Elsevier

Resuscitation

Volume 79, Issue 1, October 2008, Pages 73-81
Resuscitation

Training and educational paper
Voice advisory manikin versus instructor facilitated training in cardiopulmonary resuscitation

https://doi.org/10.1016/j.resuscitation.2008.06.012Get rights and content

Summary

Background

Training of healthcare staff in cardiopulmonary resuscitation (CPR) is time-consuming and costly. It has been suggested to replace instructor facilitated (IF) training with an automated voice advisory manikin (VAM), which increases skill level by continuous verbal feedback during individual training.

Aims

To compare a VAM (ResusciAnne CPR skills station, Laerdal Medical A/S, Norway) with IF training in CPR using a bag-valve-mask (BVM) in terms of skills retention after 3 months.

Methods

Forty-three second year medical students were included and CPR performance (ERC Guidelines for Resuscitation 2005) was assessed in a 2 min test before randomisation to either IF training in groups of 8 or individual VAM training. Immediately after training and after 3 months, CPR performance was assessed in identical 2 min tests. Laerdal PC Skill Reporting System 2.0 was used to collect data. To quantify CPR performance a scoring system based on the Cardiff test was used. Groups were compared with a Mann Whitney rank sum test.

Results

There was no statistically significant difference between the two groups when considering change in overall CPR performance score from before training to 3 months after training (P = 0.12). However, the IF group performed significantly better than the VAM group in the total score, both immediately after (P = 0.0008) and 3 months after training (P = 0.02). This difference was primarily related to the BVM skills.

Conclusion

Skill retention in CPR using a bag-valve-mask was better after 3 months when training with an instructor than with an automated voice advisory manikin.

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.

References (22)

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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.

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