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Increased survival from out-of-hospital cardiac arrest when off duty medically educated personnel perform CPR compared with laymen.
Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences.
Department of Medicine, Center for Resuscitation Science, Karolinska Institute, Solna, Sweden.
Health Metrics Unit, Institution of Medicine, Sahlgrenska Academy, University of Gothenburg University, Gothenburg, Sweden.
Department of Medicine, Center for Resuscitation Science, Karolinska Institute, Solna, Sweden.
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2017 (English)In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 120, 88-94 p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Bystander cardiopulmonary resuscitation (CPR) has been proved to save lives; however, whether survival is affected by the training level of the bystander is not fully described.

AIM: To describe if the training level of laymen and medically educated bystanders affect 30-day survival in out-of-hospital cardiac arrests (OHCA).

METHODS: This observational study included all witnessed and treated cases of bystander CPR reported to the Swedish Registry of Cardiopulmonary Resuscitation between 2010 and 2014. Bystander CPR was divided into two categories: (a) lay-byCPR (non-medically educated) and (b) med-byCPR (off duty medically educated personnel).

RESULTS: During 2010-2014, 24,643 patients were reported to the OHCA registry, of which 6850 received lay-byCPR and 1444 med-byCPR; 16,349 crew-witnessed and non-witnessed cases and those with missing information were excluded from the analysis. The median interval from collapse to call for emergency medical services was 2min in both groups (p=0.97) and 2min from collapse to start of CPR for lay-byCPR versus 1min for med-byCPR (p<0.0001). There were no significant differences in CPR methods used; 64.3% (lay-byCPR) and 65.7% (med-byCPR) applied compressions and ventilation, respectively (p=0.33). The 30-day survival was 14.7% for lay-byCPR and 17.2% for the med-byCPR group (p=0.02). The odds ratio adjusted for potential confounders regarding survival (med-byCPR versus lay-byCPR) was 1.34 (95% confidence interval, 1.11-1.62; p=0.002).

CONCLUSIONS: In cases of OHCA, medically educated bystanders initiated CPR earlier and an increased 30-day survival was found compared with laymen bystanders. These results support the need to improve the education programme for laypeople.

Place, publisher, year, edition, pages
Elsevier, 2017. Vol. 120, 88-94 p.
Keyword [en]
Bystander CPR, Cardiac arrest, Out-of-hospital cardiac arrest, Survival
National Category
Cardiac and Cardiovascular Systems
Identifiers
URN: urn:nbn:se:liu:diva-142461DOI: 10.1016/j.resuscitation.2017.08.234ISI: 000413760500022PubMedID: 28870719OAI: oai:DiVA.org:liu-142461DiVA: diva2:1153522
Funder
Swedish Heart Lung Foundation, 20130629Region Östergötland
Note

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

Available from: 2017-10-30 Created: 2017-10-30 Last updated: 2017-12-15Bibliographically approved
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. 112 p.
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: 2017-11-27Bibliographically approved

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Available from 2018-09-18 08:00

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Nord, AnetteNilsson, Lennart

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Division of Cardiovascular MedicineFaculty of Medicine and Health SciencesDepartment of Cardiology in Linköping
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