Skill acquisition and retention in automated external defibrillator (AED) use and CPR by lay responders: a prospective study

• Published in: Resuscitation 2004, Vol.60 (1), p.17-28
• Main Authors: Woollard, Malcolm, Whitfield, Richard, Smith, Anna, Colquhoun, Michael, Newcombe, Robert G, Vetter, Norman, Chamberlain, Douglas
• Format: Article
• Language: English
• Subjects: Adult; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Automated external defibrillator (AED); Biological and medical sciences; Cardiac arrest; Cardiopulmonary Resuscitation - education; CPR pré-hospitalar: Treino; Dautomático externo; Desfibrilhador automático externo (AED); Educación; Education; Educação; Electric Countershock - instrumentation; England; Female; Fibrilación ventricular; Fibrilhação; Follow-Up Studies; Health Knowledge, Attitudes, Practice; Heart Arrest - therapy; Humans; Intensive care medicine; Learning; Male; Manikins; Medical sciences; Out-of-hospital CPR; Paragem cardı́aca; Paro cardı́aco; Prospective Studies; Reanimación cardiopulmonar extrahospitalaria (RCP), Entrenamiento; Resuscitation - education; Retention (Psychology); Self Concept; Self-Assessment; Task Performance and Analysis; Teaching - methods; Training; Ventricular; Ventricular fibrillation; Videotape Recording; Volunteers - education
• ISSN: 0300-9572; 1873-1570
• DOI: 10.1016/j.resuscitation.2003.09.006

This prospective study evaluated the acquisition and retention of skills in cardio-pulmonary resuscitation (CPR) and the use of the automated external defibrillator (AED) by lay volunteers involved in the Department of Health, England National Defibrillator Programme. One hundred and twelve trainees were tested immediately before and after an initial 4-h class; 76 were similarly reassessed at refresher training 6 months later. A standardised test scenario that required assessment of the casualty, CPR and the use of an AED was evaluated using recording manikin data and video recordings. Before training only 44% of subjects delivered a shock. Afterwards, all did so and the average delay to first shock was reduced by 57 s. All trainees placed the defibrillator electrodes in an ‘acceptable’ position after training, but very few did so in the recommended ‘ideal’ position. After refresher training 80% of subjects used the correct sequence for CPR and shock delivery, yet a third failed to perform adequate safety checks before all shocks. The trainees self-assessed AED competence score was 86 (scale 0–100) after the initial class and their confidence that they would act in a real emergency was rated at a similar level. Initial training improved performance of all CPR skills, although all except compression rate had deteriorated after 6 months. The proportion of subjects able to correctly perform most CPR skills was higher following refresher training than after the initial class. Although this course was judged to be effective in teaching delivery of counter-shocks, the need was identified for more emphasis on positioning of electrodes, pre-shock safety checks, airway opening, ventilation volume, checking for signs of a circulation, hand positioning, and depth and rate of chest compressions. Este estudo prospectivo avaliou a aquisição e retenção de capacidade em ressuscitação cardiopulmonar (CPR) e no uso de desfrilhador automático externo (AED) por reanimadores leigos envolvidos no Departamento de Saúde do England National Defrillator Programme. Foram testados 112 candidatos imediatamente antes e após um aula inicial de 4 horas; 76 foram igualmente reavaliados em treino repetido 6 meses depois. Foi avaliado o desempenho num cenário de teste normalizado que requeria avaliação da vı́tima, CPR e utilização de um AED, através de informação gravada pelos manequins e gravação vı́deo. Antes do treino apenas 44% dos candidatos efectuaram um choque. Após o treino todos o