Global prevalence of cardiopulmonary resuscitation training among the general public: a scoping review

A scoping review was conducted to identify, map, and analyze international evidence from studies investigating the prevalence of community cardiopulmonary resuscitation (CPR) training. We searched major bibliographic databases and grey literature for original studies evaluating the prevalence of CPR training in the general population. Studies published from January 2000 to October 2020 were included without language or publication type restrictions. Seventy-three eligible papers reported a total of 61 population-based surveys conducted in 29 countries. More than three-fourths of the surveys were conducted in countries with high-income economies, and none in low-income countries. Over half of the surveys were at a subnational level. Globally, the proportion of laypeople trained in CPR varied greatly (median, 40%). For high-income countries, the median percentage was twice as high as that of upper middle-income countries (50% vs. 23%). The studies used heterogeneous survey methods and reporting patterns. Key methodological aspects were frequently not described. In summary, few studies have assessed CPR training prevalence among the general public. The rates of resuscitation training for the vast majority of countries remain unknown. High heterogeneity of studies precludes a reliable interpretation of the research. International Utstein-style consensus guidelines are needed to inform future research and reporting of public resuscitation training worldwide.

‘It’s the Same Thing as Giving Them CPR Training’: Rural Emergency Responders Perspectives on Naloxone

Most states in the US have implemented Good Samaritan Laws (GSLs) that provide legal protections for anyone calling law enforcement and first responders trained to administer naloxone and reverse overdoses. Despite these laws, some bystanders are reluctant to call the authorities, prompting requests to increase naloxone access and administration training among lay persons. This study examines the perceptions of emergency first responders in a frontier and remote (FAR) state to understand their job responsibilities and perceptions of layperson naloxone administration training. This study includes 22 interviews with law enforcement, EMS and/or fire personnel, members of community organizations responsible for responding to opioid overdoses. The study finds widespread support for layperson naloxone training and administration throughout Montana due to rural first responders’ inability to meet the needs of residents and an overall lack of resources to address substance use. This study adds to the literature because of it focuses on first responders in a frontier and remote area (FAR) that would benefit from layperson naloxone education and administration training due to its geographic expansiveness and the area’s overall lack of resources. A harm reduction approach that trains laypeople to administer naloxone might be FAR residents’ best chance for survival after an opioid overdose.

Out of Hospital Cardiac Arrest (OHCA): Experience of a Bystander CPR Training Program in Karachi, Pakistan

Background: Nearly 90% of out-of-hospital cardiac arrest (OHCA) patients are witnessed, yet only 2.3% received bystander CPR (cardiopulmonary resuscitation in Pakistan. This study aimed to determine retention of knowledge and skills of Hands-Only CPR among community participants in early recognition of OHCA and initiation of CPR in Karachi, Pakistan.Methods: The pre and post-tests were conducted among participants from diverse non-health-related backgrounds from July 2018 to October 2019. Participants were tested for knowledge and skills of CPR before training (pre-test), immediately after training (post-test), and six months after training (retention test). All the participants received CPR training through video and scenario-based demonstration using manikins. Post-training CPR skills of the participants were assessed using a pre-defined performance checklist. The evaluator read out numerous case scenarios to the participants, such as drowning, poisoning, and road traffic injuries, etc., and then asked them to perform the critical steps of CPR identified in the scenario on manikins. The primary outcome was the mean difference in the knowledge score and skills of the participants related to the recognition of OHCA and initiation of CPR. Results: The pre and post-tests were completed by 722 participants, whereas the retention test after 6 months was completed by 358 participants. The mean knowledge score related to the recognition of OHCA, and initiation of CPR improved significantly (p <0.001) from pre-test (47.2/100, ±13.2) to post-test (69.9/100, ±12). The mean CPR knowledge after six months (retention) reduced slightly from (69.9/100, ±12) to (64.8/100, ±9.3). The CPR skill retention for various components (correct placement of the heel of hands, complete chest recoil, check for scene safety, check for a response, and activate emergency response system) slightly deteriorated from 79% in the post-test to 72% in re-test. However, participants performed slightly better on achieving an adequate rate of chest compressions from 73.7% in post-test to 75.5% in re-test.Conclusion: Community members with non-health backgrounds can learn and retain CPR skills, allowing them to be effective bystander CPR providers in OHCA situations. We recommend training the mass population in Pakistan regarding CPR to increase the survival rate from OHCA.

