Elsevier

Resuscitation

Volume 71, Issue 2, November 2006, Pages 229-236
Resuscitation

Training and educational paper
Eighth grade students become proficient at CPR and use of an AED following a condensed training programme

https://doi.org/10.1016/j.resuscitation.2006.03.015Get rights and content

Summary

Objective

To evaluate a new, 1-h, condensed training programme to teach continuous chest compression cardiopulmonary resuscitation (CCC-CPR) and automated external defibrillator (AED) skills to a cohort of eight grade public school students.

Methods

  • Study design-prospective, interventional trial;

  • Study population-convenience sample of students from two eighth grade classes;

  • Study setting-urban, public school;

  • Study protocol-written parental consent was obtained. Student attitudes, prior experience and baseline knowledge were sampled using an initial questionnaire and a modified American Heart Association (AHA) CPR/AED pretest. Students received training in continuous chest compression CPR (CCC-CPR) and AED use through a new condensed training programme. Student CCC-CPR and AED skills were immediately tested in a standardized fashion by the study team. Four weeks later, written and practical examinations were retaken by the same students supervised by the study team. Examination score differences were analyzed using matched pair t-tests. All tests were two tailed with alpha set at 0.05. Confidence Intervals (CI) 95% were calculated as appropriate. The primary outcome measure was the percentage of students who could correctly perform CCC-CPR and application/operation of an AED in a mock adult cardiac arrest scenario.

Results

Thirty-three eligible subjects completed the programme; mean age 13.7 years; 48.5% female. Eight participants reported some prior training in CPR and AED use. Following initial training, 29/33 (87.8%) subjects demonstrated proficiency at CCC-CPR and AED application/operation in a mock adult cardiac arrest scenario. At four-weeks, 28/33 (84.8%) subjects demonstrated skill retention in similar scenario testing. Subjects also showed improvement in written knowledge regarding AED use as shown by scores on an AHA based written exam (60.9% versus 77.3%; p < 0.001).

Conclusion

With our focused, condensed training program, eighth grade public school students became proficient in CCC-CPR and AED use. This is the first study to document the ability of middle school students to learn and retain CCC-CPR and AED skills for adult sudden cardiac arrest victims with such a curriculum.

Introduction

Sudden Cardiac Arrest (SCA) is a leading cause of death, claiming approximately 300,000 lives each year in the United States.1 Outcome after SCA is dependent on critical interventions; particularly effective chest compressions, early defibrillation, and advanced life support (AHA Scientific Statement 2004).2 With current health care delivery systems in place, survival to hospital discharge remains extremely poor with estimates at or below 5%.2 In many of the nation's largest cities, neurologically intact survival is as low as 1%.3

The reasons for the dismal survival rates are many but two major contributing factors are the lack of bystander initiated CPR, and the apparent underuse of AEDs by the lay public. Both of these have been clearly documented in the state of Arizona through instituting a statewide cardiac arrest and AED registry termed the Save Hearts in Arizona Registry and Education (SHARE) Program. The lack of bystander initiated CPR can potentially be overcome in Arizona and globally by teaching chest compression only, or continuous chest compression CPR (CCC-CPR). Chest compression only CPR has been shown in animals to be dramatically better than no bystander CPR and even better than CPR with mouth-to-mouth rescue breathing when chest compressions were interrupted for a realistic 16 s for rescue breathing.4 A recent abstract from the KANTO area of Japan involving 4241 witnessed out-of-hospital cardiac arrests reports statistically improved survival with bystander chest compression only CPR versus chest compression CPR with ventilation.5 Secondly, while AEDs have been shown in a variety of settings to improve survival when used by certified trained individuals, lay individuals rarely use them.6 Both of these major problems could be overcome if citizens were taught bystander chest-compression-only CPR along with the use of AEDs.

