Retention of CPR skills learned in a traditional AHA Heartsaver course versus 30-min video self-training: a controlled randomized study.

STUDY I

Introduction

In this article, we present a study published on April 24, 2007 in association with:

  • RMC Research Corporation;
  • The Medical College of Wisconsin;
  • The University of Washington;
  • The University of Chicago Hospitals.

This is a study to compare two types of CPR instruction:

  • The first being “traditional” teaching, with a 4-hour instructor;
  • The second being “self-learning” via a 22-minute video.

Immediately post-training

Traditional classes Self-training classes
Assess responsiveness 72% 90%
Call 911 82% 71%
Overall performance 42% 60%
Ventilation volume 40% 61%
Hand placement 68% 80%
AVERAGE 60.80% 72.40%

2 months post-training

Traditional classes Self-training classes
Assess responsiveness 60% 77%
Call 911 74% 53%
Overall performance 30% 44%
Ventilation volume 36% 44%
Hand placement 59% 64%
AVERAGE 51.80% 56.40%

Students who took a self-learning course were able to perform better during their final exam. Let’s not forget that the students who took the “self-learning” training had only had a video of just 22 minutes prior to the tests.

The current 4-hour CPR course is a barrier to more widespread CPR training and older adults, in particular, are underrepresented in traditional classes. Training with a “self-instruction” program has shown that this type of training can produce short-term skills performance at least as good as those observed with “traditional” training.

This study was conducted on two hundred and eighty-five (285) adults aged 40 to 70 years who had never attended or had not received CPR training in the last 5 years. Candidates were randomly assigned to a control group without training. The two groups were divided into one or other of the following formulas:

  • The “traditional” type of training with the help of a teacher, in class and lasting 4 hours;
  • “Self-learning” type training via one of the three versions of a brief self-instruction video of 22 minutes.

CPR skills post-training performance was assessed using a scenario model by human examiners and a two-stage sensor manikin:

  • Time 1 (immediately post-training);
  • Time 2 (2 months after training).

Conclusion

At Time 1 and Time 2, the examiners rated the self-trained subjects better  than the traditionally trained subjects, with the exception of dialing 911.

The dummy’s data revealed that the performance of the self-trained subjects was better than that of the subjects trained traditionally at all times.

Self-trained subjects showed better performance  for ventilation volume, hand placement and compression depth at Time 1 and Time 2.

Performance by controls has been evaluated only once. Subjects with “traditional” cardio-rescue training and “self-trained” subjects generally showed similar rates of decline.

Two hundred and eighty-five (285) adults aged 40 to 70 years who participated in this study experienced a reduction in the performance of their CPR skills after a 2-month post-training interval. This decline is essentially the same as that observed in subjects who followed either of these two types of training (traditional or self-learning).

Traditionnal classes :

  • 4-hour CPR training called “Heartsaver” with instructor in class.

Self-training classes:

  • 22-minute video CPR self-directed training courses (VSI).

Source:

Einspruch EL, Lynch B, Aufderheide TP, Nichol G, Becker L. Retention of CPR skills learned in a traditional AHA Heartsaver course versus 30-min video self-training: a controlled randomized study. Resuscitation 2007;74(3):476-86

References:

