Improving CPR performance using an audible feedback system suitable for incorporation into an automated external defibrillator
Introduction
Healthcare professionals are expected to be highly proficient when called upon to deal with cardiopulmonary arrest, yet many only encounter this emergency on rare occasions. The introduction of automated external defibrillators (AEDs) to hospital wards has reduced considerably the level of training needed to manage ventricular fibrillation successfully, and has put defibrillation skills well within the range of general nurses [1]. However, basic life support (BLS) is often required as well as defibrillation. It is well recognized that the skills involved in the performance of BLS (rescue breathing and chest compression) are poorly acquired and poorly retained by healthcare professionals as well as laypersons [2], [3]. Many attempts have been made to improve the situation by employing different methods of teaching. One method that has been shown to be effective is to use a training manikin with a computer-based audible feedback system (voice advisory manikin system (VAM)) [4]. This gives corrective instructions when errors of technique are detected during CPR practice. Significant improvements in skill acquisition and skill retention have been reported [5].
Clinical studies are now underway to incorporate the VAM system into an AED. This will enable audible feedback to be given during CPR performed in association with the use of the AED (Laerdal Medical AS). The purpose of the current study was to determine if such a feedback system is likely to improve the quality of CPR performed by trained nurses.
Section snippets
Subjects
Thirty-six volunteers were recruited from the nursing staff of four medical wards at Colchester General Hospital, England. These wards receive acute general medical patients, mainly as emergency admissions from the accident and emergency department or from general practitioners. All the nurses were trained in BLS and had had some extended instruction in simple airway management and the principles of defibrillation. None, however, had attended an advanced life support course. Names were recorded
Results
Each inflation or compression was recorded as correct if it was within the limits set, or incorrect if outside these limits. The results for correct and incorrect inflations, correct and incorrect compression depth, incomplete hand release, and hand position too low were recorded as percentages of total numbers (of inflations or compressions). The raw data were used for mean compression and ventilation rates, mean compressions per minute, and compression as a percentage of duty cycle (ratio of
Discussion
The nurses who took part in this study were selected from those who would be expected to have to deal with sudden cardiac arrest in the normal course of their work, but they were not specialized in cardiac care nursing nor had they been trained in advanced life support skills. They were, therefore, representative of nursing staff for whom the provision of AEDs might be more appropriate than manual defibrillators [1].
The performance of CPR during the first 3-min test period was poor for each
Conclusions
This study confirms that even trained healthcare professionals, with a responsibility to respond to cardiac arrest, do not retain their BLS skills. An audible feedback system produces significant improvement in performance of CPR over a period even as short as 3 min. Although chest compression and ventilation were still poor at the end of this time, the results suggest that if the system were to be incorporated into an AED, it could lead to better performance of CPR during a resuscitation
Acknowledgements
The laptop computer, software and the resuscitation manikin were kindly loaned by Laerdal Medical, who also provided invaluable technical assistance. Expert statistical advice was provided by Professor Bjørn Auestad, Department of Technology and Natural Science, Stavanger University College, Norway.
References (6)
- et al.
Should ward nurses be using automatic external defibrillators as first responders to improve the outcome from cardiac arrest? A systematic review of the primary research
Resuscitation
(2002) - et al.
An automated voice advisory manikin system for training in basic life support without an instructor. A novel approach to CPR training
Resuscitation
(2001) - et al.
Retention of basic life support skills 6 months after training with an automated voice advisory manikin system without instructor involvement
Resuscitation
(2002)