ILCOR Advisory Statement

Education in Resuscitation

Utstein Abbey near Stavanger in Norway, hosted a meeting in 1990 on guidelines for the uniform reporting of data from out-of-hospital cardiac arrest. In this paper we describe the last 30 years of the Utstein style.

A systematic literature search identified publications from Utstein-style meetings or groups using the Utstein format.

30 outputs were found, describing primarily resuscitation structure, process and outcome measures. They originated from all over the world and from multiple medical disciplines. Some were co-published in multiple journals.

The meeting at Utstein Abbey in 1990 has had a sustained and far-reaching impact, particularly in resuscitation science, implementation and outcomes. The Utstein format will continue to evolve following the key principles from the original meeting and with the ultimate aim of improving patient care and outcomes.

The European Resuscitation Council (ERC) has produced these Systems Saving Lives guidelines, which are based on the 2020 International Consensus on Cardiopulmonary Resuscitation Science with Treatment Recommendations. The topics covered include chain of survival, measuring performance of resuscitation, social media and smartphones apps for engaging community, European Restart a Heart Day, World Restart a Heart, KIDS SAVE LIVES campaign, lower-resource setting, European Resuscitation Academy and Global Resuscitation Alliance, early warning scores, rapid response systems, and medical emergency team, cardiac arrest centres and role of dispatcher.

Utstein-style reporting templates provide a structured framework with which to compare systems of care for cardiac arrest. The 2004 Utstein reporting template encompassed both out-of-hospital and in-hospital cardiac arrest. A 2015 update of the Utstein template focused on out-of-hospital cardiac arrest, which makes this update of the in-hospital template timely. Representatives of the International Liaison Committee on Resuscitation developed an updated in-hospital Utstein reporting template iteratively by meeting face-to-face, by teleconference, and by online surveys between 2013 and 2018. Data elements were grouped by hospital factors, patient variables, pre-event factors, cardiac arrest and postresuscitation processes, and outcomes. Elements were classified as core or supplemental by use of a modified Delphi process. Variables were described as core if they were considered essential. Core variables should enable reasonable comparisons between systems and are considered essential for quality improvement programs. Together with core variables, supplementary variables are considered useful for research.

The efficacy of learning basic life support (BLS) through self-instruction is not clearly understood. The aim of our review was to compare the effect of self-instruction with that of traditional instruction on learners taking BLS courses.

We searched the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, CINAHL, PsycInfo and SCI-EXPANDED databases for randomized control trials (RCTs) or randomized cluster-controlled trials published from January 1, 1966 to April 25, 2015 which compared self-instruction with traditional instruction in BLS courses. Characteristics, participants, design and outcomes of included studies were extracted.

The search yielded 2119 unique articles, of which 19 RCTs and 3 randomized cluster-controlled trials were included. The learners were different across studies, including laypersons, parents and caretakers of children, university or high school students, medical, pharmacy and nursing students, and practicing nurses. Self-instructional material included DVD, videotapes, on-line learning or interactive computer programs accompanied with synchronous or asynchronous hands-on practice. There were no studies comparing clinical outcomes between the different instructional methods. In evaluating skill performance, there was variability among studies in the skill assessment tools utilized and time of assessment. Nevertheless, the most frequent conclusion of these studies was that self-instruction had similar performance compared with traditional courses. Four studies which measured cognitive knowledge outcomes all demonstrated similar outcomes between the two methods.

Although it remains inconclusive about which is superior between the two methods, considering the potential to train many more rescuers and to reduce resource utilization, well-designed self-instruction with hands-on practice may be an alternative to traditional BLS courses.