  1. Swor, R., Compton, S., Farr, L. et al, Perceived self-efficacy in performing and willingness to learn cardiopulmonary resuscitation in an elderly population in a suburban community. Am J Crit Care. 2003;12:65–70
  2. Todd, K.H., Heron, S.L., Thompson, M. et al, Simple CPR: a randomized, controlled trial of video self-instructional cardiopulmonary resuscitation training in an African American church congregation. Ann Emerg Med. 1999;34:730–737
  3. Todd, K.H., Braslow, A., Brennan, R.T. et al, Randomized, controlled trial of video self-instruction versus traditional CPR training. Ann Emerg Med. 1998;31:364–369
  4. Ramirez, A.G., Weaver, F.J., Raizner, A.E., Dorfman, S.B., Herrick, K.L., Gotto, A.M. The efficacy of lay CPR instruction: an evaluation. Am J Public Health. 1977;67:1093–1095
  5. Kaye, W., Rallis, S.F., Mancini, M.E. et al, The problem of poor retention of cardiopulmonary resuscitation skills may lie with the instructor, not the learner or the curriculum. Resuscitation. 1991;21:67–87
  6. Berden, H.J., Willems, F.F., Hendrick, J.M. et al, How frequently should basic cardiopulmonary resuscitation training be repeated to maintain adequate skills?. Br Med J. 1993;306:1576–1577
  7. Brennan, R.T., Braslow, A. Skill mastery in public CPR classes. Am J Emerg Med. 1998;16:653–657
  8. Chamberlain, D., Smith, A., Colquhon, M. et al, Randomised controlled trials of staged teaching for basic life support. 2. Comparison of CPR performance and skill retention using either staged instruction or conventional training. Resuscitation. 2001;50:27–37
  9. Edwards, M.J., Hannah, K.J. An examination of the use of interactive videodisc cardiopulmonary resuscitation instruction for the lay community. Comput Nurs. 1985;3:250–252
  10. Kaye, W., Mancini, M.E. Teaching adult resuscitation in the United States—time for a rethink. Resuscitation. 1998;37:177–187
  11. Moser, D.K., Dracup, K., Guzy, P.M. et al, Cardiopulmonary resuscitation skills retention in family members of cardiac patients. Am J Emerg Med. 1990;8:498–503
  12. Morgan, C.L., Donnelly, P.D., Lester, C.A., Assar, D.H. Effectiveness of the BBC’s 999 training roadshows on cardiopulmonary resuscitation: video performance of cohort unforewarned participants at home six months afterwards. BMJ. 1996;313:912–916
  13. Donnelly, P., Assar, D., Lester, C. A comparison of manikin CPR performance by lay persons trained in three variations of basic life support guidelines. Resuscitation. 2000;45:195–199
  14. Handley, A.J., Handley, J.A. Improving CPR performance using an audible feedback system suitable for incorporation into an automated external defibrillator. Resuscitation. 2003;57:57–62
  15. Eisenberg, M.S., Damon, S., Mandel, L. et al, CPR instruction by videotape: results of a community project. Ann Emerg Med. 1995;25:198–202
  16. Pane, G.A., Salness, K.A. A survey of participants in a mass CPR training course. Ann Emerg Med. 1987;16:1112–1116
  17. Brennan, R.T. Student, instructor, and course factors predicting achievement in CPR training classes. Am J Emerg Med. 1991;9:220–224
  18. Brennan, R.T., Braslow, A. Are we training the right people yet? A survey of participants in public cardiopulmonary resuscitation classes. Resuscitation. 1998;37:21–25
  19. Wik, L., Brennan, R.T., Braslow, A. A peer-training model for instruction of basic cardiac life support. Resuscitation. 1995;29:119–128
  20. Flint, L.S., Billi, J.E., Kelly, K., Mandel, L., Newell, L., Stapleton, E.R. Education in adult basic life support training programs. Ann Emerg Med. 1993;22:468–474
  21. Lynch, B., Einspruch, E.L., Nichol, G. et al, Effectiveness of a 30-minute CPR self-instruction program for lay responders: a controlled randomized study. Resuscitation. 2005;67:31–43
