Training and educational paperVoice advisory manikin versus instructor facilitated training in cardiopulmonary resuscitation☆
Introduction
In-hospital cardiac arrest (IHCA) is a relatively common condition with an incidence of 1–5 events per 1000 hospital admissions, and approximately 20% of patients with IHCA survive to hospital discharge.1 The chance of survival increases, if time from cardiac arrest to cardiopulmonary resuscitation (CPR) is short2 but the quality of CPR is also important.3, 4 When training hospital staff in basic life support (BLS) a higher skill level at the end of training and the possibility of frequent re-training improve skill retention.5 Unfortunately, prolonged BLS courses or frequent courses for hospital staff to improve skills will drain resources, and most employees never attend a cardiac arrest.6 ERC 2005 Guidelines for Resuscitation suggest that interactive computer based training of first responders may be a valuable alternative to instructor based courses.7 An automated voice advisory manikin (VAM) is able to increase skill level by means of continuous verbal feedback during individual CPR training without an instructor.8 In addition, long-term skill retention has been demonstrated for short re-training sessions using VAM.9, 10 These studies have addressed CPR training for laypersons including mouth-to-mouth ventilations. However, the effect of VAM in combination with bag-valve-mask (BVM) ventilations has not been studied previously and there are no reports of direct comparison between VAM training and instructor facilitated (IF) training.
The aim of this study was to compare VAM training to IF training in in-hospital CPR, including the use of a BVM.
We hypothesised that VAM CPR training for healthcare providers using a BVM would result in better overall skill retention after 3 months than conventional instructor facilitated training.
Our research question was as follows. Is there a difference between VAM training and IF training in improving individuals CPR performance?
Section snippets
Methods
In February 2007, we recruited second-year medical students by means of advertisements in the weekly journal of medical students at the University of Copenhagen. Twelve months earlier they had passed a mandatory BLS course that consisted of standard BLS manoeuvres including CPR with mouth-to-mouth ventilations. Participants would receive a payment of €25 for their contribution.
Results
In total, 43 second-year medical students, which correspond to approximately 15% of the students on that semester, responded positively to the invitation to participate. Of these 17 (40%) were male and median age was 21 [20–21] (Table 3). All 43 participants completed pre-test, training and post-test. One participant from the instructor-facilitated group was lost to follow-up due to a pending exam (Figure 1).
There was no statistically significant difference between the two groups when
Discussion
The most important finding of this study was, that the VAM was unable to teach how to use a BVM effectively under the study conditions and this aspect affected the overall CPR performance and retention. A significant difference was seen in the immediate post-test scores as well as the follow-up scores but there was no significant difference in the change from pre-test to follow-up. The inability to detect a significant difference in the change is most likely explained by type II error, related
Conclusions
Better skill retention was obtained in cardiopulmonary resuscitation using a bag-valve-mask with an instructor than an automated voice advisory manikin.
Conflict of interests
The first author has received an unrestricted research grant from the Laerdal Foundation, but neither the Laerdal Foundation nor Laerdal Medical have taken any part in either designing the study, analysing data or approving the manuscript.
None of the remaining authors have financial or personal relationships with the organizations involved in this study.
Acknowledgements
The authors would like to thank resuscitation officer Torben Frost for training the participants and resuscitation officer Michael Kammer for his valuable aid with the VAM. Furthermore, we wish to thank research fellow Christian Meyhoff, medical students Morten Jon Andersen, Christian Steen Hansen, Mikael Henriksen, and Alexander Kyhnel for their contribution during the project.
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Cited by (45)
Part 8: Education, implementation, and teams. 2015 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations
2015, ResuscitationCitation Excerpt :Meta-analysis was not possible. For the important outcome of skill performance at course conclusion, we found 28 low-quality studies (downgraded for risk of bias, imprecision, and indirectness) that demonstrated some limited improvement in CPR quality.50,191–217 Compression depth, compression rate, chest recoil, hand placement, hands-off time, and ventilation were used as markers of CPR quality.
Simulation exercise to improve retention of cardiopulmonary resuscitation priorities for in-hospital cardiac arrests: A randomized controlled trial
2015, ResuscitationCitation Excerpt :This study evaluated the impact of brief in-situ simulation sessions focusing on choreography and teamwork to achieve key resuscitation priorities as it relates to IHCA. Most other studies evaluate the effectiveness of training interventions on the quality of interventions provided; the quality of compressions and ventilations, not teamwork.25,26,31–36 The data clearly revealed improved performance of the initial priorities with short, frequent training sessions.
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A Spanish translated version of the summary of this article appears as Appendix in the final online version at doi:10.1016/j.resuscitation.2008.06.012.