Elsevier

Resuscitation

Volume 76, Issue 3, March 2008, Pages 419-424
Resuscitation

Training and educational paper
Public access resuscitation program including defibrillator training for laypersons: A randomized trial to evaluate the impact of training course duration,☆☆

https://doi.org/10.1016/j.resuscitation.2007.08.019Get rights and content

Summary

Background

Time to cardiopulmonary resuscitation (CPR) is a main determinant of survival after out-of-hospital cardiac arrest. Only widespread implementation of training courses for laypersons can decrease response time.

Methods and results

In this prospective randomized trial, we evaluated how laypersons retained CPR skills and skills in using the automated external defibrillator (AED). A total of 1095 volunteers were randomly assigned to receive CPR/AED-training courses of 2 h (375 persons), 4 h (378 persons) or 7 h (342 persons) duration. Courses were held in accordance with the guidelines for CPR. All trainees were tested immediately after the initial class in a standardized test scenario using an AED and a manikin. Either at 6 or at 12 months, retests were given to 164 and 206 volunteers, respectively. In 479 volunteers, retesting was completed at both 6- and 12-month intervals. At the immediate tests, the 7-h training group showed a slightly higher rate of correct responses (7 h: 96%, 4 h: 94%, 2 h: 92%) (p < 0.001). Skill retention decreased significantly in the three groups and was lowest after 12 months if no 6-month retests were done. In trainees who did undergo retesting at 6 months, skills did not deteriorate at 12 months. There were no significant differences between the three groups (overall correct responses: 2 h: 72%, 4 h: 73%, 7 h: 74%) (ns).

Conclusions

A 2-h class is sufficient to acquire and retain CPR and AED skills for an extended time period provided that a brief re-evaluation is performed after 6 months.

Introduction

Sudden out-of-hospital cardiac arrest remains a leading cause of death worldwide. It is estimated that in Western populations, 0.5–1/1000 adults die each year from sudden cardiac death outside the hospital setting.1, 2 The “chain of survival” outlines opportunities to improve outcome through prompt activation of the local Emergency Medical System (EMS), through early cardiopulmonary resuscitation (CPR), defibrillation and timely advanced life support.3 For several years, the American Heart Association (AHA) and the European Resuscitation Council (ERC) have prompted the development of lay rescuer programs including training in the use of the automated external defibrillator (AED) in order to improve survival of sudden cardiac arrest victims.4 It has been demonstrated that trained laypersons can use the AED safely and effectively in a variety of public settings.5

In this study, we investigated the relation between training course duration and retention of attained skills, to provide a basis for recommendations on the optimal training programs for volunteers in basic life support (BLS) including AED use.

Section snippets

Participants

The study was conducted between October 2002 and November 2005. Out of 1095 lay volunteers, 132 training groups averaging 8 participants were randomly assigned to receive 2, 4 or 7 h of theoretical and practical instruction. The volunteers were recruited from 23 different companies and agencies in Berlin (Table 1). All participants were trained in CPR (precordial compression and mouth-to-mouth ventilation) and the use of the AED in accordance with the guidelines for cardiopulmonary resuscitation

Participants

Among 1095 volunteers, 375, 378 and 342 were assigned to 2-, 4-, or 7-h classes. The demographic data for the three groups are summarized in Table 1.

Immediate test

Among the randomized volunteers, 1066 trainees (97.3%) completed the test immediately after training. In the 7-h group, the rate of correct overall responses was slightly higher (7-h group: 96.3%, 4-h group: 93.9%, 2-h group: 91.5%) (p < 0.001) (Figure 1).

Discussion

This is the first randomized trial comparing the effectiveness of a 2-, 4- and 7-h AED/CPR course on resuscitation skills of laypersons.

Earlier studies defined the duration of CPR/AED classes arbitrarily.6, 7, 8 While a standard 8-h curriculum used to be quite common for classes offered by rescue organizations, more recent studies on lay resuscitation often report on 4-h classes.6, 8 Other authors believe, however, that 4 h may still be too long and present an obstacle to widespread CPR training.

Conflict of interest statement

Disclosures: DA, HRA and SH have received speaking fees from Medtronic. The other authors report no disclosures.

Acknowledgments

The authors wish to thank Dr. Peter Rauh for his assistance with the statistical analysis and Mrs Angelika Mathes for her secretarial assistance.

Statement of responsibility: The authors had full access to the data and take responsibility for its integrity. All authors have read and agree to the manuscript as written.

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A Spanish translated version of the summary of this article appears as Appendix in the final online version at 10.1016/j.resuscitation.2007.08.019.

☆☆

Clinical Trial Registration: This study represents results from a clinical trial. The trial was started September 2002.

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