Continuous cardiopulmonary resuscitation training compared to single training by laypersons

Background. Compression-Only Cardiopulmonary Resuscitation

(COCPR) has been broadly studied during the last few years and specially introduced into lay rescuers’ training. The aim of the study was to compare the quality of COCPR performed by laypersons (Group A) who attended a single cardiopulmonary resuscitation (CPR) training course, and those (Group B) who underwent regular CPR training every 6 months.

Methods. Both groups completed the “Heartsaver CPR AED” course of the American Heart Association. After 30 minutes they were required to perform COCPR on a manikin with a skills reporter system.

Results. Comparing the 76 once only trained laypersons to the 74 continuously trained lay rescuers, we found that average age (20 versus 40 years old), male gender (54% versus 93%), body mass index (BMI)

(24.9 versus 27.3 kg/m2) and regular physical exercise (55% versus 36%) proved significant predictors, p<0.01, p<0.01, p<0.01 and p=0.04 respectively. Regarding COCPR-quality, the percentage of efficient chest compressions (43% versus 58%), average depth of compression (45 versus 50 mm) and percentage of error-free compressions (36% versus 50%) indicated a significant statistical difference, with p=0.01, p=0.01 and p<0.01 respectively. However, the average frequency of compressions per minute (121 versus 124), the percentage of correct hand positioning during chest compressions (87% versus 90%) and the average duty cycle (47% versus 45%) did not display a significant difference.

Conclusion. The continuous CPR training group obtained better results regarding quality of chest compressions when compared with single CPR training.

cardiac massage, cardiopulmonary resuscitation, out-of-hospital cardiac arrest, emergency medicine, resuscitation

1. World Health Organization. “The 10 leading causes of death by income group 2011” (Worldwide). Accessed May 2014. Available at:

http://www.who.int/mediacentre/factsheets/fs310/en/.

2. Ministério da Saúde/SVS – Sistema de Informações sobre Mortalidade –SIM. Accessed May 2014. Available at:

http://tabnet.datasus.gov.br/cgi/tabcgi.exe?idb2012/c08.def

3. John RM, Tedrow UB, Koplan BA, Albert CM, Epstein LM, Sweeney MO, et al. Ventricular arrhythmias and sudden cardiac death. Lancet

2012;27;380(9852):1520-9.

4. SOS-KANTO study group. Cardiopulmonary resuscitation by bystanders with chest compression only (SOS-KANTO): an observational study. Lancet 2007;367:920-6.

5. Bohm K, Rosenqvist M, Herlitz J, Hollenberg J, Svensson L. Survival is similar after standard treatment and chest compression only in out-of-hospital bystander cardiopulmonary resuscitation. Circulation

2007;116:2908-12.

6. Sasaki M, Iwami T, Kitamura T, Nomoto S, Nishiyama C, Sakai T, et. al. Incidence and outcome of out-of-hospital cardiac arrest with public access defibrillation – a descriptive epidemiological study in a large urban community. Circ J 2011;75:2821-6.

7. Wissenberg M, Lippert FK, Folke F, Weeke P, Hansen CM, Christensen EF, et al. Association of national initiatives to improve cardiac arrest management with rates of bystander intervention and patient survival after out-of-hospital cardiac arrest. JAMA 2013;310:1377-84.

8. Shoichi Ohta, Hiroshi Takyu, Hiroyuki Nakao, Shigeki Kushimoto, Atsushi Hiraide, Tetsuya Sakamoto, et. al. Utilization of automated external defibrillators installed in commonly used areas of Japanese hospitals. Signa Vitae 2013;8:21-4.

9. Bobrow BJ, Clark LL, Ewy GA, Chikani V, Sanders AB, Berg RA, et al. Minimally interrupted cardiac resuscitation by emergency medical services for out-of-hospital cardiac arrest. JAMA 2008;299:1158-65.

10. Ong ME, Ng FS, Anushia P, Tham LP, Leong BS, Ong VY, et al. Comparison of chest compression only and standard cardiopulmonary resuscitation for out-of-hospital cardiac arrest in Singapore. Resuscitation 2008;78:119-26.

11. Hallstrom A, Cobb L, Johnson E, Copass M. Cardiopulmonary resuscitation by chest compression alone or with mouth-to-mouth ventilation. N Engl J Med 2000;342:1546-53.

12. Ewy GA, Zuercher M, Hilwig RW, Sanders AB, Berg RA, Otto CW, et al. Improved neurological outcome with continuous chest compressions compared with 30:2 compressions-to-ventilation cardiopulmonary resuscitation in a realistic swine model of out-of-hospital cardiac arrest. Circulation 2007;116:2525-30.

13. Sayre MS, Berg RA, Cave DM, Page RL, Potts J, White RD. Hands-only (compression-only) cardiopulmonary : A call to action for bystander response to adults who experience out-of-hospital sudden cardiac arrest. A science advisory for the public from the American Heart Association Emergency Cardiovascular Care Committee. Circulation 2008;117:2162-7.

