Elsevier

Resuscitation

Volume 127, June 2018, Pages 14-20
Resuscitation

Simulation and education
Basic life support training into cardiac rehabilitation programs: A chance to give back. A community intervention controlled manikin study

https://doi.org/10.1016/j.resuscitation.2018.03.018Get rights and content

Abstract

Aim

Early basic life support is crucial to enhance survival from out-of-hospital cardiac arrest but rates remain low, especially in households. High-risk groups’ training has been advocated, but the optimal method is unclear. The CArdiac REhabilitation and BAsic life Support (CAREBAS) project aims to compare the effectiveness of two basic life support educational strategies implemented in a cardiac rehabilitation program.

Methods

A community intervention study including consecutive patients enrolled on an exercise-based cardiac rehabilitation program after acute coronary syndrome or revascularization was conducted. A standard basic life support training (G-Stan) and a novel approach integrating cardiopulmonary resuscitation hands-on rolling refreshers (G-CPR) were randomly assigned to each group and compared. Basic life support performance was assessed by means of simulation at baseline, following brief instruction and after the 2-month program.

Results

114 participants were included and 108 completed the final evaluation (G-Stan:58, G-CPR:50). Basic life support performance was equally poor at baseline and significantly improved following a brief instruction. A better skill retention was found after the 2-month program in G-CPR, significantly superior for safety and sending for an automated external defibrillator. Confidence and self-perceived preparation were also significantly greater in G-CPR after the program.

Conclusions

Integrating cardiopulmonary resuscitation hands-on rolling refreshers in the training of an exercise-based cardiac rehabilitation program is feasible and improves patients’ skill retention and confidence to perform a basic life support sequence, compared to conventional training. Exporting this formula to other programs may result in increased numbers of trained citizens, enhanced social awareness and bystander resuscitation.

Introduction

Although early cardiopulmonary resuscitation (CPR) and defibrillation are crucial for improving outcomes and survival of out-of-hospital cardiac arrest (OHCA) [[1], [2], [3]], less than half of victims receive bystander assistance [4,5]. Shortening the time to advanced care is also critical, which implies performing the sequence of actions that comprise the basic life support (BLS) sequence as part of the chain of survival [6].

Most of OHCA occur at home, with particularly low reported rates of survival [7] and bystander BLS [8] compared to other settings. Patients with a cardiac history −especially of coronary disease- are at increased risk of adverse events, including sudden cardiac death [5,9,10]. BLS training among patients and their families has been encouraged [11,12] but scarcely applied. Cardiac rehabilitation programs have demonstrated to improve quality of life after myocardial infarction and reduce readmissions, cardiovascular events and cardiovascular mortality. With a comprehensive approach including risk factor modification, medication adherence and physical exercise, they have been recognized as an essential component of care [13]. Moreover, they provide a valuable educational setting for patients and ability to disseminate knowledge in their familiar and social environment. Even if they appear to be a safe and feasible frame to implement such training [14], the optimal method is unclear.

The CArdiac REhabilitation and BAsic life Support (CAREBAS) project is rooted in this concern for improving outcomes of OHCA by implementing BLS learning in a cardiac rehabilitation program at a tertiary University hospital. Even if the effectiveness of CPR rolling refreshers to achieve psychomotor competence by healthcare staff has been well characterized [[15], [16], [17], [18]], no previous studies have assessed their usefulness to remind the complete BLS sequence. This 6-month project aims to compare a new training formula integrating these CPR refreshers to a standard course regarding performance, retention and self-perceived preparation in BLS depending on the strategy assigned.

Section snippets

Methods

The project is conducted in the frame of an exercise-based cardiac rehabilitation program at a single centre in Santiago de Compostela, Galicia (Spain). The study complies with the Declaration of Helsinki and was approved by the Clinical Research Ethics Committee of our hospital.

Participants’ characteristics

A total of 114 patients were included in the study (G-Stan: 61, G-CPR: 53). Of these, 3 in each group were excluded from T2 analysis because either they abandoned the program or did not fulfil the required minimum of 80% training sessions for any reason including work, illness or injuries (Fig. 1).

Baseline characteristics are presented in Table 1. Diagnosis at admission was predominantly acute coronary syndrome (98.2%), with only two patients in G-CPR enrolling on the program after elective

Discussion

In this sample of patients with coronary disease undertaking a cardiac rehabilitation program skills to perform a BLS sequence were poor at baseline, improved substantially after brief instruction and showed opposite trends after the program, with marked deterioration in the standard-training group and reasonably maintenance in the CPR-training group. In addition, confidence and self-perceived preparation to act in a hypothetical situation of OHCA were also enhanced in the latter group. Our

Conclusions

Exercise-based cardiac rehabilitation programs provide an optimal frame to implement BLS learning among cardiac patients and their families, taking advantage of the existing resources. The integration of CPR hands-on rolling refreshers into exercise training enhanced patients’ retention of a BLS protocol, as well as their confidence and self-perceived preparation to act. This formula could be exportable to other programs on an affordable inversion, resulting in increased numbers of trained

Conflicts of interest

None.

Acknowledgements

The authors thank all those who voluntarily contributed to the realization of this project, especially C. Gómez-González for her excellent collaboration during the data collection, M. Sestayo-Fernández for her language editing and F. Gude-Sampedro and G. Prada-Ramallal for their statistical assessment.

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    A Spanish translated version of the abstract of this article appears as Appendix in the final online version at https://doi.org/10.1016/j.resuscitation.2018.03.018.

    1

    SAMID-II Network, Spain, ISCIII-Sub-Directorate General for Research Assessment and Promotion and the European Regional Development Fund (ERDF), ref. RD12/0026.

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