Because time to defibrillation remains a critical element in a successful resuscitation, the automated external defibrillator (AED) was developed to broaden the pool of available rescuers. The addition of AED training to CPR training in lay volunteers has been shown to produce superior survival compared to conventional CPR training alone.7 Several studies have even demonstrated that very young previously untrained children can be taught to successfully operate an AED.8, 9

Education and public participation, however, remain the cornerstones in promoting and developing a successful public access defibrillation (PAD) programme. With a ready pool of young potential rescuers available in our public schools, we sought to develop a new condensed CPR/AED curriculum that could easily be incorporated into public school education.

For the purpose of our present study, we developed a 1-h, condensed AED/CPR training programme addressing the most common victim of cardiac arrest, the adult. Subsequently, we conducted a prospective investigation to test the hypothesis that a sample of eighth grade students would demonstrate and retain proficiency at continuous chest compression (CCC)-CPR and AED use after administration of a condensed, 1-h, training programme at their school during classroom hours.

Section snippets

Study design

This was a prospective, interventional investigation.

Study setting

The study was conducted at Madison Meadows Middle School located in Phoenix, Arizona. The school is located in a suburban neighborhood of generally middle class families. Phoenix Children's Hospital (Phoenix, Arizona) served as the study's sponsoring institution and its IRB approved the protocol prior to study initiation.

Study population

The Madison Meadows Middle School was chosen as the site of the study due to its reputation as a strong public school

Results

There were 42 students who were eligible to participate in the programme. Of those, 33 received parental consent and completed the programme. The additional 9 students received parental consent and completed the initial training. Regrettably they were never tested. They were, however, recaptured without further education and tested 4 weeks later. Subjects mean age was 13.7 years and 48.5% were female. Eight participants reported some prior training in CPR and AED use. Following initial

Discussion

Because ventricular fibrillation remains the most common treatable rhythm in cardiac arrest, rapid access to defibrillation is critical to a successful resuscitation.10 It has been stated that chances for successful defibrillation decrease by about 7–10% for every 1-min delay in delivering electrical counter-shock therapy for ventricular fibrillation.2 Thus, any delay in treatment greatly reduces the chances for a successful resuscitation. Cities that have low survival rates have long delays

Study limitations

Our study suffers from several limitations. These include small sample size, a narrow population demographics, and incomplete data collection. We chose the sample size based on the size of two eighth grade classes at the participating school within a specific class period. Our goal was to insert the CPR/AED training programme into a typical school day without disruption of the general curriculum for that day. Although we asked if prior to this study students had received any CPR and AED

Conclusion

With our focused, condensed training programme, eighth grade public school students became proficient in CCC-CPR and AED use. This is the first study to document the ability of middle school students to learn and retain CCC-CPR and AED skills for adult sudden cardiac arrest victims with such a curriculum.

Acknowledgements

The authors are grateful to Mr. Marc Ashton, Ashton Safety and the Zoll Medical Corporation for providing AEDs and manikins for the project, Kristin Slee, RN for her assistance in both training and testing of students, Mr. Richard Porter, Arizona Department of Health Services Office of Epidemiology and Statistics for providing statistical guidance and analysis, and the Madison Meadows Middle School, Phoenix, Arizona for generously allowing this project on their campus.

References (12)

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    The same applies to the use of AED in schoolchildren CPR. There is an increasing body of scientific evidence that even younger schoolchildren of both genders can easily learn the usage of AED [46,55–57]. However, as only 25–50% of the patients suffer from ventricular fibrillation at the onset of advanced life support [58], inclusion of AED in schoolchildren CPR curricula remains debated [47].

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    Automated External Defibrillator (AED) usage is essential to improving sudden cardiac arrest outcome (Hallstrom et al., 2004; La Torre et al., 2008), and is a vital part of CPR education (Reder & Quan, 2003). Previous studies have shown successful CPR training in school-aged children (Jones et al., 2007; Connolly et al., 2007), but only few have included AED education as part of their program (Kelley et al., 2006). Over the past few years, the amount of schools and public facilities that have introduced Automated External Defibrillators (AED) has increased.

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A Spanish translated version of the summary of this article appears as Appendix in the online version at doi:10.1016/j.resuscitation.2006.03.015.

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