Effects of a mandatory basic life support training programme on the no-flow fraction during in-hospital cardiac resuscitation: An observational study

Müller, Michael; Richter, Torsten; Papkalla, Norbert; Poenicke, Cynthia; Herkner, Carsten; Osmers, Anne; Brenner, Sigrid; Koch, Thea; Schwanebeck, Uta; Heller, Axel R.

doi:10.1016/j.resuscitation.2014.03.046

Cited by 21 publications

(8 citation statements)

References 22 publications

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“…In these cases, a defibrillator capable of manual defibrillation was used. However, an observational study showed that the NFF during in-hospital BLS with the use of an AED can be as low as 0.30 when nurses repetitively perform the BLS/ AED algorithm in a BLS training course [ 13 ].…”

Section: Discussionmentioning

confidence: 99%

Quality of basic life support when using different commercially available public access defibrillators

Müller

Poenicke

Kurth

et al. 2015

Scand J Trauma Resusc Emerg Med

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BackgroundBasic life support (BLS) guidelines focus on chest compressions with a minimal no-flow fraction (NFF), early defibrillation, and a short perishock pause. By using an automated external defibrillator (AED) lay persons are guided through the process of attaching electrodes and initiating defibrillation. It is unclear, however, to what extent the voice instructions given by the AED might influence the quality of initial resuscitation.MethodsUsing a patient simulator, 8 different commercially available AEDs were evaluated within two different BLS scenarios (ventricular fibrillation vs. asystole). A BLS certified instructor acted according to the current European Resuscitation Council 2010 Guidelines and followed all of the AED voice prompts. In a second set of scenarios, the rescuer anticipated the appropriate actions and started already before the AED stopped speaking. A BLS scenario without AED served as the control. All scenarios were run three times.ResultsThe time until the first chest compression was 25 ± 2 seconds without the AED and ranged from 50 ± 3 to 148 ± 13 seconds with the AED depending on the model used. The NFF was .26 ± .01 without the AED and between .37 ± .01 and .72 ± .01 when an AED was used. The perishock pause ranged from 12 ± 0 to 46 ± 0 seconds. The optimized sequence of actions reduced the NFF, which ranged now from .32 ± .01 to .41 ± .01, and the perishock pause ranging from 1 ± 1 to 19 ± 1 seconds.ConclusionsVoice prompts given by commercially available AED merely meet the requirements of current evidence in basic life support. Furthermore, there is a significant difference between devices with regard to time until the first chest compression, perishock pause, no-flow fraction and other objective measures of the quality of BLS. However, the BLS quality may be improved with optimized handling of the AED. Thus, rescuers should be trained on the respective AED devices, and manufacturers should expend more effort in improving user guidance to shorten the NFF and perishock pause.Electronic supplementary materialThe online version of this article (doi:10.1186/s13049-015-0123-1) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Quality of basic life support when using different commercially available public access defibrillators

Müller

Poenicke

Kurth

et al. 2015

Scand J Trauma Resusc Emerg Med

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“…Improving skill retention in BLS education is an important issue because it may lead to a higher success rate of resuscitation and improve outcome [3, 22]. Quality of chest compressions is one of the most important factors that determines the outcome of a cardiac arrest patient [20].…”

Section: Discussionmentioning

confidence: 99%

The timing of testing influences skill retention after basic life support training: a prospective quasi-experimental study

Kovács

Jenei

Csordás³

et al. 2019

BMC Med Educ

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BackgroundProper basic life support (BLS) is key in improving the survival of out-of-hospital cardiac arrest. BLS skills deteriorate in three to 6 months after training. One method to improve skill retention may be using the “testing effect” to test skills at the end of a BLS course. The aim of our study was to investigate whether either testing or the timing of such testing after BLS training have any influence on skill retention.MethodsThis was a post-test only, partial coverage, prospective quasi-experimental study designed to evaluate a BLS training course among 464 fifth year medical students at Semmelweis University in the first semester of 2013/2014. Groups were systematically but non-randomly assigned to either a control group that took no exam or one of two experimental groups that took an exam (N = 179, NoExam group; N = 165, EndExam group – exam at the end of the BLS training; N = 120, 3mExam group – exam 3 months after the BLS training). The ability to perform ten prescribed essential BLS steps was evaluated during a skill retention assessment 2 months after the course in the NoExam, 2 months after the course (and the exam) in the EndExam and 5 months after the course (2 months after the exam) in the 3mExam group to measure skill retention and the effect of our intervention. Scores were calculated for each BLS step, and also summed up as a total score. We used Kruskal-Wallis test to assess differences in skill retention.ResultsOverall, NoExam and EndExam groups showed similar skill retention. The mean total score (and many of the sub-scores) of students was significantly higher in the 3mExam group compared to both the NoExam and the EndExam groups, and there was no difference in the total score (and many of the sub-scores) of the latter two groups. The 3mExam group had less variability in total scores (and many of the sub-scores) than the other two groups.ConclusionOur study provides evidence that testing these skills 3 months after BLS training may be more effective than either testing immediately at the end of the course or no testing at all.

