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Bystander CPR: New aspects of CPR training among students and the importance of bystander education level on survival
Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences.
2017 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background: It has been proved that bystander cardiopulmonary resuscitation (CPR) saves lives; however, which training method in CPR is most instructive and whether survival is affected by the training level of the bystander have not yet been fully described.

Aim: To identify the factors that may affect 7th grade students’ acquisition of CPR skills during CPR training and their willingness to act, and to describe 30-day survival from outof- hospital cardiac arrest (OHCA) after bystander CPR and the actions performed by laymen versus off-duty medically educated personnel.

Methods: Studies I–III investigate a CPR training intervention given to students in 7th grade during 2013–2014. The classes were randomized to the main intervention: the mobile phone application (app) or DVD-based training. Some of the classes were randomized to one or several additional interventions: a practical test with feedback, reflection, a web course, a visit from elite athletes and automated external defibrillator (AED) training. The students’ practical skills, willingness to act and knowledge of stroke symptoms, symptoms of acute myocardial infarction (AMI) and lifestyle factors were assessed directly after training and at 6 months using the Laerdal PC SkillReporting system (and entered into a modified version of the Cardiff test scoring sheet) and a questionnaire. The Cardiff test resulted in a total score of 12–48 points, and the questionnaire resulted in a total score of 0–7 points for stroke symptoms, 0–9 points for symptoms of AMI and 0– 6 points on lifestyle factors. Study IV is based on retrospective data from the national quality register, the Swedish registry of cardiopulmonary resuscitation, 2010-2014.

Results: A total of 1339 students were included in the CPR training intervention. The DVD-based group was superior to the app-based group in CPR skills, with a total score of 35 (SD 4.o) vs 33 (SD 4.2) points directly after training (p<0.001) and 33 (SD 4.0) vs 31 (SD 4.2) points at six months (p<0.001). Of the additional interventions, the practical test with feedback had the greatest influence regarding practical skills: at six months the intervention group scored 32 (SD 3.9) points and the control group (CPR only) scored 30 (SD 4.0) points (p<0.001). Reflection, the web course, visits from elite athletes and AED training did not further increase the students’ acquisition of practical CPR skills.

The students who completed the web course Help-Brain-Heart received a higher total score for theoretical knowledge in comparison with the control group, directly after training: stroke 3.8 (SD 1.8) vs 2.7 (SD 2.0) points (p<0.001); AMI 4.0 (SD 2.0) vs 2.5 (SD 2.0) points (p<0.001); lifestyle factors 5.4 (SD 1.2) vs 4.5 (SD 2.0) points p<0.001.

Most of the students (77% at 6 months), regardless of the intervention applied, expressed that they would perform both chest compressions and ventilations in a cardiac arrest (CA) situation involving a relative. If a stranger had CA, a significantly lower proportion of students (32%; p<0.001) would perform both compressions and ventilations. In this case, however, many would perform compressions only.

In most cases of bystander-witnessed OHCA, CPR was performed by laymen. Off-duty health care personnel bystanders initiated CPR within 1 minute vs 2 minutes for laymen (p<0.0001). Thirty-day survival was 14.7% among patients who received CPR from laymen and 17.2% (p=0.02) among patients who received bystander CPR from off-duty health care personnel.

