was followed by a practical, hands-on workshop at the skills laboratory. Data was collected using the questionnaires and comparisons were made between the pre and post-test responses. RESULTS: Seventy-five medical students and 41 doctors were enrolled into this study. Overall, their knowledge of BLS and their exposure to previous BLS training were poor, but there was a significant improvement in the mean scores, and the overall performance after viewing the video just one time; t = 27.30, p = .000 and χ² = 116.01; p = .000 respectively. CONCLUSION: This study reveals poor knowledge and exposure to basic life support training among both medical students and practicing doctors. It further reveals the value of a novel training method in improving BLS knowledge.

INTRODUCTION: Bien que cruciale en médecine, la maîtrise de la réanimation cardio-pulmonaire reste faible dans de nombreux pays à revenu faible et moyen (PRFM), principalement en raison du manque d'infrastructures de formation et d'expertise facilement accessibles. SUJETS ET MÉTHODES: La présente étude visait à évaluer les connaissances en matière de réanimation cardio-pulmonaire de base (Basic Life Support - BLS) parmi les étudiants en médecine et les médecins au Nigeria, ainsi qu'à évaluer la valeur d'une méthode d'enseignement par vidéo pour améliorer la base de connaissances en BLS. Il s'agissait d'une étude prospective à deux cohortes menée sur une durée d'un mois. Chaque groupe de participants a fait l'objet d'une évaluation initiale de ses connaissances en matière de réanimation cardio-pulmonaire à l'aide d'un questionnaire. Ensuite, la vidéo CHEMPIONS-BLS de 45 minutes a été projetée. À l'issue de la séance vidéo, le même questionnaire a été administré à chaque groupe de participants. Cette séance a été suivie d'un atelier pratique au laboratoire de compétences. Les données ont été collectées à l'aide des questionnaires et des comparaisons ont été faites entre les réponses avant et après le test. RÉSULTATS: Soixante-quinze étudiants en médecine et 41 médecins ont participé à cette étude. Dans l'ensemble, leur connaissance du BLS et leur exposition à une formation BLS antérieure étaient faibles, mais il y a eu une amélioration significative des scores moyens et de la performance globale après avoir visionné la vidéo une seule fois ; t = 27,30, p = .000 et χ² = 116,01 ; p = .000 respectivement. CONCLUSION: Cette étude révèle que les étudiants en médecine et les médecins en exercice ont une connaissance et une exposition insuffisantes à la formation aux soins de base en réanimation. Elle révèle également l'intérêt d'une nouvelle méthode de formation pour améliorer les connaissances en matière de BLS. Mots clés: Soins de base en réanimation (BLS), Réanimation cardiopulmonaire (RCP), Éducation médicale, Arrêt cardiaque extrahospitalier (OHCA), Formation post-COVID, Formation médicale continue (FMC), Hôpital universitaire spécialisé d'Irrua (ISTH), Le Nigeria.

Self-Confidence, Satisfaction, and Knowledge of Nursing Students with Training in Basic Life Support in Pregnant Women: A Cross-Sectional Study.

BACKGROUND: A flipped classroom integrating clinical simulation has been shown to be effective for basic life support (BLS) competencies in nursing students. Cardiopulmonary arrests (CPAs) in pregnant women have a low incidence but high morbidity and mortality. Current trends show an increasing incidence; however, most official university nursing training curricula do not include specific training modules for BLS in pregnant women. This study aims to know the satisfaction and self-confidence of nursing students with respect to a training intervention regarding in BLS in pregnant women. Additionally, it aims to assess the adequacy of this intervention for acquiring the necessary knowledge on the subject. METHODS: A cross-sectional study was conducted at the University of Jaen in 2022. Data were collected on sociodemographic factors, previous contact with the topic, and topic knowledge in addition to the use of an SCLS questionnaire to measure satisfaction. Participants took the BLS training (a flipped classroom integrating clinical simulation on this topic) before answering the questionnaire. RESULTS: A total of 136 students participated. The mean score on the BLS questionnaire was 9.10 out of 10 (SD = 1.01). The mean score for the SCLS questionnaire for females was 62.36 (SD = 7.70) and 56.23 (SD = 16.94) for the male group. Age showed a statistically significant association with SCLS score: the score decreased with an increase in age (p < 0.001). CONCLUSIONS: The flipped classroom, integrating simulation for BLS in pregnant women, improves self-confidence, satisfaction, and knowledge on the topic.

