Elsevier

Resuscitation

Volume 81, Issue 2, February 2010, Pages 211-216
Resuscitation

Simulation and education
Education in cardiopulmonary resuscitation in Sweden and its clinical consequences

https://doi.org/10.1016/j.resuscitation.2009.10.014Get rights and content

Abstract

Aim

To describe the use of cardiopulmonary resuscitation (CPR) training programmes in Sweden for 25 years and relate those to changes in the percentage of patients with out of hospital cardiac arrest (OHCA) who receive bystander CPR.

Methods

Information was gathered from (a) the Swedish CPR training registry established in 1983 and includes most Swedish education programmes in CPR and (b) the Swedish Cardiac Arrest Register (SCAR) established in 1990 and currently covers about 70% of ambulance districts in Sweden.

Results

CPR education in Sweden functions according to a cascade principle (instructor-trainers who train instructors who then train rescuers in CPR). Since 1989, 5000 instructor-trainers have taught more than 50,000 instructors who have taught nearly 2 million of Sweden's 9 million inhabitants adult CPR. This is equivalent to one new rescuer per 100 inhabitants every year in Sweden. In addition, since 1989, there are 51,000 new rescuers in Advanced Life Support (ALS), since 1996, 41,000 new Basic Life Support (BLS) rescuers with Automated External Defibrillation (AED) training, and since 1998, there are 93,000 new rescuers in child CPR. As a result of this CPR training the number of bystander CPR attempts for OHCA in Sweden increased from 31% in 1992 to 55% in 2007.

Conclusion

By using a cascade principle for CPR education nearly 2 million rescuers were educated in Sweden (9 million inhabitants) between 1989 and 2007. This resulted in a marked increase in bystander CPR attempts.

Introduction

In Sweden, a large number of patients die suddenly every year and the majority of cases have a clear cardiac aetiology.1 The majority of these deaths occur out of hospital. The most common fatal rhythm in OHCA is ventricular fibrillation.2, 3 The aetiology of OHCA varies between the patient age groups. With advancing age, cardiac causes are more prevalent. Other causes of OHCA include drug overdoses, suffocation, trauma, drowning and suicide.4

The implementation of the ‘chain of survival’ is fundamental for the outcome of OHCA.5 Time is the most critical factor at every link in the chain. Particularly, early access to the emergency medical services (EMS) and early CPR have been shown to improve outcomes.6, 7 As a result, bystander CPR has been reported to be associated with a clear increase in survival among patients found in a shockable and non-shockable rhythm.8, 9

In 1981, Holmberg, as the chairman of a working group within the Swedish Society of Cardiology (SSC) started to develop a national CPR education programme. Inspired by the American Heart Association programme and a local education programme from Rogaland in Norway, the Swedish education programme was completed in 1983. The implementation of CPR in Sweden started by inviting 24 doctors from different parts of Sweden to Marstrand, a small island off the Swedish west coast, where they participated in the very first CPR-course and became the first instructor-trainers. They then returned home to start their own CPR-cascades. The cascade principle for education in CPR is designed for both health care providers and lay people.10

The aim of this study was to describe the use of CPR training programmes in Sweden over the last 25 years and to relate it to changes in the percentage of patients with OHCA who receive bystander CPR.

Section snippets

Setting and target population

The target population is the country of Sweden with 9.1 million inhabitants.

CPR training programme

The CPR training programme that was published in 1983 was a 3-hour programme for training in the “adult one-rescuer CPR” technique. It was designed both for lay people and for medical professionals. It was standardised for medical content, teaching material and teaching methodology using a detailed instructor's manual. It started with a 20-minute video that first showed a dramatic cardiac arrest situation to motivate

Adult

Almost 2 million rescuers in Sweden have been educated in CPR since 1983 with a mean of nearly 100,000 persons a year and about 1000 per 100,000 inhabitants per year (Table 1). The numbers of rescuers educated every year do not appear to change much over time (Fig. 1). A total of 50,000 instructors and 2500 instructor-trainers have been educated simultaneously during this period (Fig. 2). Between 1983 and 1989, some 250,000 rescuers were educated in CPR.

Child

Nearly 100,000 rescuers have been

Bystander CPR can save lives

Persons suffering a cardiac arrest can be kept alive with CPR in the majority of cases until professional help arrives and further action including defibrillation can be taken.12, 13 For CPR to have a real life-saving effect in society a large percentage of the population must be trained in CPR. To achieve this, it is not enough to have guidelines or describe the CPR procedure and have training programmes that could apply to the population. The most important step is to implement large-scale

Conclusion

Using a cascade principle for CPR education, almost 2 million rescuers were educated in Sweden (9 million inhabitants) between 1983 and 2007. This has resulted in a marked increase in bystander CPR attempts particularly those performed by non-health care providers during the same period.

Conflicts of interest

No conflict of interest has been declared by the authors.

Acknowledgement

This study was supported by grants from the Laerdal Foundation.

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A Spanish translated version of the abstract of this article appears as Appendix in the final online version at doi:10.1016/j.resuscitation.2009.10.014.

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