An evolutionary approach to continuously estimate CPR quality parameters from a wrist-worn inertial sensor

Cardiopulmonary resuscitation (CPR) is one of the most critical emergency interventions for sudden cardiac arrest. In this paper, a robust sinusoidal model-fitting method based on a Evolution Strategy inspired algorithm for CPR quality parameters – naming chest compression frequency and depth – as measured by an inertial measurement unit (IMU) attached to the wrist is presented. The proposed approach will allow bystanders to improve CPR as part of a continuous closed-loop support system once integrated into a smartphone or smartwatch application. By evaluating the model’s precision with data recorded by a training mannequin as reference standard, a variance for the compression frequency of $$\pm 2.22$$ ± 2.22 compressions per minute (cpm) has been found for the IMU attached to the wrist. It was found that this previously unconsidered position and thus, the use of smartwatches is a suitable alternative to the typical placement of phones in hand for CPR training.

Comparison of extended reality and conventional methods of basic life support training: protocol for a multinational, pragmatic, noninferiority, randomised clinical trial (XR BLS trial)

Background Conventional cardiopulmonary resuscitation (CPR) training for the general public involves the use of a manikin and a training video, which has limitations related to a lack of realism and immersion. To overcome these limitations, virtual reality and extended reality technologies are being used in the field of medical education. The aim of this study is to explore the efficacy and safety of extended reality (XR)-based basic life support (BLS) training. Methods This study is a prospective, multinational, multicentre, randomised controlled study. Four institutions in 4 countries will participate in the study. A total of 154 participants will be randomly assigned to either the XR group or the conventional group stratified by institution and sex (1:1 ratio). Each participant who is allocated to either group will be sent to a separate room to receive training with an XR BLS module or conventional CPR training video. All participants will perform a test on a CPR manikin after the training. The primary outcome will be mean compression depth. The secondary outcome will be overall BLS performance, including compression rate, correct hand position, compression, and full release and hands-off time. Discussion Using virtual reality (VR) to establish a virtual educational environment can give trainees a sense of realism. In the XR environment, which combines the virtual world with the real world, trainees can more effectively learn various skills. This trial will provide evidence of the usefulness of XR in CPR education. Trial registration ClinicalTrials.gov NCT04736888. Registered on 29 January 2021

GAMBARAN PENGETAHUAN RESUSITASI JANTUNG PARU PADA DEWASA MUDA

Cardiopulmonary resuscitation (RJP) is a useful rescue technique in an emergency. In Indonesia data on the level of CPR knowledge in the community, especially young adults are still minimal, so researchers are interested in knowing the level of CPR knowledge in young people, especially students. The purpose of this study was to describe the level of cardiopulmonary resuscitation knowledge and the influence of online training on changes in the level of knowledge about CPR. Research that uses cross sectional descriptive research design to determine the level of knowledge of cardiopulmonary resuscitation and pre-test and post-test design to find out the difference in knowledge levels before being given intervention and after being given CPR knowledge intervention. The online CPR training activity was attended by 287 respondents, consisting of 63 men and 224 women. The age range that took part in this study was 16 years to 29 years, with the majority of respondents aged 18 years. The result of the average pretest score is 46.73 and the posttest average is 53.47. The statistical test showed that there was a significant difference between the respondents' pretest scores compared to the post-test scores (Wilcoxon, p=0.000). It can be concluded that there was an increase in the knowledge of participants who took part in the CPR training.Resusitasi jantung paru (RJP) merupakan teknik penyelamatan yang berguna dalam keadaan darurat. Di Indonesia data mengenai tingkat pengetahuan RJP pada masyarakat khususnya dewasa muda masih minim. Tujuan penelitian ini untuk mengetahui gambaran tingkat pengetahuan resusitasi jantung paru dan pengaruh training online terhadap perubahan tingkat pengetahuan mengenai RJP. Penelitian yang menggunakan desain penelitian deskriptif cross sectional untuk menentukan gambaran tingkat pengetahuan resusitasi jantung paru dan pre-test and post-test design untuk mengetahui perbedaan tingkat pengetahuan sebelum diberikan intervensi dan sesudah diberikan intervensi pengetahuan RJP. Kegiatan pelatihan RJP daring diikuti oleh 287 responden, yang terdiri dari 63 laki-laki dan 224 perempuan. Rentang usia yang mengikuti penelitian ini adalah 16 tahun hingga 29 tahun, dengan responden terbanyak berusia 18 tahun. Hasil nilai rata-rata prestest sebesar 46.73 dan nilai rata-rata posttest adalah 53.47. Uji statistik menunjukkan adanya perbedaan bermakna antara nilai pretest responden dibanding nilai post test (Wilcoxon, p=0.000). Dapat disimpulkan bahwa terjadi peningkatan pengetahuan peserta yang mengikuti pelatihan RJP.

