Elsevier

Resuscitation

Volume 77, Issue 1, April 2008, Pages 87-94
Resuscitation

Manikin and simulation study
The effectiveness of cardiopulmonary resuscitation instruction: Animation versus dispatcher through a cellular phone

https://doi.org/10.1016/j.resuscitation.2007.10.023Get rights and content

Summary

Introduction

We developed a cardiopulmonary resuscitation (CPR) instruction programme using motion capture animation integrated into cellular phones. We compared the effectiveness of animation-assisted CPR instruction with dispatcher-assisted instruction in participants with no previous CPR training.

Methods

This study was a single blind cluster randomized trial. Participants were allocated to either animation-assisted CPR (AA-CPR; 8 clusters, 44 participants) group or dispatcher-assisted CPR (DA-CPR; 8 clusters, 41 participants). The overall performance and time of each step of CPR cycle were recorded on a checklist by 3 assessors. The objective performances were evaluated using the Resusci®Anne SkillReporter™ Manikin. Differences between the groups were compared using an independent t-test adjusted for the effect of clustering.

Results

The AA-CPR group had a significantly better checklist score (p < 0.001) and time to completion of 1 CPR cycle (p < 0.001) than the DA-CPR group. In an objective assessment of psychomotor skill, the AA-CPR group demonstrated more accurate hand positioning (68.8 ± 3.6%, p = 0.033) and compression rate (72.4 ± 3.7%, p = 0.015) than DA-CPR group. However, the accuracy of compression depth (p = 0.400), ventilation volume (p = 0.977) and flow rate (p = 0.627) were below 30% in both groups.

Conclusion

Audiovisual animated CPR instruction through a cellular phone resulted in better scores in checklist assessment and time interval compliance in participants without CPR skill compared to those who received CPR instructions from a dispatcher; however, the accuracy of important psychomotor skill measures was unsatisfactory in both groups.

Introduction

Since the emergence of cardiopulmonary resuscitation (CPR) and defibrillation, and the development of emergency medical systems (EMS), the survival rate of patients suffering from out-of-hospital cardiac arrest has improved substantially. Stiell et al. attributed this improvement in the survival of out-of-hospital cardiac arrest victims to three factors: bystander CPR by lay persons, first responders (fire and police department) and automatic external defibrillator (AED) application in less than 8 min.1 Bystander CPR is known to be the most important factor linked to the neurological outcome and quality of life in patients who survive.2 Despite this importance, only 14.1–38.5% of cardiac arrest victims are given bystander CPR.[3], [4], [5], [6] To improve the quality of bystander CPR, Eisenberg and co-workers suggested CPR instruction by a well-trained emergency medical dispatcher via telephone.[7], [8] Recent publications report a better survival rate in dispatcher-assisted bystander CPR compared with no CPR at all.[9], [10] Nevertheless, the caller might have difficulties understanding the instructions provided by voice. Therefore, delay in starting CPR and the capability of the instructors are the limiting factors of dispatcher-assisted CPR.[11], [12]

We hypothesized that an audio-visual animated instruction would result in a better quality bystander CPR than dispatcher-assisted instruction. In this study, we defined bystander CPR as CPR provided by a lay person who does not know how to perform CPR.

Section snippets

Participants

The study participants were hospital employees, who attended a mandatory CPR training course in the Education & Training Center of our hospital during November 2006. Each training class consisted of 5–7 non-medical personnel and was treated as a unit. After an explanatory session about the study objectives, the participants signed a consent form approved by the hospital's institutional review board committee. No commercial or financial benefits were provided to study participants.

Study design

This study was

Results

Among the 21 BLS training classes during the study period, 5 classes were excluded because medical/nursing personnel were included. The remaining 16 classes were randomly allocated to 8 classes of the DA-CPR group and 8 classes of the AA-CPR group. During the study, 7 participants (four of the DA-CPR, three of the AA-CPR group, respectively) were excluded because of an interrupted session or data acquisition error. Finally, 85 participants completed the entire session, 41 in the DA-CPR group

Discussion

With increased public awareness of the importance of bystander CPR to improve the outcome of a cardiac arrest patient, the ability to perform CPR is considered an essential skill for community members, and CPR training is becoming popular. Many instructional materials in various formats can be found on the internet such as still pictures, video clip, hand-drawn animation, among others. However, we believe that these resources cannot always replace formal, hands-on CPR training because there are

Conclusions

Audiovisual animated CPR instruction through a cellular phone resulted in better score in checklist assessment and time interval compliance in participants without CPR skill compared to those who received CPR instructions from a dispatcher; however, the accuracy of important psychomotor skill measures was unsatisfactory in both groups.

More research is needed to provide an effective and efficient CPR instruction via cellular phone to the public, the development of an optimal method for

Conflict of interest

The first author, Dr. Choa, and Yonsei University have taken out a patent for the ‘system and method for providing BLS,’ and have registered in the Korean Intellectual Property Office (Patent number: 10-0650027). CPR animation used in this study was developed and revised from the CPR instruction program that was already patented. This study was supported by a grant from the Korea Health 21 Research and Development Project, Ministry of Health and Welfare, Republic of Korea (A020608).

Acknowledgements

The authors are indebted to all the employees of Severance Hospital who participated in our study for their essential contributions.

References (25)

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A Spanish translated version of the summary of this article appears as Appendix in the final online version at doi:10.1016/j.resuscitation.2007.10.023.

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