Elsevier

Resuscitation

Volume 73, Issue 3, June 2007, Pages 417-424
Resuscitation

Training and educational paper
An evaluation of objective feedback in basic life support (BLS) training

https://doi.org/10.1016/j.resuscitation.2006.10.017Get rights and content

Summary

Background

Studies show that acquisition and retention of BLS skills is poor, and this may contribute to low survival from cardiac arrest. Feedback from instructors during BLS training is often lacking. This study investigates the effects of continuous feedback from a manikin on chest compression and ventilation techniques during training compared to instructor feedback alone.

Materials and methods

A prospective randomised controlled trial. First-year healthcare students at the University of Birmingham were randomised to receive training in standard or feedback groups. The standard group were taught by an instructor using a conventional manikin. The feedback group used a ‘Skillreporter’ manikin, which provides continuous feedback on ventilation volume and chest compression depth and rate in addition to instructor feedback. Skill acquisition was tested immediately after training and 6 weeks later.

Results

Ninety-eight participants were recruited (conventional n = 49; Skillreporter n = 49) and were tested after training. Sixty-six students returned (Skillreporter n = 34; conventional n = 32) for testing 6 weeks later. The Skillreporter group achieved better compression depth (39.96 mm versus 36.71 mm, P < 0.05), and more correct compressions (58.0% versus 40.4%, P < 0.05) at initial testing. The Skillreporter group also achieved more correct compressions at week 6 (43.1% versus 26.5%, P < 0.05).

Conclusions

This study demonstrated that objective feedback during training improves the performance of BLS skills significantly when tested immediately after training and at re-testing 6 weeks later. However, CPR performance declined substantially over time in both groups.

Introduction

Survival from cardiac arrest remains poor.1, 2, 3 The early management of cardiac arrest is based on the concept of the “Chain of Survival”.4, 5 The correct performance of basic life support (BLS) is a critical step in this chain. Since the majority of cardiac arrests are witnessed,6 bystander cardiopulmonary resuscitation (CPR) has been shown to be an important predictor of increased survival to hospital discharge.7, 8 The two major skills required in CPR are chest compressions and rescue breaths. Chest compressions are important for perfusion of vital organs and priming the heart for successful defibrillation.9 Delivery of adequate rescue breath volume is required for ventilation and proper performance is vital to minimise stomach inflation.3, 10, 11

Despite the importance of BLS, studies have shown that these skills are not acquired adequately. Acquisition of BLS skills can be difficult. One study reported that lay rescuers performed only 1.7% of rescue breaths and 3.5% of chest compressions correctly immediately after instruction.12 Ventilation technique has been documented to be poorly acquired13 with ventilation flow rates tending to be in excess of guidelines.9 Retention of BLS skills is also poor, particularly chest compressions and rescue breaths. Moser and Coleman reviewed the retention of these skills. They found that skill retention starts declining as early as 2 weeks after initial training and often reaches pre-training levels after 1 or 2 years.14 The poor acquisition and retention of skills are likely to contribute to the low survival rates from cardiac arrest. A large-scale study has shown that only 2% of patients suffering out-of-hospital cardiac arrest survived to hospital discharge.1

Feedback devices have been used in an effort to improve the acquisition of CPR skills. Continuous correcting verbal feedback has been shown to do this.15 Wik et al. suggested that this continuous visual–audio feedback from manikins may enable BLS instructors to concentrate on factors other than psychomotor skills. For these reasons feedback may have an important role in BLS training. However, no evidence has been found to show that these skills are retained longer than when using conventional manikin teaching methods.

The aim of this study was to assess whether objective feedback from a manikin during instructor facilitated CPR training improves the acquisition and retention of BLS skills.

Section snippets

Material and methods

We recruited 100 first year healthcare students from the University of Birmingham, UK. All candidates were undertaking a compulsory 8 h peer-led BLS and automated external defibrillator course.16 Ethical approval was granted by the South Birmingham Research Ethics Committee. Verbal consent was obtained from candidates and instructors. The present study was a randomised controlled trial. The candidates were randomised into either conventional manikin (n = 50) or Skillreporter manikin groups (n = 50)

Results

In total, 98 candidates participated in initial testing. (n = 49 for both Skillreporter and conventional manikin groups). The Skillreporter group consisted of 35 women (71%) and 14 men (29%). The conventional manikin group consisted of 29 women (59%) and 20 men (41%). Mean age in both groups was similar. Despite e-mail, text message and telephone follow-up contact, only 66 of the 98 candidates attended retention testing at 6 weeks (Skillreporter group n = 32, conventional manikin group n = 34).

Figure

Discussion

The most important finding in the study was that objective feedback (using a Skillreporter manikin) improved acquisition and retention of chest compression skills significantly 6 weeks after initial training. However, despite these improvements, there was still a significant decay in skills 6 weeks after initial training, with the percentage of correct compressions and ventilations even in the Skillreporter group falling under 50% by 6 weeks.

The quality of CPR is an important determinant of

Conclusions

The use of audio and visual feedback prompts from a resuscitation manikin was associated with improved CPR performance when tested on a manikin both immediately following training and at re-testing 6 weeks later. However, CPR performance declined substantially over time in both groups.

Conflict of interest

None declared.

Acknowledgements

Thanks to Clare Roberts (Resuscitation Training Officer at George Elliot Hospital) for providing a Skillreporter manikin and to Dr. Jonathan Smart (Laerdal Medical) for providing the VAM system software. Also to David Watkin, Alice Dudley, Sara Mensforth, Saskia Pederson, Mike Helme and Rebecca Dicks for teaching the candidates. The manikins used in this study were provided by a grant from the Resuscitation Council (UK). Dr Perkins is supported by a DH (NIHR) Clinician Scientist Awards.

References (35)

Cited by (108)

  • Comparing student nurse knowledge and performance of basic life support algorithm actions: An observational post-retention test design study

    2020, Nurse Education in Practice
    Citation Excerpt :

    A review by Hamilton (2005) provides an interesting overview of factors that appear to enhance nurses' skill and knowledge retention during or after CPR training. Multiple studies concluded that overall BLS/ALS skills deteriorate faster than BLS/ALS knowledge (Smith et al., 2008; Spooner et al., 2007; Yang et al., 2012). Ackermann (2009) investigated the use of high-fidelity simulation on the retention of CPR knowledge and skills and found a general decrease in CPR knowledge and skills after three months.

  • The evaluation of laypersons awareness of basic life support at the university in Izmir

    2019, Turkish Journal of Emergency Medicine
    Citation Excerpt :

    However, there was no statistically significant difference between the BLS and AED responses of those who had BLS training and who did not have any training before. Practical and simple training, multimedia presentations, and feedback from trainers are considered as factors that positively affect the permanence of the skills.24 Therefore, BLS training programs should be organized in accordance with current guidelines and include practical skills, as well as theoretical information.25

View all citing articles on Scopus

A Spanish translated version of the summary of this article appears as Appendix in the final online version at 10.1016/j.resuscitation.2006.10.017.

View full text