Conclusions: The DVD-based method was superior to the app-based method in terms of teaching practical CPR skills to 7th grade students. Of the additional interventions, a practical test with feedback was the most efficient intervention to increase learning outcome. The additional interventions, reflection, web course, visit from elite athletes and AED did not increase CPR skills further. However, the web course Help-Brain-Heart improved the students’ acquisition of theoretical knowledge regarding stroke, AMI and lifestyle factors. For OHCA, off-duty health care personnel bystanders initiated CPR earlier and 30-day survival was higher compared with laymen bystanders.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2017. , 112 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1580
Keyword [en]
CPR, CPR training, BLS, Laymen, Bystander CPR, Students, Out-of-hospital cardiac arrest, Cardiac arrest, Mobile application, DVD, Feedback, Reflection, Web course, Cardiff test, Myocardial infarction, Stroke, Lifestyle factors, Elite athletes, Willingness, Survival
Keyword [sv]
HLR, HLR-utbildning, Lekman, Högstadieelever, Hjärtstopp, Webutbildning, Dvd, Mobil applikation, Återkoppling, Reflektion, Cardiff test, Hjärtinfarkt, Stroke, Levnadsvanor, Elitidrottare, Motivation, Överlevnad
National Category
Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-142460DOI: 10.3384/diss.diva-142460ISBN: 9789176854778 (print)OAI: oai:DiVA.org:liu-142460DiVA: diva2:1153723
Public defence
2017-12-14, Berzeliussalen, Campus US, Linköping, 13:00 (Swedish)
Opponent
Supervisors
Funder
Swedish Heart Lung Foundation, 20130629Region Östergötland
Available from: 2017-10-31 Created: 2017-10-31 Last updated: 2017-11-01Bibliographically approved
List of papers
1. Effect of mobile application-based versus DVD-based CPR training on students practical CPR skills and willingness to act: a cluster randomised study
Open this publication in new window or tab >>Effect of mobile application-based versus DVD-based CPR training on students practical CPR skills and willingness to act: a cluster randomised study
Show others...
2016 (English)In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 6, no 4, e010717- p.Article in journal (Refereed) Published
Abstract [en]

Objectives: The aim was to compare students practical cardiopulmonary resuscitation (CPR) skills and willingness to perform bystander CPR, after a 30 min mobile application (app)-based versus a 50 min DVD-based training. Settings: Seventh grade students in two Swedish municipalities. Design: A cluster randomised trial. The classes were randomised to receive app-based or DVD-based training. Willingness to act and practical CPR skills were assessed, directly after training and at 6 months, by using a questionnaire and a PC Skill Reporting System. Data on CPR skills were registered in a modified version of the Cardiff test, where scores were given in 12 different categories, adding up to a total score of 12-48 points. Training and measurements were performed from December 2013 to October 2014. Participants: 63 classes or 1232 seventh grade students (13-year-old) were included in the study. Primary and secondary outcome measures: Primary end point was the total score of the modified Cardiff test. The individual variables of the test and self-reported willingness to make a life-saving intervention were secondary end points. Results: The DVD-based group was superior to the app-based group in CPR skills; a total score of 36 (3338) vs 33 (30-36) directly after training (pamp;lt;0.001) and 33 (30-36) and 31 (28-34) at 6 months (pamp;lt;0.001), respectively. At 6 months, the DVD group performed significantly better in 8 out of 12 CPR skill components. Both groups improved compression depth from baseline to follow-up. If a friend suffered cardiac arrest, 78% (DVD) versus 75% (app) would do compressions and ventilations, whereas only 31% (DVD) versus 32% (app) would perform standard CPR if the victim was a stranger. Conclusions: At 6 months follow-up, the 50 min DVD-based group showed superior CPR skills compared with the 30 min app-based group. The groups did not differ in regard to willingness to make a life-saving effort.

Place, publisher, year, edition, pages
BMJ PUBLISHING GROUP, 2016
National Category
Other Medical Sciences not elsewhere specified
Identifiers
urn:nbn:se:liu:diva-129507 (URN)10.1136/bmjopen-2015-010717 (DOI)000376391400104 ()27130166 (PubMedID)
Note

Funding Agencies|Foundation for cardiopulmonary resuscitation in Sweden; Swedish Resuscitation Council; Swedish Heart-Lung Foundation [20130629]; County Council of Ostergotland

Available from: 2016-06-20 Created: 2016-06-20 Last updated: 2017-10-31
2. Effect of two additional interventions, test and reflection, added to standard cardiopulmonary resuscitation training on seventh grade students practical skills and willingness to act: a cluster randomised trial
Open this publication in new window or tab >>Effect of two additional interventions, test and reflection, added to standard cardiopulmonary resuscitation training on seventh grade students practical skills and willingness to act: a cluster randomised trial
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2017 (English)In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 7, no 6, e014230Article in journal (Refereed) Published
Abstract [en]

