Nicolas Mpotos

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.

Combining video instruction followed by voice feedback in a self-learning station for acquisition of Basic Life Support skills: a randomised non-inferiority trial.

INTRODUCTION Current computerised self-learning (SL) stations for Basic Life Support (BLS) are an alternative to instructor-led (IL) refresher training but are not intended for initial skill acquisition. We developed a SL station for initial skill acquisition and evaluated its efficacy. METHODS In a non-inferiority trial, 120 pharmacy students were randomised to IL small group training or individual training in a SL station. In the IL group, instructors demonstrated the skills and provided feedback. In the SL group a shortened Mini Anne™ video, to acquire the skills, was followed by Resusci Anne Skills Station™ software (both Laerdal, Norway) with voice feedback for further refinement. Testing was performed individually, respecting a seven week interval after training for every student. RESULTS One hundred and seventeen participants were assessed (three drop-outs). The proportion of students achieving a mean compression depth 40-50mm was 24/56 (43%) IL vs. 31/61 (51%) SL and 39/56 (70%) IL vs. 48/61 (79%) SL for a mean compression depth ≥ 40 mm. Compression rate 80-120/min was achieved in 49/56 (88%) IL vs. 57/61 (93%) SL and any incomplete release (≥ 5 mm) was observed in 31/56 (55%) IL and 35/61 (57%) SL. Adequate mean ventilation volume (400-1000 ml) was achieved in 29/56 (52%) IL vs. 36/61 (59%) SL. Non-inferiority was confirmed for depth and although inconclusive, other areas came close to demonstrate it. CONCLUSIONS Compression skills acquired in a SL station combining video-instruction with training using voice feedback were not inferior to IL training.

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.

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.

Training to deeper compression depth reduces shallow compressions after six months in a manikin model.

INTRODUCTION Studies show that students, trained to perform compressions between 40 and 50mm deep, often do not achieve sufficient depth at retention testing. We hypothesized that training to achieve depths >50mm would decrease the proportion of students with depth <40mm after 6 months, compared to students trained to a depth interval of 40-50mm. METHODS A basic life support (BLS) self-learning station was attended by 190 third year medicine students. They were first offered the possibility to refresh their skills, following the instructions of a 15min abbreviated Mini Anne™ video (Laerdal, Norway) using a full size torso and a face shield. This was followed by further training using Resusci Anne Skills Station™ software (Laerdal, Norway). Voice feedback was provided according to randomisation to a standard group (SG) 40-50mm and a deeper group (DG) >50mm. Quality of compressions was tested after 6 months. RESULTS The SG and DG groups consisted of 90 (67% female) and 100 (58% female) participants respectively. At the end of training, all students reached the target depth without overlap between groups. After 6 months, the proportion of students achieving a depth <40mm was 26/89 (29%) in the SG vs. 12/89 (14%) in the DG (P=0.01). The proportion of students with a depth >50mm was 5/89 (6%) for the SG and 44/89 (49%) in the DG (P<0.001). CONCLUSIONS The educational strategy to train students to a deeper depth, reduced shallow compressions 6 months after training.

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.

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.

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

BackgroundCurrent 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).MethodsAs 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.ResultsDuring 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.ConclusionsOur 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 registrationB67020097543

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.

Studies claiming efficacy of CPR training interventions: Which skills should be assessed and how should data be reported to allow comparison?

Mpotos, Nicolas Valcke, Martin Van der Vleuten, Cees Monsieurs, Koenraad Letter Ireland Resuscitation. 2012 Dec;83(12):e217. doi: 10.1016/j.resuscitation.2012.05.030. Epub 2012 Aug 23.