Simulation and educationRetraining basic life support skills using video, voice feedback or both: A randomised controlled trial☆
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)
- et al.
European Resuscitation Council Guidelines for Resuscitation 2010. Section 2. Adult basic life support and use of automated external defibrillators
Resuscitation
(2010) - et al.
Retention of CPR skills learned in a traditional AHA heartsaver course versus 30-min video self-training: a controlled randomized study
Resuscitation
(2007) - et al.
Prospective, randomized trial of the effectiveness and retention of 30-min layperson training for cardiopulmonary resuscitation and automated external defibrillators: The American Airlines Study
Resuscitation
(2007) - et al.
An evaluation of objective feedback in basic life support (BLS) training
Resuscitation
(2007) - et al.
Public access resuscitation program including defibrillator training for laypersons: a randomized trial to evaluate the impact of training course duration
Resuscitation
(2008) - et al.
Evaluation of staff's retention of ACLS and BLS skills
Resuscitation
(2008) - et al.
Skill acquisition and retention in automated external defibrillator (AED) use and CPR by lay responders: a prospective study
Resuscitation
(2004) - et al.
Optimal refresher training intervals for AED and CPR skills: a randomised controlled trial
Resuscitation
(2006) - et al.
European Resuscitation Council Guidelines for Resuscitation 2010. Section 9. Principles of education in resuscitation
Resuscitation
(2010) - et al.
Combining video instruction followed by voice feedback in a self-learning station for acquisition of Basic Life Support skills: a randomised non-inferiority trial
Resuscitation
(2011)
Training to deeper compression depth reduces shallow compressions after six months in a manikin model
Resuscitation
CPR training without an instructor: development and evaluation of a video self-instructional system for effective performance of cardiopulmonary resuscitation
Resuscitation
Randomized, controlled trial of video self-instruction versus traditional CPR training
Ann Emerg Med
Cardiopulmonary resuscitation performance of subjects over forty is better following half-hour video self-instruction compared to traditional four-hour classroom training
Resuscitation
An automated voice advisory manikin system for training in basic life support without an instructor. A novel approach to CPR training
Resuscitation
Effects and limitations of an AED with audiovisual feedback for cardiopulmonary resuscitation: a randomized manikin study
Resuscitation
A preliminary feasibility study of a short DVD-based distance-learning package for basic life support
Resuscitation
Influence of chest compression rate guidance on the quality of cardiopulmonary resuscitation performed on manikins
Resuscitation
Cited by (19)
Improving CPR quality with distributed practice and real-time feedback in pediatric healthcare providers – A randomized controlled trial
2018, ResuscitationCitation Excerpt :The use of real-time feedback during CPR training has been shown to improve CPR performance in healthcare providers [10,26]. Some studies have shown that short CPR self-learning sessions with feedback during CPR training improved CPR skill acquisition [10,26–29] as well as perception of CPR quality [19]. However, the use of real-time feedback was not incorporated into distributed practice educational designs in these studies.
Part 8: Education, implementation, and teams. 2015 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations
2015, ResuscitationCitation Excerpt :The other study demonstrated a significant difference between control wards and intervention wards (introduction of a critical care outreach service) with all patients (OR, 0.70; 95% CI, 0.50–0.97), and matched randomized patients (OR, 0.52; 95% CI, 0.32–0.85).219 Of the 33 nonrandomized studies reporting mortality, no studies reported statistically significant worse outcomes for the intervention; 15 studies with no adjustment demonstrated no significant improvement220–234; 6 studies with no adjustment demonstrated significant improvement235–240; 1 study with no adjustment reported on rates, which improved with MET, but did not report on significance241; 1 study with no adjustment demonstrated significant improvement for medical patients but not surgical patients (combined significance not reported)242; 4 studies with adjustment demonstrated significant improvement both before and after adjustment243,244,250,252; 2 studies with adjustment demonstrated no significant improvement both before and after adjustment245,246; 2 studies with adjustment demonstrated significant improvement before adjustment but not after adjustment247,251; 1 study with adjustment demonstrated significant improvement before adjustment but not after adjustment27; 1 study that reported on both unexpected mortality and overall mortality showed significant improvement both before and after adjustment for unexpected mortality but no significant improvement both before and after adjustment for overall mortality249; and 1 before-after study that presented “after” data for unexpected mortality in 3 separate time bands demonstrated significant improvement in time band 3 before adjustment and in time bands 2 and 3 after adjustment.248 The heterogeneous nature of the studies prevents pooling of data; however, there is a suggestion of improved hospital survival in those hospitals that introduce a MET service, and a suggestion of a dose-response effect, with higher-intensity systems (eg, higher MET calling rates, senior medical staff on MET teams) being more effective.
Effects of two retraining strategies on nursing students' acquisition and retention of BLS/AED skills: A cluster randomised trial
2015, ResuscitationCitation Excerpt :Individuals’ overall competency in procedural skills was rated according to ILCOR recommendations: 1 = not competent; 2 = questionably competent; 3 = competent; 4 = very good, and 5 = outstanding.34 Competency level for technical skills was set up according to the European Resuscitation Council (ERC) guidelines and other authors’ recommendations as follows:16,24,35,36 (1) ≥70% of chest compressions with depth = 50-60 mm, (2) ≥70% of chest compressions at rate = 100–120/min, (3) ≥70% of chest compressions with correct hand position (lower 1/3 of sternum), (4) ≥70% of chest compressions with complete release (<5 mm), (5) ≥70% of rescue breaths between 400–1000 ml, (6) mean no flow-time≤5 s. BRS-SES scores vary from 0–100.
Repetitive sessions of formative self-testing to refresh CPR skills: A randomised non-inferiority trial
2014, ResuscitationCitation Excerpt :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).
Efficiency of short individualised CPR self-learning sessions with automated assessment and feedback
2013, ResuscitationCitation Excerpt :Video alone showed not to be sufficient to acquire CPR skills.13 To retrain CPR skills in a SL station adequately, voice feedback exercises appeared to be more effective than a video.14 To report clinical competence the proportion of successful participants should be assessed against a predefined pass level.15
- ☆
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.