Objectives The aim of this research is to investigate if two additional interventions, test and reflection, after standard cardiopulmonary resuscitation (CPR) training facilitate learning by comparing 13-year-old students practical skills and willingness to act. Settings Seventh grade students in council schools of two municipalities in south-east Sweden. Design School classes were randomised to CPR training only (O), CPR training with a practical test including feedback (T) or CPR training with reflection and a practical test including feedback (RT). Measures of practical skills and willingness to act in a potential life-threatening situation were studied directly after training and at 6 months using a digital reporting system and a survey. A modified Cardiff test was used to register the practical skills, where scores in each of 12 items resulted in a total score of 12-48 points. The study was conducted in accordance with current European Resuscitation Council guidelines during December 2013 to October 2014. Participants 29 classes for a total of 587 seventh grade students were included in the study. Primary and secondary outcome measures The total score of the modified Cardiff test at 6 months was the primary outcome. Secondary outcomes were the total score directly after training, the 12 individual items of the modified Cardiff test and willingness to act. Results At 6 months, the T and O groups scored 32 (3.9) and 30 (4.0) points, respectively (pamp;lt;0.001), while the RT group scored 32 (4.2) points (not significant when compared with T). There were no significant differences in willingness to act between the groups after 6 months. Conclusions A practical test including feedback directly after training improved the students acquisition of practical CPR skills. Reflection did not increase further CPR skills. At 6-month follow-up, no intervention effect was found regarding willingness to make a life-saving effort.

Place, publisher, year, edition, pages
BMJ Publishing Group Ltd, 2017
National Category
Other Medical Sciences not elsewhere specified
Identifiers
urn:nbn:se:liu:diva-140073 (URN)10.1136/bmjopen-2016-014230 (DOI)000406391200048 ()28645953 (PubMedID)2-s2.0-85021624804 (Scopus ID)
Note

Funding Agencies|Foundation for Cardiopulmonary Resuscitation in Sweden; Swedish Resuscitation Council; Swedish Heart-Lung Foundation [20130629]; County Council of Ostergotland

Available from: 2017-08-28 Created: 2017-08-28 Last updated: 2017-10-31Bibliographically approved
3. The effect of a national web course "Help-Brain-Heart" as a supplemental learning tool before CPR training: a cluster randomised trial
Open this publication in new window or tab >>The effect of a national web course "Help-Brain-Heart" as a supplemental learning tool before CPR training: a cluster randomised trial
Show others...
2017 (English)In: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, ISSN 1757-7241, E-ISSN 1757-7241, Vol. 25, 93Article in journal (Refereed) Published
Abstract [en]

Background: The effectiveness of cardiopulmonary resuscitation (CPR) learning methods is unclear. Our aim was to evaluate whether a web course before CPR training, teaching the importance of recognition of symptoms of stroke and acute myocardial infarction (AMI) and a healthy lifestyle, could influence not only theoretical knowledge but also practical CPR skills or willingness to act in a cardiac arrest situation. Methods: Classes with 13-year-old students were randomised to CPR training only (control) or a web course plus CPR training (intervention). Data were collected (practical test and a questionnaire) directly after training and at 6 months. CPR skills were evaluated using a modified Cardiff test (12-48 points). Knowledge on stroke symptoms (0-7 points), AMI symptoms (0-9 points) and lifestyle factors (0-6 points), and willingness to act were assessed by the questionnaire. The primary endpoint was CPR skills at 6 months. CPR skills directly after training, willingness to act and theoretical knowledge were secondary endpoints. Training and measurements were performed from December 2013 to October 2014. Results: Four hundred and thirty-two students were included in the analysis of practical skills and self-reported confidence. The mean score for CPR skills was 34 points after training (control, standard deviation [SD] 4.4; intervention, SD 4.0; not significant [NS]); and 32 points at 6 months for controls (SD 3.9) and 33 points for intervention (SD 4.2; NS). At 6 months, 73% (control) versus 80% (intervention; P = 0.05) stated they would do compressions and ventilation if a friend had a cardiac arrest, whereas 31% versus 34% (NS) would perform both if the victim was a stranger. One thousand, two hundred and thirty-two students were included in the analysis of theoretical knowledge; the mean scores at 6 months for the control and intervention groups were 2.8 (SD 1.6) and 3.2 (SD 1.4) points (P amp;lt; 0.001) for stroke symptoms, 2.6 (SD 2.0) and 2.9 (SD 1.9) points (P = 0.008) for AMI symptoms and 3.2 (SD 1.2) and 3.4 (SD 1.0) points (P amp;lt; 0.001) for lifestyle factors, respectively. Discussion: Use of online learning platforms is a fast growing technology that increases the flexibility of learning in terms of location, time and is available before and after practical training. Conclusions: A web course before CPR training did not influence practical CPR skills or willingness to act, but improved the students theoretical knowledge of AMI, stroke and lifestyle factors.