Outcomes of basic versus advanced prehospital life support in severe pediatric trauma.

OBJECTIVE: The role of basic life support (BLS) vs. advanced life support (ALS) in pediatric trauma is controversial. Although ALS is widely accepted as the gold standard, previous studies have found no advantage of ALS over BLS care in adult trauma. The objective of this study was to evaluate whether ALS transport confers a survival advantage over BLS among severely injured children. METHODS: A retrospective cohort study of data included in the Israeli National Trauma Registry from January 1, 2011, through December 31, 2020 was conducted. All the severely injured children (age < 18 years and injury severity score [ISS] ≥16) were included. Patient survival by mode of transport was analyzed using logistic regression. RESULTS: Of 3167 patients included in the study, 65.1% were transported by ALS and 34.9% by BLS. Significantly more patients transported by ALS had ISS ≥25 as well as abnormal vital signs at admission. The ALS and BLS cohorts were comparable in age, gender, mechanism of injury, and prehospital time. Children transported by ALS had higher in-hospital mortality (9.2% vs. 0.9%, p < 0.001). Following risk adjustment, patients transported by ALS teams were significantly more likely to die than patients transported by BLS (adjusted OR 2.27, 95% CI 1.05-5.41, p = 0.04). Patients with ISS ≥50 had comparable mortality rates in both groups (45.9% vs. 55.6%, p = 0.837) while patients with GCS <9 transported by ALS had higher mortality (25.9% vs. 11.5%, p = 0.019). Admission to a level II trauma center vs. a level I hospital was also associated with increased mortality (adjusted OR 2.78 (95% CI 1.75-4.55, p < 0.001). CONCLUSIONS: Among severely injured children, prehospital ALS care was not associated with lower mortality rates relative to BLS care. Because of potential confounding by severity in this retrospective analysis, further studies are warranted to validate these results.

Assessment of Basic Life Support Knowledge Among Medical Students in Jordan: Implications for Improving Out-of-Hospital Cardiac Arrest and Road Traffic Accident Survival Rates.

This study aimed to assess the level of basic life support (BLS) knowledge among fifth- and sixth-year medical students in Jordan, identify differences in knowledge levels between male and female students and between different universities, and provide insights into the current status of BLS training in medical education in Jordan. The study had 570 respondents, with females constituting 61.1% of the sample. The total average score for medical students was 12.24/17 (72%), and there was a considerable variation in the response rate between universities. The study found that students whose source of knowledge was previous college courses had the highest mean score, and only 24.9% knew the proper position of both hands while doing chest compressions. The study underscores the importance of adequate BLS training for healthcare providers to improve survival rates and reduce mortality and morbidity associated with out-of-hospital cardiac arrest and road traffic accidents. The findings of this study could inform future interventions aimed at improving BLS knowledge and skills.

Innovative Tele-Instruction Approach Impacts Basic Life Support Performance: A Non-inferiority Trial.

Background: Sustaining Basic Life Support (BLS) training during the COVID-19 pandemic bears substantial challenges. The limited availability of highly qualified instructors and tight economic conditions complicates the delivery of these life-saving trainings. Consequently, innovative and resource-efficient approaches are needed to minimize or eliminate contagion while maintaining high training standards and managing learner anxiety related to infection risk. Methods: In a non-inferiority trial 346 first-year medical, dentistry, and physiotherapy students underwent BLS training at AIXTRA-Competence Center for Training and Patient Safety at the University Hospital RWTH Aachen. Our objectives were (1) to examine whether peer feedback BLS training supported by tele-instructors matches the learning performance of standard instructor-guided BLS training for laypersons; and (2) to minimize infection risk during BLS training. Therefore, in a parallel group design, we compared arm (1) Standard Instructor Feedback (SIF) BLS training (Historical control group of 2019) with arm (2) a Tele-Instructor Supported Peer-Feedback (TPF) BLS training (Intervention group of 2020). Both study arms were based on Peyton's 4-step approach. Before and after each training session, objective data for BLS performance (compression depth and rate) were recorded using a resuscitation manikin. We also assessed overall BLS performance via standardized instructor evaluation and student self-reports of confidence via questionnaire. Non-inferiority margins for the outcome parameters and sample size calculation were based on previous studies with SIF. Two-sided 95% confidence intervals were employed to determine significance of non-inferiority. Results: The results confirmed non-inferiority of TPF to SIF for all tested outcome parameters. A follow-up after 2 weeks found no confirmed COVID-19 infections among the participants. Conclusion: Tele-instructor supported peer feedback is a powerful alternative to in-person instructor feedback on BLS skills during a pandemic, where infection risk needs to be minimized while maximizing the quality of BLS skill learning. Trial registration: https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00025199, Trial ID: DRKS00025199.