14. Mpotos N, De Wever B, Cleymans N, Raemaekers J, Loeys T, Herregods L, et. al. Repetitive sessions of formative self-testing to refresh CPR skills: A randomised non-inferiority trial. Resuscitation 2014;85:1282-6.

15. Li Q, Zhou RH, Liu J, Lin J, Ma EL, Liang P, et. al. Pre-training evaluation and feedback improved skills retention of basic life support in medical students. Resuscitation 2013;84:1274-8.

16. Nicol P, Carr S, Cleary G, Celenza A. Retention into internship of resuscitation skills learned in a medical student resuscitation program incorporating an Immediate Life Support course. Resuscitation

2011;82:45-50.

17. Frkovic V, Sustic A, Zeidler F, Protic A, Desa K. A brief reeducation in cardiopulmonary resuscitation after six months – the benefit from timely repetition. Signa Vitae 2008;3: 24-8.

18. Berg RA, Hemphill R, Abella BS, Aufderheide TP, Cave DM, Hazinski MF, et al. Part 5: adult basic life support: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 2010;122:S685-705.

19. Gonzalez MM, Timerman S, Gianotto-Oliveira R, Polastri TF, Canesin MF, Lage SG, et al. Sociedade Brasileira de Cardiologia. I Diretriz de Ressuscitação Cardiopulmonar e Cuidados Cardiovasculares de Emergência da Sociedade Brasileira de Cardiologia. Arq Bras Cardiol 2013;101(2 Suppl 3):1-221.

20. Handley AJ, Handley SA. Improving CPR performance using an audible feedback system suitable for incorporation into an automated external defibrillator. Resuscitation 2003; 57:57-62.

21. Gianotto-Oliveira R, Gonzalez MM, Oliveira EN, Nishimura LS, Quilici AP, Abrão KC et. al. Continuous chest compression performed by lay people before and after training. Rev Bras Clin Med 2012;10:95-9.

22. Bobrow BJ, Vadeboncoeur TF, Spaite DW, Potts J, Denninghoff K, Chikani V, et al. The effectiveness of ultrabrief and brief educational videos for training lay responders in hands-only cardiopulmonary resuscitation: implications for the future of citizen cardiopulmonary resuscitation training. Circ Cardiovasc Qual Outcomes 2011;4:220-6.

23. Semeraro F, Taggi F, Tammaro G, Imbriaco G, Marchetti L, Cerchiari EL. iCPR: a new application of high-quality cardiopulmonary resuscitation training. Resuscitation 2011; 82:436-41.

24. Bolle SR, Johnsen E, Gilbert M. Video calls for dispatcher-assisted cardiopulmonary resuscitation can improve the confidence of lay rescuers-surveys after simulated cardiac arrest. J Telemed Telecare 2011;17:88-92.

25. Zhou M, Ran Q, Liu Y, Li Y, Liu T, Shen H. Effects of sustained abdominal aorta compression on coronary perfusion pressures and restoration of spontaneous circulation during cardiopulmonary resuscitation in swine. Resuscitation 2011;82:1087-91.

26. Paradis NA, Halperin HR, Zviman M, Barash D, Quan W, Freeman G. Coronary perfusion pressure during external chest compression in pseudo-EMD, comparison of systolic versus diastolic synchronization. Resuscitation 2012; 83:1287-91.

27. Bobrow BJ, Spaite DW, Berg RA, Stolz U, Sanders AB, Kern KB, et al. Chest compression–only CPR by lay rescuers and survival from out-of-hospital cardiac arrest. JAMA 2010;304:1447-54.

28. Nishiyama C, Iwami T, Kawamura T, Ando M, Yonemoto N, Hiraide A, et al. Quality of chest compressions during continuous CPR; comparison between chest compression-only CPR and conventional CPR. Resuscitation 2010;81:1152-5.

29. Cason CL, Trowbridge C, Baxley SM, Ricard MD. A counterbalanced cross-over study of the effects of visual, auditory and no feedback on performance measures in a simulated cardiopulmonary resuscitation. BMC Nurs 2011;10:15.

30. Kern KB, Stickney RE, Gallison L. Metronome improves compression and ventilation rates during CPR on a manikin in a randomized trial. Resuscitation 2010; 81:206-10.

31. Fonseca AHIRM, Fonseca FIRM, Gianotto-Oliveira R, Barral TN, Gonzalez MM, Timerman S. Evaluation of frequency and depth of chest compressions performed with the use of metronome. Rev Bras Clin Med 2012;10:175-8.

32. You JS, Chung SP, Chang CH, Park I, Lee HS, Kim S, et al. Effects of flashlight guidance on chest compression performance in cardiopulmonary resuscitation in a noisy environment. Emerg Med J 2013;30:628-32.

33. Krasteva V, Jekova I, Didon JP. An audiovisual feedback device for compression depth, rate and complete chest recoil can improve the CPR performance of laypersons during self-training on a manikin. Physiol Meas 2011;32:687-99.