  22. Batcheller, A.M., Brennan, R.T., Braslow, A. et al, Cardiopulmonary resuscitation performance of subjects over forty is better following half-hour video self-instruction compared to traditional 4-hour classroom training. Resuscitation. 2000;43:101–110
  23. Braslow, A., Brennan, R.T., Newman, M.M. et al, CPR training without an instructor: development and evaluation of a video self-instructional system for effective performance of cardiopulmonary resuscitation. Resuscitation. 1997;34:207–220
  24. Starr, L.M. An effective CPR home learning system: a program evaluation. AAOHN J. 1998;46:289–295
  25. Boyle, A.J., Wilson, A.M., Connelly, K. et al, Improvement in timing and effectiveness of external cardiac compressions with a new non-invasive device: the CPR-Ezy. Resuscitation. 2002;54:63–67
  26. Wik, L., Myklebust, H., Auestad, B.H., Steen, P.A. Retention of basic life support skills 6 months after training with an automated voice advisory manikin system without instructor involvement. Resuscitation. 2002;52:273–279
  27. Knowles, M. The adult learner: a neglected species. Gulf Publishing, Houston, TX; 1984
  28. Knowles, M. Self-directed learning: a guide for learners and teachers. Association Press, New York; 1975
  29. Cross, K.P. Adults as learners: increasing participation and facilitating learning. Jossey-Bass, San Francisco; 1981
  30. Chamberlain, D.A., Hazinski, M.F. Education in resuscitation: an ILCOR symposium. Circulation. 2003;108:2575–2594
  31. Birnbaum, A., McBurnie, M.A., Powell, J. et al, Modeling instructor preferences for CPR and AED competence estimation. Resuscitation. 2005;64:333–339
  32. Moser, D.K., Coleman, S. Recommendations for improving cardiopulmonary resuscitation skills retention. Heart Lung. 1992;21:372–380
  33. SAS software, Version 8.2 of the SAS System for Windows. Copyright© 1999–2001 SAS Institute Inc. SAS and all other SAS Institute Inc. product or service names are registered trademarks or trademarks of SAS Institute Inc., Cary, NC, USA.
  34. Hedges, L., Olkin, I. Statistical methods for meta-analysis. Academic Press, New York; 1985
  35. Weaver, F.J., Ramirez, A.G., Dorfman, S.B., Raizner, A.E. Trainee’s retention of cardiopulmonary resuscitation: how quickly they forget. JAMA. 1979;241:901–903
  36. Dracup, K., Doering, L.V., Moser, D.K., Evangelista, L. Retention and use of cardiopulmonary resuscitation skills in parents of infants at risk for cardiopulmonary arrest. Pediatric Nurs. 1998;24:219–225
  37. Tweed, W.A., Wilson, E., Isfeld, B. Retention of cardiopulmonary resuscitation skills after initial overtraining. Crit Care Med. 1980;8:651–653
  38. Seaman, J.E., Greene, B.G., Watson-Perczel, M. A behavioral system for assessing and training cardiopulmonary resuscitation skills among emergency medical technicians. J Appl Behav Anal. 1986;19:125–135
  39. Woollard, M., Whitfiled, R., Smith, A. et al, Skill acquisition and retention in automated external defibrillator (AED) use and CPR by lay responders: a prospective study. Resuscitation. 2004;60:17–28
  40. Gass, D.A., Curry, L. Physicians’ and nurses’ retention of knowledge and skill after training in cardiopulmonary resuscitation. Can Med Assoc J. 1983;128:550–551
  41. Ali, J., Cohen, R., Adam, R. et al, Attrition of cognitive and trauma management skills after the advanced trauma life support (ATLS) course. J Trauma: Injury Infect Crit Care. 1996;40:860–866
  42. Kaczorowski, J., Levitt, C., Hammond, M. et al, Retention of neonatal resuscitation skills and knowledge: a randomized controlled trial. Family Med. 1998;30:705–711
  43. Stross, J.K. Maintaining competency in advanced cardiac life support skills. JAMA. 1983;249:3339–3341
  44. American Heart Association. AHA Guidelines 2005. Circulation 2005;112:IV-12–IV-17
  45. Palese, A., Trenti, G., Sbrojavacca, R. Effectiveness of retraining after basic cardiopulmonary resuscitation courses: a literature review. Assist Inferm Ric. 2003;22:68–75