Provider Visual Attention Correlates With the Quality of Pediatric Resuscitation: An Observational Eye-Tracking Study.

Background: Eye-tracking devices are an innovative tool to understand providers' attention during stressful medical tasks. The knowledge about what gaze behaviors improve (or harm) the quality of clinical care can substantially improve medical training. The aim of this study is to identify gaze behaviors that are related to the quality of pediatric resuscitation. Methods: Forty students and healthcare providers performed a simulated pediatric life support scenario, consisting of a chest compression task and a ventilation task, while wearing eye-tracking glasses. Skill Reporter software measured chest compression (CC) quality and Neo Training software measured ventilation quality. Main eye-tracking parameters were ratio [the number of participants who attended a certain area of interest (AOI)], dwell time (total amount of time a participant attended an AOI), the number of revisits (how often a participant returned his gaze to an AOI), and the number of transitions between AOIs. Results: The most salient AOIs were infant chest and ventilation mask (ratio = 100%). During CC task, 41% of participants also focused on ventilation bag and 59% on study nurse. During ventilation task, the ratio was 61% for ventilation bag and 36% for study nurse. Percentage of correct CC rate was positively correlated with dwell time on infant chest (p = 0.044), while the overall CC quality was negatively correlated with dwelling outside of pre-defined task-relevant AOIs (p = 0.018). Furthermore, more dwell time on infant chest predicted lower leakage (p = 0.042). The number of transitions between AOIs was unrelated to CC parameters, but correlated negatively with mask leak during ventilations (p = 0.014). Participants with high leakage shifted their gaze more often between ventilation bag, ventilation mask, and task-irrelevant environment. Conclusion: Infant chest and ventilation mask are the most salient AOIs in pediatric basic life support. Especially the infant chest AOI gives beneficial information for the resuscitation provider. In contrast, attention to task-irrelevant environment and frequent gaze shifts seem to harm the quality of care.

Impact of structured basic life-support course on nurses' cardiopulmonary resuscitation knowledge and skills: Experience of a paediatric department in low-resource country.

INTRODUCTION: The study aimed to assess the impact of a modified paediatric basic life support (BLS) training on paediatric nurses' knowledge and skills in the main tertiary level public hospital in Rwanda. METHODS: A prospective, before-and-after educational intervention study was performed. Nurses working in the paediatric department at Centre Hospitalier Universitaire de Kigali (CHUK) were enrolled after consenting to the study. A modified BLS training was administered using didactic lectures, videos, case discussions, and simulations. Knowledge and skills were assessed before, immediately and six months after the training, using the American Heart Association (AHA) multiple-choice questions test and simulation scenarios. Ethical approval from the hospital's investigational review board was obtained before the start of the study. RESULTS: Fifty-seven nurses working in paediatric department were included in the study, most with advanced nursing degrees. At baseline, only 3.5% scored above 80% on the knowledge test and none were able to perform high-quality one-rescuer CPR. Knowledge and high-quality one-rescuer CPR skills improved significantly immediately after the training, with 63.2% scoring above 80% and 63.2% capable of performing high-quality one-rescuer CPR (p < 0.01). Six months later, only 45.6% scored above 80% and 15.8% were capable of performing high-quality one-rescuer CPR (p < 0.01). Some skills, such as delivering breaths using bag-mask device, showed better retention. CONCLUSION: In the paediatric department of the main public tertiary care hospital in Rwanda, nurses' baseline knowledge and skills in providing BLS was poor but can increase with focused BLS training. Due to the decline in knowledge and skills over six months, the use of debriefing and focused trainings following resuscitation events and improved implementation of yearly departmental refresher courses are recommended.

