Elsevier

Resuscitation

Volume 84, Issue 1, January 2013, Pages 72-77
Resuscitation

Simulation and education
Retraining basic life support skills using video, voice feedback or both: A randomised controlled trial

https://doi.org/10.1016/j.resuscitation.2012.08.320Get rights and content

Abstract

Introduction

The optimal strategy to retrain basic life support (BLS) skills on a manikin is unknown. We analysed the differential impact of a video (video group, VG), voice feedback (VFG), or a serial combination of both (combined group, CG) on BLS skills in a self-learning (SL) environment.

Methods

Two hundred and thirteen medicine students were randomly assigned to a VG, a VFG and a CG. The VG refreshed the skills with a practice-while-watching video (abbreviated Mini Anne™ video, Laerdal, Norway) and a manikin, the VFG with a computer-guided manikin (Resusci Anne Skills Station™, Laerdal, Norway) and the CG with a serial combination of both. Each student performed two sequences of 60 compressions, 12 ventilations and three complete cycles of BLS (30:2). The proportions of students achieving adequate skills were analysed using generalised estimating equations analysis, taking into account pre-test results and training strategy.

Results

Complete datasets were obtained from 192 students (60 VG, 69 VFG and 63 CG). Before and after training, ≥70% of compressions with depth ≥50 mm were achieved by 14/60 (23%) vs. 16/60 (27%) VG, 24/69 (35%) vs. 50/69 (73%) VFG and 19/63 (30%) vs. 41/63 (65%) CG (P < 0.001). Compression rate 100–120/min was present in 27/60 (45%) vs. 52/60 (87%) VG, 28/69 (41%) vs. 44/69 (64%) VFG and 27/63 (43%) vs. 42/63 (67%) CG (P = 0.05). Achievement of ≥70% ventilations with a volume 400–1000 ml was present in 29/60 (49%) vs. 32/60 (53%) VG, 32/69 (46%) vs. 52/69 (75%) VFG and 25/63 (40%) vs. 51/63 (81%) CG (P = 0.001). There was no between-groups difference for complete release.

Conclusions

Voice feedback and a sequential combination of video and voice feedback are both effective strategies to refresh BLS skills in a SL station. Video training alone only improved compression rate. None of the three strategies resulted in an improvement of complete release.

Introduction

The European Resuscitation Council (ERC) 2010 Guidelines recommend a compression depth of at least 50 mm, followed by complete release, at a rate of at least 100/min with minimal interruptions, in order to provide adequate circulation.1 Most studies, however, show that cardiopulmonary resuscitation (CPR) skills decay within three to 6 months after initial training.2, 3, 4, 5, 6, 7, 8, 9, 10, 11 This results in highly variable and often poor basic life support (BLS) quality, even when performed by trained healthcare providers, including hospital-based nurses and physicians.12, 13, 14, 15 The need for efficient retraining of BLS skills is obvious, but the optimal format for self-instructional refresher training is still one of the knowledge gaps to be addressed.10, 11

A sequential combination of a practice-while-watching video (Mini-Anne™, Laerdal, Norway) followed by training with voice feedback exercises appears to be an effective strategy to train and retrain BLS skills in a self-learning (SL) station.16, 17 However, the differential impact of each component in this combined learning strategy is unknown. We hypothesised that retraining BLS skills with the combination of a learning-while-watching video followed by further practice with voice feedback would result in a higher proportion of students with adequate BLS skills compared to either strategy alone.

Section snippets

Participants

The study was approved by the Ethics Committee of Ghent University Hospital. During the academic year 2010–2011, 214 of 216 eligible third year medicine students agreed to participate. The students were told that different educational strategies for refresher training in a SL station would be applied and evaluated. As BLS training was a mandatory part of the medicine student's curriculum, all students had followed an initial instructor-led BLS course during their first year and a refresher

Recruitment and baseline data

Two hundred and fourteen students signed an informed consent and agreed to participate in the study. One student could not participate because of a medical reason. Student's characteristics are summarised in Table 1.

Prior to the involvement of the non-obstructive observer, the study protocol was violated by 10 students: five students exceeded the training time, three students did not respect the exercise sequence and two students did not complete the exercise sequence. In 11 students,

Discussion

Our results demonstrate that medicine students, retrained with voice feedback or with the serial combination of video and voice feedback, showed a significant improvement in mean compression depth, compression rate and mean ventilation volume. Students retrained with video only showed significant improvement in compression rate. None of the three alternative retraining strategies resulted in a significant improvement in complete release. A significant difference in resuscitation performance

Conclusions

Voice feedback and a sequential combination of video and voice feedback are both effective strategies to refresh BLS skills in a SL station. Video training alone did only improve compression rate. None of the three strategies resulted in an improvement of complete release.

Conflict of interest statement

Laerdal (Stavanger, Norway) provided the manikin, the face shields and the Resusci Anne Skills Station™ licenses for the study. Laerdal has taken no part in neither designing the study, analysing data nor writing of the manuscript. The authors have received a grant from the Laerdal Foundation.

Acknowledgements

We are grateful to the management of Ghent University Hospital, to the IT department for computer support, to Charlotte Vankeirsbilck for administrative support and to all the students who participated in the study. The Flash™ module was programmed by Uniweb bvba (Strombeek-Bever, Belgium) and was embedded in the existing Resusci Anne Skills Station™ software with the help of Laerdal Sophus programmers (Laerdal, Sweden).

References (36)

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    If not achieved, a message was displayed asking the student to perform a new test. To be considered competent, participants had to achieve a 70% combined assessment score consisting of ≥70% compressions with a depth of ≥50 mm and ≥70% compressions with complete release (<5 mm) and a compression rate of 100–120 min−1 and ≥70% ventilations with a volume of 400–1000 ml.14,17 After the test, feedback was automatically provided on-screen to the student accompanied by feedforward (i.e. how to improve in the future) in case the student was not successful (Fig. 1).

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A Spanish translated version of the summary of this article appears as Appendix in the final online version at http://dx.doi.org/10.1016/j.resuscitation.2012.08.320.

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