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Effect of mobile application-based versus DVD-based CPR training on students practical CPR skills and willingness to act: a cluster randomised study
Linköping University, Faculty of Medicine and Health Sciences. Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine.
Karolinska Institute, Sweden.
Karolinska Institute, Sweden.
Linköping University, Department of Behavioural Sciences and Learning, Education, Teaching and Learning. Linköping University, Faculty of Educational Sciences.
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2016 (English)In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 6, no 4, e010717- p.Article in journal (Refereed) Published
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Text
Abstract [en]

Objectives: The aim was to compare students practical cardiopulmonary resuscitation (CPR) skills and willingness to perform bystander CPR, after a 30 min mobile application (app)-based versus a 50 min DVD-based training. Settings: Seventh grade students in two Swedish municipalities. Design: A cluster randomised trial. The classes were randomised to receive app-based or DVD-based training. Willingness to act and practical CPR skills were assessed, directly after training and at 6 months, by using a questionnaire and a PC Skill Reporting System. Data on CPR skills were registered in a modified version of the Cardiff test, where scores were given in 12 different categories, adding up to a total score of 12-48 points. Training and measurements were performed from December 2013 to October 2014. Participants: 63 classes or 1232 seventh grade students (13-year-old) were included in the study. Primary and secondary outcome measures: Primary end point was the total score of the modified Cardiff test. The individual variables of the test and self-reported willingness to make a life-saving intervention were secondary end points. Results: The DVD-based group was superior to the app-based group in CPR skills; a total score of 36 (3338) vs 33 (30-36) directly after training (pamp;lt;0.001) and 33 (30-36) and 31 (28-34) at 6 months (pamp;lt;0.001), respectively. At 6 months, the DVD group performed significantly better in 8 out of 12 CPR skill components. Both groups improved compression depth from baseline to follow-up. If a friend suffered cardiac arrest, 78% (DVD) versus 75% (app) would do compressions and ventilations, whereas only 31% (DVD) versus 32% (app) would perform standard CPR if the victim was a stranger. Conclusions: At 6 months follow-up, the 50 min DVD-based group showed superior CPR skills compared with the 30 min app-based group. The groups did not differ in regard to willingness to make a life-saving effort.

Place, publisher, year, edition, pages
BMJ PUBLISHING GROUP , 2016. Vol. 6, no 4, e010717- p.
National Category
Other Medical Sciences not elsewhere specified
Identifiers
URN: urn:nbn:se:liu:diva-129507DOI: 10.1136/bmjopen-2015-010717ISI: 000376391400104PubMedID: 27130166OAI: oai:DiVA.org:liu-129507DiVA: diva2:940105
Note

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

Available from: 2016-06-20 Created: 2016-06-20 Last updated: 2017-11-28
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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Kreitz-Sandberg, SusanneNilsson, Lennart

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