Cardiopulmonary resuscitation (CPR) training strategies in the times of COVID-19: a systematic literature review comparing different training methodologies.

BACKGROUND: Traditional, instructor led, in-person training of CPR skills has become more challenging due to COVID-19 pandemic. We compared the learning outcomes of standard in-person CPR training (ST) with alternative methods of training such as hybrid or online-only training (AT) on CPR performance, quality, and knowledge among laypersons with no previous CPR training. METHODS: We searched PubMed and Google Scholar for relevant articles from January 1995 to May 2020. Covidence was used to review articles by two independent researchers. Effective Public Health Practice Project (EPHPP) Quality Assessment Tool was used to assess quality of the manuscripts. RESULTS: Of the 978 articles screened, twenty met the final inclusion criteria. All included studies had an experimental design and moderate to strong global quality rating. The trainees in ST group performed better on calling 911, time to initiate chest compressions, hand placement and chest compression depth. Trainees in AT group performed better in assessing scene safety, calling for help, response time including initiating first rescue breathing, adequate ventilation volume, compression rates, shorter hands-off time, confidence, willingness to perform CPR, ability to follow CPR algorithm, and equivalent or better knowledge retention than standard teaching methodology. CONCLUSION: AT methods of CPR training provide an effective alternative to the standard in-person CPR for large scale public training.

Verbal Motivation vs. Digital Real-Time Feedback during Cardiopulmonary Resuscitation: Comparing Bystander CPR Quality in a Randomized and Controlled Manikin Study of Simulated Cardiac Arrest.

OBJECTIVE: The use of smartphone applications increases bystander CPR quality as well as the use of telephone CPR protocols. The present prospective, randomized, controlled manikin trial analyses the effects of a smartphone application (PocketCPR©) on CPR quality in a bystander CPR scenario compared to a dispatcher-assisted telephone CPR with the additional use of a metronome and verbal motivation. Methods: 150 laypersons were included to perform 8-minute CPR on a manikin. Volunteers were randomly assigned to one of three groups: (1) dispatcher-assisted telephone CPR (telephone-group), (2) dispatcher-assisted telephone CPR combined with the smartphone-application (telephone + app-group) and (3) dispatcher-assisted telephone CPR with additional verbal motivation ("push harder, release completely," every 20 seconds, starting after 60 seconds) and a metronome with 100 min-1 (telephone + motivation-group). Results: Median compression depth did not differ significantly between the study groups (p = 0.051). However, in the post hoc analysis median compression depth in the telephone + motivation-group was significantly elevated compared to the telephone + app-group (59 mm [IQR 47-67 mm] vs. 51 mm [IQR 46-57 mm]; p = 0.025). The median number of superficial compressions was significantly reduced in the telephone + motivation-group compared to the telephone + app-group (70 [IQR 3-362] vs. 349 [IQR 88-538]; p = 0.004), but not compared to the telephone-group (91 [IQR 4-449]; p = 0.707). In contrast to the other study groups, median compression depth of the telephone + motivation-group increased over time. Chest compressions with correct depth were found significantly more often in the telephone + app-group compared to the other study groups (p = 0.011). Median compression rate in the telephone + app-group was significantly elevated (108 min-1 [IQR 96-119 min-1]) compared to the telephone-group (78 min-1 [IQR 56-106 min-1]; p < 0.001) and the telephone + motivation-group (99 min-1 [IQR 91-101 min-1]; p < 0.001). Conclusions: The use of a smartphone application as well as verbal motivation by a dispatcher during telephone CPR leads to higher CPR quality levels compared to standard telephone CPR. Thereby, the use of the smartphone application mainly shows an increase in compression rate, while increased compression rate with simultaneously increased compression depth was only apparent in the telephone + motivation-group.

Awareness and attitude of final year students towards the learning and practice of cardiopulmonary resuscitation at the University of Ibadan in Nigeria.

