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Article Critique: Training interval in cardiopulmonary resuscitation
Brittany Spence, BSN, RN, CEN - Carilion Roanoke Memorial Hospital Emergency Department
Article Review of: Oermann, M.H., Krusmark, M.A., Kardong-Edgren, S., Jastrzembski, T.S., & Gluck, K.A. (2020). Training interval in cardiopulmonary resuscitation, PLoS ONE, 15(1), e0226786. https://doi.org/10.1371/journal.pone.0226786
Cardiac arrests can occur unexpectedly in any type of setting, and having providers that are competent with Basic Life Support (BLS) is especially important in the healthcare setting. This article describes a research study that compares four different cardiopulmonary resuscitation (CPR) retraining intervals for nursing students for best impact on high quality compressions and ventilations. The study was conducted with first year prelicensure nursing students who were re-certified in the same BLS option by the American Heart Association or the American Red Cross.
The study was approved by The Institutional Review Boards (IRBs) from 4 universities, while the remaining schools participated through a collaborative agreement with Duke University. A sample of 475 students from 10 United States schools of nursing were randomly selected for this study. Students were then randomly assigned to different CPR training intervals: 101 nurses were selected for daily training, 116 for weekly training, 108 for monthly training, and 150 for quarterly training. The rationale for these groupings was not described, although this would have been helpful to understand the methodology.
Laerdal Resusci Anne QCPR adult manikins were used for CPR training within a Resuscitation Quality Improvement (RQI) mobile simulation station, and outcomes were measured by compression and ventilation quality defined by the RQI program (Oermann et al., 2020). A strength of this study was the use of the same standardized manikin with feedback technology and the same quality scale for each student, ensuring that all feedback obtained was measured consistently. Using a percentage scale of 0-100%, seven scores were obtained for each student: overall compression score, percentage of compressions with adequate depth, rate, release, volume, correct hand placement and overall ventilation score. The data collected from the students in each area were analyzed using the R statistical software.
Regardless of the specific training interval, each area showed improvements from the beginning to the end of the study. All of the students were tested in the compression categories with their previous BLS certification, and all students scored under 75% before further training. After the last training session, students in all training increments showed improvements. The combined compression areas of scoring showed a mean improvement ranging from 80.6% - 90%, the most improvement being in those that were trained daily. The combined ventilation areas of scoring showed a mean of 18.4% prior to more frequent training, and the mean improvement percentage ranged from 68.1% - 88.1%, the most improvement also being in those that were trained daily. It was noted that the lowest area of improvement was shown in those that had the least frequent – quarterly - training. An improvement to 80.6% was noted for quarterly trained students in combined compression areas, and an improvement to 68.1% was noted for quarterly trained students in combined ventilation areas. Receiving daily training resulted in the most favorable outcomes in this study, meaning that more frequent practice of CPR showed improved results.
Conclusions
One of the limitations to this study is all participants in this study were nursing students. It could be possible that older, more experienced healthcare workers could yield different findings. Healthcare workers who use BLS skills on a more frequent basis may already be profficient in all of the compression and ventilation areas tested, and healthcare workers who work in other settings may be more comparable to the students in this study. Another limitation highlighted in this article was that of extra training for some students. It was stated that 47 participants were able to experience an extra training session during the time of the study. This was not factored into the overall results of the study. It is possible that those 47 students were more improved than others because of this additional training, which could have altered the results of the study.
Although BLS certification renewal is required every two years, based on this study, more frequent training may be needed to assure that the necessary skills can be carried out proficiently. One barrier to such implementation in hospitals and other healthcare settings may be cost and availability. Training staff at significantly more frequent intervals will be costly for companies. This would also mean that more staff time taken from the care of patients would be needed for the additional training, at least for staff in areas with less regular use of BLS skills on a daily basis. Areas such as emergency departments or intensive care units may require less training than ambulatory areas. It is important that BLS skills training frequency be based on the best available evidence. A more complete examination of the literature is warranted to make evidence-based practice decisions. However, this review provides an essential first step for analyzing the evidence and determining need for further study.