Keep Me in the Loop: Real-Time Feedback with Multimodal Data

This paper describes the CPR Tutor, a real-time multimodal feedback system for cardiopulmonary resuscitation (CPR) training. The CPR Tutor detects training mistakes using recurrent neural networks. The CPR Tutor automatically recognises and assesses the quality of the chest compressions according to five CPR performance indicators. It detects training mistakes in real-time by analysing a multimodal data stream consisting of kinematic and electromyographic data. Based on this assessment, the CPR Tutor provides audio feedback to correct the most critical mistakes and improve the CPR performance. The mistake detection models of the CPR Tutor were trained using a dataset from 10 experts. Hence, we tested the validity of the CPR Tutor and the impact of its feedback functionality in a user study involving additional 10 participants. The CPR Tutor pushes forward the current state of the art of real-time multimodal tutors by providing: (1) an architecture design, (2) a methodological approach for delivering real-time feedback using multimodal data and (3) a field study on real-time feedback for CPR training. This paper details the results of a field study by quantitatively measuring the impact of the CPR Tutor feedback on the performance indicators and qualitatively analysing the participants’ questionnaire answers.

Abstract 12052: A Comprehensive Simulation-Based Training for E-CPR Improves the Neurological Outcome of Patients With Refractory Cardiac Arrest

Background: Extracorporeal cardiopulmonary resuscitation (E-CPR) has been utilized as a rescue strategy for patients with refractory cardiac arrest (CA). To improve the outcome of E-CPR, we developed a comprehensive simulation-based E-CPR training program. In the present study we assessed whether the E-CPR training improved the mortality and the neurological outcome. Methods: We have implemented the comprehensive E-CPR simulation training program twice a year to the medical team, which consists of emergency physicians, cardiologists, nurses, clinical engineers, and radiographers using a mock vascular model for E-CPR (ECMO cannulation). We assessed collapse to ECMO time, cumulative 30-day survival and good neurological outcome at hospital discharge defined as the cerebral performance categories (CPC) of 1 or 2. Results: Fifty-three consecutive patients received E-CPR for OHCA from January 2012 to December 2020 in which 31 patients were prior to (until September 2017) and 22 were after (from October 2017) the initiation of the E-CPR training. No differences were found in age, rates of witnessed and bystander-CPR, shockable rhythms, or acute coronary syndrome (ACS). Intra-aortic balloon pump was used in 87% patients prior to and 27% patients after the training (p<0.001), and a microaxial Impella pump was used in 55% after the training. Collapse to ECMO time was significantly shorter after the training (p<0.001). Cumulative 30-day survival and the rate of favorable neurological outcome were significantly higher after the training (p<0.05). Multivariate cox proportional hazard analysis revealed that age (hazard ratio [HR], 1.38 (10 years increase), 95% confidence interval [CI], 1.12-1.73, p=0.002), Collapse to ECMO time (HR, 1.14, 95%CI, 1.04-1.23, p=0.006), and additional Impella use (HR, 0.23, 95% CI, 0.08-0.69, p=0.0009) were significantly associated with the 30-day survival. Conclusions: The E-CPR training significantly improved the collapse to ECMO time. The faster deployment of ECMO improves the neurological outcome and 30-day survival in patients with refractory CA. Additional use of Impella may improve the survival.