INTRODUCTION: Out-of-hospital cardiac arrest (OHCA) is a major cause of sudden cardiac death which can be prevented by early cardiopulmonary resuscitation (CPR). International bodies recommend that basic life support (BLS) skills be taught in schools in order to increase the rate of bystander CPR and reduce mortality from OHCA. We are not aware of any BLS education program for non-healthcare students in Nigeria. This study was to assess the awareness and attitude to acquiring BLS skills among university students. METHODS: We conducted a cross-sectional study among final year university undergraduates using a questionnaire that assessed students' sociodemographic characteristics, awareness of CPR, previous experiences, and attitude to basic life support (BLS). Counts and proportions were compared for the demographic characteristics using Chi-squared and Fisher's exact tests. RESULTS: Four hundred and seventy-five students from 15 faculties participated in this study, median age was 22.8 years (interquartile range: 21.2-24.5 years). Majority (82.5%) have heard of CPR, 29.7% have undergone CPR training; 77.3% of those who had been trained were confident that they could perform CPR. Previous CPR training was significantly associated with faculty, year of study and age. Eighty-nine (18.7%) students have witnessed someone die from a trauma. Four hundred and fifty (94.7%) respondents would like to get BLS training, 440 (92.6%) think that CPR training should be included in the school curriculum. CONCLUSION: There is good awareness and positive attitude to the acquisition and practice of cardiopulmonary resuscitation among university students in Nigeria. Few students however, have been trained to administer bystander cardiopulmonary resuscitation. Therefore, there is a need to implement university wide BLS education in Nigeria.

Healthcare professionals' knowledge on cardiopulmonary resuscitation correlated with return of spontaneous circulation rates after in-hospital cardiac arrests: A multicentric study between university hospitals in 12 European countries.

BACKGROUND: In-hospital cardiac arrest is a major cause of death in European countries, and survival of patients remains low ranging from 20% to 25%. AIMS: The purpose of this study was to assess healthcare professionals' knowledge on cardiopulmonary resuscitation among university hospitals in 12 European countries and correlate it with the return of spontaneous circulation rates of their patients after in-hospital cardiac arrest. METHODS AND RESULTS: A total of 570 healthcare professionals from cardiology, anaesthesiology and intensive care medicine departments of European university hospitals in Italy, Poland, Hungary, Belgium, Spain, Slovakia, Germany, Finland, The Netherlands, Switzerland, France and Greece completed a questionnaire. The questionnaire consisted of 12 questions based on epidemiology data and cardiopulmonary resuscitation training and 26 multiple choice questions on cardiopulmonary resuscitation knowledge. Hospitals in Switzerland scored highest on basic life support (P=0.005) while Belgium hospitals scored highest on advanced life support (P<0.001) and total score in cardiopulmonary resuscitation knowledge (P=0.01). The Swiss hospitals scored highest in cardiopulmonary resuscitation training (P<0.001). Correlation between cardiopulmonary resuscitation knowledge and return of spontaneous circulation rates of patients with in-hospital cardiac arrest demonstrated that each additional correct answer on the advanced life support score results in a further increase in return of spontaneous circulation rates (odds ratio 3.94; 95% confidence interval 2.78 to 5.57; P<0.001). CONCLUSION: Differences in knowledge about resuscitation and course attendance were found between university hospitals in 12 European countries. Education in cardiopulmonary resuscitation is considered to be vital for patients' return of spontaneous circulation rates after in-hospital cardiac arrest. A higher level of knowledge in advanced life support results in higher return of spontaneous circulation rates.

Evaluation of self-reported confidence amongst radiology staff in initiating basic life support across hospitals in the Cape Town Metropole West region.

BACKGROUND: The immediate response to cardiac arrest is regarded as the most time-critical intervention. First responders for cardiac arrests in imaging departments are often radiology staff. The study aim was to determine radiology staff members' confidence in initiating basic life support. OBJECTIVES: The objectives of this study included determining the general confidence levels regarding identifying cardiac arrest and initiation of basic life support (BLS) amongst Radiology staff within the studied sites, as well as to identify potential areas of uncertainty. Another objective included identifying what would contribute to increasing levels of confidence and competence in identifying cardiac arrest and initiating BLS. METHOD: A multi-centre cross-sectional survey was conducted using peer-validated, anonymous questionnaires. Questionnaires were distributed to radiology staff working in public sector hospitals within the Cape Town Metropole West. Due to the limited subject pool, a convenience sample was collected. Data were therefore statistically analysed using only summary statistics (mean, standard deviation, proportions, and so on), and detailed comparisons were not made. RESULTS: We disseminated 200 questionnaires, and 74 were completed (37%). There were no incomplete questionnaires or exclusions from the final sample. Using a 10-point Likert scale, the mean ability to recognise cardiac arrest was 6.45 (SD ± 2.7), securing an airway 4.86 (SD ± 2.9), and providing rescue breaths and initiating cardiac compressions 6.14 (SD ± 2.9). Only two (2.7%) of the participants had completed a basic life support course in the past year; 11 (14.8%) had never completed any basic life support course and 28 (37.8%) had never completed any life support or critical care course. Radiologists, radiology trainees and nurses had the greatest confidence in providing rescue breaths and initiating cardiac compressions from all the groups. CONCLUSION: The study demonstrated a substantial lack of confidence in providing basic life support in the participating hospital imaging departments' staff. The participants indicated that regular training and improved support systems would increase confidence levels and improve skills.

