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The effect of a national web course "Help-Brain-Heart" as a supplemental learning tool before CPR training: a cluster randomised trial
Linköping University, Department of Medical and Health Sciences. Linköping University, Faculty of Medicine and Health Sciences.
Karolinska Institute, Sweden.
Karolinska Institute, Sweden.
University of Borås, Sweden.
Show others and affiliations
2017 (English)In: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, ISSN 1757-7241, E-ISSN 1757-7241, Vol. 25, article id 93Article in journal (Refereed) Published
Abstract [en]

Background: The effectiveness of cardiopulmonary resuscitation (CPR) learning methods is unclear. Our aim was to evaluate whether a web course before CPR training, teaching the importance of recognition of symptoms of stroke and acute myocardial infarction (AMI) and a healthy lifestyle, could influence not only theoretical knowledge but also practical CPR skills or willingness to act in a cardiac arrest situation. Methods: Classes with 13-year-old students were randomised to CPR training only (control) or a web course plus CPR training (intervention). Data were collected (practical test and a questionnaire) directly after training and at 6 months. CPR skills were evaluated using a modified Cardiff test (12-48 points). Knowledge on stroke symptoms (0-7 points), AMI symptoms (0-9 points) and lifestyle factors (0-6 points), and willingness to act were assessed by the questionnaire. The primary endpoint was CPR skills at 6 months. CPR skills directly after training, willingness to act and theoretical knowledge were secondary endpoints. Training and measurements were performed from December 2013 to October 2014. Results: Four hundred and thirty-two students were included in the analysis of practical skills and self-reported confidence. The mean score for CPR skills was 34 points after training (control, standard deviation [SD] 4.4; intervention, SD 4.0; not significant [NS]); and 32 points at 6 months for controls (SD 3.9) and 33 points for intervention (SD 4.2; NS). At 6 months, 73% (control) versus 80% (intervention; P = 0.05) stated they would do compressions and ventilation if a friend had a cardiac arrest, whereas 31% versus 34% (NS) would perform both if the victim was a stranger. One thousand, two hundred and thirty-two students were included in the analysis of theoretical knowledge; the mean scores at 6 months for the control and intervention groups were 2.8 (SD 1.6) and 3.2 (SD 1.4) points (P amp;lt; 0.001) for stroke symptoms, 2.6 (SD 2.0) and 2.9 (SD 1.9) points (P = 0.008) for AMI symptoms and 3.2 (SD 1.2) and 3.4 (SD 1.0) points (P amp;lt; 0.001) for lifestyle factors, respectively. Discussion: Use of online learning platforms is a fast growing technology that increases the flexibility of learning in terms of location, time and is available before and after practical training. Conclusions: A web course before CPR training did not influence practical CPR skills or willingness to act, but improved the students theoretical knowledge of AMI, stroke and lifestyle factors.

Place, publisher, year, edition, pages
BIOMED CENTRAL LTD , 2017. Vol. 25, article id 93
Keyword [en]
CPR training; Web course; Willingness; Infarction; Stroke; Lifestyle factors; Students
National Category
Other Medical Sciences not elsewhere specified
Identifiers
URN: urn:nbn:se:liu:diva-141119DOI: 10.1186/s13049-017-0439-0ISI: 000410326900001PubMedID: 28899418OAI: oai:DiVA.org:liu-141119DiVA, id: diva2:1144765
Note

Funding Agencies|Foundation for Cardiopulmonary Resuscitation in Sweden; Swedish Resuscitation Council; Swedish Heart-Lung Foundation [20130629]; County Council of Ostergotland

Available from: 2017-09-27 Created: 2017-09-27 Last updated: 2018-04-16
In thesis
1. Bystander CPR: New aspects of CPR training among students and the importance of bystander education level on survival
Open this publication in new window or tab >>Bystander CPR: New aspects of CPR training among students and the importance of bystander education level on survival
2017 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background: It has been proved that bystander cardiopulmonary resuscitation (CPR) saves lives; however, which training method in CPR is most instructive and whether survival is affected by the training level of the bystander have not yet been fully described.

Aim: To identify the factors that may affect 7th grade students’ acquisition of CPR skills during CPR training and their willingness to act, and to describe 30-day survival from outof- hospital cardiac arrest (OHCA) after bystander CPR and the actions performed by laymen versus off-duty medically educated personnel.