Abstract 12583: Low-Dose, High-Frequency Psychomotor CPR Skills Training Results in Improved and Sustained Performance of Optimal Adult/Child Ventilations in Fire-Based EMS Personnel

Background: Hyper/over-ventilation (HOV) negatively effects cerebral blood and coronary artery flow during cardiac arrest. The resuscitation quality improvement (RQI) model of low-dose, high-frequency (LDHF) CPR training has been shown to improve CPR skills. Due to the deleterious impact of HOV on survival, our study seeks to determine if the RQI model improves ventilation skills for EMS personnel. We test the hypothesis that the RQI training results in improved and sustained ventilation performance. Methods: In 2014, our department transitioned from traditional BLS/ACLS training to the RQI model. Performance metrics are captured automatically for each rescuer on a quarterly basis using high-fidelity mannequins. Inclusion: All data from adult RQI attempts by EMS personnel from 2015-2019. Exclusion: attempts by non-EMS personnel. The 1 outcome measure is the overall mean (95% CI) ventilation score (composite measure, range 0-100, derived from average volume/rate and % with correct volume). The 2nd outcome measure is the proportion (95%CI) of rescuers with ventilation scores >90%. Data were extracted from RQI and analyzed with Prism statistical software. Comparisons for the 1 outcome was performed using one-way ANOVA and we report mean and 95% CI and proportions and 95% CI as appropriate. Results: During the study period, 740 personnel completed 1,490 ventilation activities in the baseline period and 5,077 in the subsequent years. The mean (95% CI) composite ventilation scores for the baseline was 84.10 (83.09,85.10) vs 2016 = 83.13 (82.17,84.09), 2017=88.79 (87.91,89.66), 2018=90.36 (89.45, 91.27), 2019= 88.59 (87.37, 89.81) for years 2016-2019; F= 41.36, R2=0.024, p value <0.0001. 10outcome: In the baseline RQI year, there were 55.3 % (95%CI= 52.8,57.8) participants with composite ventilation scores >/=90% vs. 2016= 53.5% (51.2,55.8), 2017=65.2%(62.6,68.6), 2018= 71.7%(69.1,74.3) and 2019=69.3%(66.1,72.2) in subsequent years. Limitations: Individual performance not reported, single agency. Conclusions: LDHF CPR training improves proper, and exceptional, ventilation performance in fire-based EMS personnel. Our results may be useful for other EMS agencies who are considering transitioning to LDHF training such as the RQI system.

Abstract 12216: Association Between CPR Confidence With Anxiety in Out of Hospital Cardiac Arrest Survivors

Introduction: There is a lack of data about specific interventions or resources that might reduce anxiety and depression in OHCA survivors. One possible factor contributing to anxiety or depression might be worry by the survivor or their family members about performing CPR or responding to a future cardiac arrest. Hypothesis: We hypothesize that there is an association of confidence about performing CPR with anxiety and depression during recovery after cardiac arrest. Methods: We enrolled subjects who were discharged home from the hospital after cardiac arrest and provided them with self-paced CPR training kits. Subjects reported Generalized Anxiety Disorder 7-item scale (GAD7), Hospital Anxiety and Depression Scale (HADS-A), and CPR knowledge and comfort scores before discharge and at 6 months. Subjects reported use of the training kit. We tested for associations between variables using chi-square and compared follow up scores using Wilcoxon signed-rank test. Results: We enrolled 95 subjects (65 male, majority in the age range of 56-65), all of whom completed the initial surveys. 19 patients met criteria for anxiety via GAD7 (=>10), 23 via HADS-A (=>8). Of subjects who were not comfortable performing CPR, 16/60 (27%) met GAD7 criteria compared to 3/32 (9%) who were comfortable (p=0.03).Of those not comfortable performing CPR 20/60 (33%) met HADS-A criteria compared to 3/35 (9%) who were comfortable (p=0.007).. At 6 months post discharge, 25 subjects completed follow up surveys (16 male, majority in the 56-65 age range). 12/25 (48%) used the CPR training kit; 6 met criteria for anxiety via GAD7, 9 via HADS-A. Of subjects who used the CPR kits, 1/12 (8%) met GAD7 criteria compared to those who did not use the CPR kits 5/13 (38%). Of those who used the CPR kits 3/12 (25%) met HADS-A criteria compared to those who did not use the kits 6/13 (46%), these findings however were not statistically significant (p=0.07,0.27) Additionally, those who used the CPR training kits relative to those who did not use kits had a decrease in GAD7 scores (-1.83 vs +1.84) at 6 months. Conclusion: Anxiety scores were associated with confidence about performing CPR before being discharged and using the CPR kits was associated with an improvement in anxiety scores.