The role of a checklist for assessing the quality of basic life support performance: an observational cohort study.

BACKGROUND: Training lay rescuers in Basic Life Support (BLS) is essential to improve bystander cardiopulmonary resuscitation (CPR) rates; in addition, simple methods are needed to provide feedback on CPR performance. This study evaluated whether a simple observational checklist can be used by BLS instructors to adequately measure the quality of BLS performance as an alternative to other feedback devices. METHODS: The BLS performances of 152 first-year medical students (aged 21.4 ± 3.9 years) were recorded on video, and objective data regarding the quality of the BLS were documented using Laerdal PC SkillReporting software. The performances were categorized according to quality. Ten BLS instructors observed the videos and completed a ten-point checklist based on the Cardiff Test of BLS (version 3.1) to assess the performances. The validity of the checklist was reviewed using interrater reliability as well as by comparing the checklist-based results with objective performance data. RESULTS: Matching the checklist-based evaluation with the objective performance data revealed high levels of agreement for very good (82%) and overall insufficient (75%) performances. Regarding the checklist-based evaluation, interrater reliability depended on the checklist item; thus, some items were more easily identified correctly than others. The highest and lowest levels of agreement were observed for the items "undressed torso" and "complete release between compressions" (mean joint-probability 95 and 67%, respectively). CONCLUSIONS: The observational checklist adequately distinguished sufficient from insufficient BLS performances and offered an assessment of items not incorporated by SkillReporting software such as the initial assessment or undressing the chest. Although its usefulness was reduced for scaling intermediate performance groups, the checklist may be overall a useful rating tool in BLS-training if objective feedback devices are not available, for example, due to large groups of participants or limited training time.

Comparison of a newly established emotional stimulus approach to a classical assessment-driven approach in BLS training: a randomised controlled trial.

OBJECTIVE: The study objective was to implement two strategies (short emotional stimulus vs announced practical assessment) in the teaching of resuscitation skills in order to evaluate whether one led to superior outcomes. SETTING: This study is an educational intervention provided in one German academic university hospital. PARTICIPANTS: First-yearmedical students (n=271) during the first3 weeks of their studies. INTERVENTIONS: Participants were randomly assigned to one of two groups following a sequence of random numbers: the emotional stimulus group (EG) and the assessment group (AG). In the EG, the intervention included watching an emotionally stimulating video prior to the Basic Life Support (BLS) course. In the AG, a practical assessment of the BLS algorithm was announced and tested within a 2 min simulated cardiac arrest scenario. After the baseline testing, a standardised BLS course was provided. Evaluation points were defined 1 week and 6 months after. PRIMARY OUTCOME MEASURES: Compression depth (CD) and compression rate (CR) were recorded as the primary endpoints for BLS quality. RESULTS: Within the study, 137 participants were allocated to the EG and 134 to the AG. 104 participants from EG and 120 from AG were analysed1 week after the intervention, where they reached comparable chest-compression performance without significant differences (CR P=0.49; CD P=0.28). The chest-compression performance improved significantly for the EG (P<0.01) and the AG (P<0.01) while adhering to the current resuscitation guidelines criteria for CD and CR. CONCLUSIONS: There was no statistical difference between both groups' practical chest-compression-performance. Nevertheless, the 2 min video sequence used in the EG with its low production effort and costs, compared with the expensive assessment approach, provides broad opportunities for applicability in BLS training.

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.