Place, publisher, year, edition, pages
BIOMED CENTRAL LTD, 2017
Keyword
CPR training; Web course; Willingness; Infarction; Stroke; Lifestyle factors; Students
National Category
Other Medical Sciences not elsewhere specified
Identifiers
urn:nbn:se:liu:diva-141119 (URN)10.1186/s13049-017-0439-0 (DOI)000410326900001 ()28899418 (PubMedID)
Note

Funding Agencies|Foundation for Cardiopulmonary Resuscitation in Sweden; Swedish Resuscitation Council; Swedish Heart-Lung Foundation [20130629]; County Council of Ostergotland

Available from: 2017-09-27 Created: 2017-09-27 Last updated: 2017-10-31
4. Increased survival from out-of-hospital cardiac arrest when off duty medically educated personnel perform CPR compared with laymen.
Open this publication in new window or tab >>Increased survival from out-of-hospital cardiac arrest when off duty medically educated personnel perform CPR compared with laymen.
Show others...
2017 (English)In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 120, 88-94 p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Bystander cardiopulmonary resuscitation (CPR) has been proved to save lives; however, whether survival is affected by the training level of the bystander is not fully described.

AIM: To describe if the training level of laymen and medically educated bystanders affect 30-day survival in out-of-hospital cardiac arrests (OHCA).

METHODS: This observational study included all witnessed and treated cases of bystander CPR reported to the Swedish Registry of Cardiopulmonary Resuscitation between 2010 and 2014. Bystander CPR was divided into two categories: (a) lay-byCPR (non-medically educated) and (b) med-byCPR (off duty medically educated personnel).

RESULTS: During 2010-2014, 24,643 patients were reported to the OHCA registry, of which 6850 received lay-byCPR and 1444 med-byCPR; 16,349 crew-witnessed and non-witnessed cases and those with missing information were excluded from the analysis. The median interval from collapse to call for emergency medical services was 2min in both groups (p=0.97) and 2min from collapse to start of CPR for lay-byCPR versus 1min for med-byCPR (p<0.0001). There were no significant differences in CPR methods used; 64.3% (lay-byCPR) and 65.7% (med-byCPR) applied compressions and ventilation, respectively (p=0.33). The 30-day survival was 14.7% for lay-byCPR and 17.2% for the med-byCPR group (p=0.02). The odds ratio adjusted for potential confounders regarding survival (med-byCPR versus lay-byCPR) was 1.34 (95% confidence interval, 1.11-1.62; p=0.002).

CONCLUSIONS: In cases of OHCA, medically educated bystanders initiated CPR earlier and an increased 30-day survival was found compared with laymen bystanders. These results support the need to improve the education programme for laypeople.

Place, publisher, year, edition, pages
Elsevier, 2017
Keyword
Bystander CPR, Cardiac arrest, Out-of-hospital cardiac arrest, Survival
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:liu:diva-142461 (URN)10.1016/j.resuscitation.2017.08.234 (DOI)000413760500022 ()28870719 (PubMedID)
Funder
Swedish Heart Lung Foundation, 20130629Region Östergötland
Note

Funding agencies: Foundation for Cardiopulmonary Resuscitation in Sweden; Swedish Resuscitation Council; Swedish Heart-Lung Foundation [20130629]; County Council of Ostergotland

Available from: 2017-10-30 Created: 2017-10-30 Last updated: 2017-11-13

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