What is an Effective Cardiopulmonary Resuscitation Training Mode?
Out-of-hospital cardiac arrest (OHCA) poses a significant threat to public health, with an annual incidence of approximately 55 per 100,000 in North America and 59 per 100,000 in Asia. The success rate of resuscitation in cardiac arrest patients is a critical concern, and both the American Heart Association (AHA) and the European Resuscitation Council have developed and continuously updated cardiopulmonary resuscitation (CPR) guidelines to address this issue. CPR training is a fundamental component of these guidelines, and efforts in China have also been made to improve the success rate of resuscitation by integrating international best practices with local characteristics. This article explores the effectiveness of CPR training modes, particularly focusing on the experiences and findings of the Chinese County Hospital Emergency Alliance (CCHEA).
The CCHEA, led by the Chinese Journal of Emergency Medicine and chaired by the emergency branch of the Chinese Medical Association, comprises nearly 3,000 member units. One of its primary objectives is to enhance CPR training for emergency personnel in county hospitals. Over two years of CPR training for member units, it was observed that the CPR skills of county medical workers were uneven, insufficient to handle daily rescue work for cardiac arrest patients. To address this, the CCHEA implemented a feedback teaching mode in over 100 training sessions for county hospitals. This approach aimed to standardize CPR techniques among trainees.
During the 6th Asia-Pacific Emergency Medicine Forum held in Haikou on April 23, 2021, the CCHEA, in collaboration with YuWell (China) and Pumeikang (Germany), organized a four-hour CPR training session. The training was conducted by six AHA-certified Basic Life Support (BLS) instructors and utilized advanced training equipment, including SimMan BLS (Laerdal, Norway), Primedic AED (Metrax GmbH, Germany), and CPR Feedback Device (PalmCPR, SunLife Science, China). The environmental conditions were favorable, with temperatures ranging from 24 to 32°C, humidity at 70%, and indoor temperature at 25°C. All participants were professional medical staff.
To assess the effectiveness of the training, a pre-training test was conducted to evaluate the quality of simulated chest compressions using PalmCPR (with feedback turned off, only collecting data). The same test was repeated post-training. The results were disappointing. In the first test, involving 37 participants, the compliance rate for compression speed was 18.3%, and for compression depth, it was 45.9%. In the second test, with 28 participants, the compliance rates were 30.6% for compression speed and 42.8% for compression depth. These results were surprising, especially the minimal improvement in compression depth compliance.
Further analysis focused on the 25 trainees who participated in the full training session. Among these, 16 indicators were monitored. The only significant improvements were in the accuracy rate of compressions (13.5% pre-training vs. 30.1% post-training) and the compliance rate of compression frequency (43.3% pre-training vs. 85.4% post-training). The full chest rebound rate showed slight improvement (80.8% pre-training vs. 84.9% post-training), while the compliance rate of compression depth remained virtually unchanged (42.2% pre-training vs. 43.4% post-training).
The training data from county-level hospital alliances are available on the Alibaba cloud, but due to the scattered nature of counties and the disappointing results reflected by the current data, it has not been compiled yet. The expectation is to use this data as a baseline for comparison after continuous training takes effect.
This training model represents real-world research, with minimal intervention and an analysis of the actual training effect through background data. The results raise important questions about the effectiveness of current CPR training methods. The training was conducted by AHA-certified instructors in strict accordance with AHA teaching processes and quality requirements, using a small class size with a 1:6 teacher-student ratio. Despite these efforts, the correct rate of CPR compression was only 30.1% post-training. The pre-training correct rate was even lower at 13.5%. These findings are concerning, especially considering that the participants were professional emergency medical staff.
The implications of these findings extend beyond the training session. Emergency medical staff are not only responsible for the rescue of cardiac arrest patients but also for training the public. If their CPR skills are not up to standard, their ability to effectively train others is compromised. The AHA has emphasized the use of CPR feedback devices in training since the 2015 guidelines, and this study supports the notion that feedback resuscitation may be a more effective scheme in practical applications. The 2021 guidelines further emphasize the clinical use of CPR feedback devices.
In this training, a shift was made from full feedback training to no feedback training and assessment, with a hierarchical analysis of personnel from open training to limited training. The results indicated that the training effect was not satisfactory. This suggests that greater use of feedback tools in first-line rescue work may be necessary to save more lives before an efficient training model is established.
The study highlights the need for reflection on current CPR training methods and the quality of training conducted nationwide. It calls for a more effective approach to CPR training to achieve standardized and efficient CPR in practice. The findings underscore the importance of feedback devices in training and the potential benefits of their increased use in both training and clinical settings.
In conclusion, the effectiveness of CPR training modes remains a critical area of research. The findings from this study suggest that while current training methods may improve certain aspects of CPR performance, they fall short in achieving overall competency, particularly in compression depth. The integration of feedback devices in training and clinical practice may offer a more effective solution, but further research is needed to develop and validate efficient training models. The ultimate goal is to enhance the quality of CPR performed by both medical professionals and the public, thereby improving the outcomes for cardiac arrest patients.
doi.org/10.1097/CM9.0000000000001946
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