Methods: Studies I–III investigate a CPR training intervention given to students in 7th grade during 2013–2014. The classes were randomized to the main intervention: the mobile phone application (app) or DVD-based training. Some of the classes were randomized to one or several additional interventions: a practical test with feedback, reflection, a web course, a visit from elite athletes and automated external defibrillator (AED) training. The students’ practical skills, willingness to act and knowledge of stroke symptoms, symptoms of acute myocardial infarction (AMI) and lifestyle factors were assessed directly after training and at 6 months using the Laerdal PC SkillReporting system (and entered into a modified version of the Cardiff test scoring sheet) and a questionnaire. The Cardiff test resulted in a total score of 12–48 points, and the questionnaire resulted in a total score of 0–7 points for stroke symptoms, 0–9 points for symptoms of AMI and 0– 6 points on lifestyle factors. Study IV is based on retrospective data from the national quality register, the Swedish registry of cardiopulmonary resuscitation, 2010-2014.

Results: A total of 1339 students were included in the CPR training intervention. The DVD-based group was superior to the app-based group in CPR skills, with a total score of 35 (SD 4.o) vs 33 (SD 4.2) points directly after training (p<0.001) and 33 (SD 4.0) vs 31 (SD 4.2) points at six months (p<0.001). Of the additional interventions, the practical test with feedback had the greatest influence regarding practical skills: at six months the intervention group scored 32 (SD 3.9) points and the control group (CPR only) scored 30 (SD 4.0) points (p<0.001). Reflection, the web course, visits from elite athletes and AED training did not further increase the students’ acquisition of practical CPR skills.

The students who completed the web course Help-Brain-Heart received a higher total score for theoretical knowledge in comparison with the control group, directly after training: stroke 3.8 (SD 1.8) vs 2.7 (SD 2.0) points (p<0.001); AMI 4.0 (SD 2.0) vs 2.5 (SD 2.0) points (p<0.001); lifestyle factors 5.4 (SD 1.2) vs 4.5 (SD 2.0) points p<0.001.

Most of the students (77% at 6 months), regardless of the intervention applied, expressed that they would perform both chest compressions and ventilations in a cardiac arrest (CA) situation involving a relative. If a stranger had CA, a significantly lower proportion of students (32%; p<0.001) would perform both compressions and ventilations. In this case, however, many would perform compressions only.

In most cases of bystander-witnessed OHCA, CPR was performed by laymen. Off-duty health care personnel bystanders initiated CPR within 1 minute vs 2 minutes for laymen (p<0.0001). Thirty-day survival was 14.7% among patients who received CPR from laymen and 17.2% (p=0.02) among patients who received bystander CPR from off-duty health care personnel.

Conclusions: The DVD-based method was superior to the app-based method in terms of teaching practical CPR skills to 7th grade students. Of the additional interventions, a practical test with feedback was the most efficient intervention to increase learning outcome. The additional interventions, reflection, web course, visit from elite athletes and AED did not increase CPR skills further. However, the web course Help-Brain-Heart improved the students’ acquisition of theoretical knowledge regarding stroke, AMI and lifestyle factors. For OHCA, off-duty health care personnel bystanders initiated CPR earlier and 30-day survival was higher compared with laymen bystanders.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2017. p. 112
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1580
Keyword
CPR, CPR training, BLS, Laymen, Bystander CPR, Students, Out-of-hospital cardiac arrest, Cardiac arrest, Mobile application, DVD, Feedback, Reflection, Web course, Cardiff test, Myocardial infarction, Stroke, Lifestyle factors, Elite athletes, Willingness, Survival, HLR, HLR-utbildning, Lekman, Högstadieelever, Hjärtstopp, Webutbildning, Dvd, Mobil applikation, Återkoppling, Reflektion, Cardiff test, Hjärtinfarkt, Stroke, Levnadsvanor, Elitidrottare, Motivation, Överlevnad
National Category
Health Sciences
Identifiers
urn:nbn:se:liu:diva-142460 (URN)10.3384/diss.diva-142460 (DOI)9789176854778 (ISBN)
Public defence
2017-12-14, Berzeliussalen, Campus US, Linköping, 13:00 (Swedish)
Opponent
Supervisors
Funder
Swedish Heart Lung Foundation, 20130629Region Östergötland
Available from: 2017-10-31 Created: 2017-10-31 Last updated: 2018-04-03Bibliographically approved

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Kreitz-Sandberg, SusanneNilsson, Lennart
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Department of Medical and Health SciencesFaculty of Medicine and Health SciencesEducation, Teaching and LearningFaculty of Educational SciencesDivision of Cardiovascular MedicineDepartment of Cardiology in Linköping
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