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“…Especially the handling of the AED and its incorporation in the CPR-choreography is an important issue and becomes more and more part of critical discussion [ 11 – 13 ]. The main question remains whether the use of an AED prolongs the hands-off time in CPR [ 14 ]. In our study we found a time elapse from switching on the AED to the first compression registered by the AED of 34 (32–52) seconds .…”

Section: Discussionmentioning

confidence: 99%

“…Thus further interpretation of this study with regard to the influence of an AED is not possible. In a prospective study Müller et al found similar ROSC-rates in patients after in-hospital cardiac arrest with and without the use of an AED [ 14 ]. They concluded that this could be due to an increase of the hands-off time while using an AED.…”

Section: Discussionmentioning

confidence: 99%

“…They concluded that this could be due to an increase of the hands-off time while using an AED. In the same study the authors found an increasing ROSC-rate over time (2008–2012) in patients after in-hospital cardiac arrest from 48 % (2008) to 72 % (2012) [ 14 ]. One possible reason for this increase was a consequent training in BLS for nurses and physicians.…”

Section: Discussionmentioning

confidence: 99%

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Monitoring of in-hospital cardiac arrest events with the focus on Automated External Defibrillators – a retrospective observational study

Wurmb

Vollmer

Sefrin

et al. 2015

Scand J Trauma Resusc Emerg Med

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BackgroundPatients with cardiac arrest have lower survival rates, when resuscitation performance is low. In In-hospital settings the first responders on scene are usually nursing staff without rhythm analysing skills. In such cases Automated External Defibrillators (AED) might help guiding resuscitation performance. At the Wuerzburg University Hospital (Germany) an AED-program was initiated in 2007.Aim of the presented study was to monitor the impact of Automated External Defibrillators on the management of in-hospital cardiac arrest events.MethodsThe data acquisition was part of a continuous quality improvement process of the Wuerzburg University Hospital. For analysing the CPR performance, the chest compression rate (CCR), compression depth (CCD), the no flow fraction (NFF), time interval from AED-activation to the first compression (TtC), the time interval from AED-activation to the first shock (TtS) and the post schock pause (TtCS) were determined by AED captured data. A questionnaire was completed by the first responders.ResultsFrom 2010 to 2012 there were 359 emergency calls. From these 53 were cardiac arrests with an AED-application. Complete data were available in 46 cases. The TtC was 34 (32–52) seconds (median and IQR).The TtS was 30 (28–32) seconds (median and IQR) . The TtCS was 4 (3–6) seconds (median and IQR) . The CCD was 5.5 ± 1 cm while the CCR was 107 ± 11/min. The NFF was calculated as 41 %.ROSC was achieved in 21 patients (45 %), 8 patients (17 %) died on scene and 17 patients (37 %) were transferred under ongoing CPR to an Intensive Care Unit (ICU).ConclusionThe TtS and TtC indicate that there is an AED-user dependent time loss. These time intervals can be markedly reduced, when the user is trained to interrupt the AED’s “chain of advices” by placing the electrode-paddles immediately on the patient’s thorax. At this time the AED switches directly to the analysing mode. Intensive training and adaption of the training contents is needed to optimize the handling of the AED in order to maximize its advantages and to minimize its disadvantages.

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Effects of a mandatory basic life support training programme on the no-flow fraction during in-hospital cardiac resuscitation: An observational study

Cited by 21 publications

References 22 publications

Quality of basic life support when using different commercially available public access defibrillators

Quality of basic life support when using different commercially available public access defibrillators

The timing of testing influences skill retention after basic life support training: a prospective quasi-experimental study

Monitoring of in-hospital cardiac arrest events with the focus on Automated External Defibrillators – a retrospective observational study

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