Evaluation of the effectiveness of basic pediatric cardiopulmonary resuscitation training by testing

Abstract

In 1988 the American Heart Association (AHA) and the American Academy of Pediatrics (AAP) introduced fi rst pediatric courses, pediatric basic life support 34 Матеріали навчально-методичної конференції 18 квітня 2018 року (PBLS) and pediatric advanced life support (PALS). Since 2004 the use of automated external defi brillators (AED) on children was approved by the AHA. In 2010 the AHA updated their CPR guidelines which stated the importance of high quality CPR (suffi cient rate and depth without excessively ventilating) and the changes of the order of interventions from airway, breathing, chest compressions (ABC) to chest compressions, airway, breathing (CAB). The AHA’s PBLS and PALS courses have been updated to refl ect new science in the 2015 AHA Guidelines update for CPR, these recommendations were used as basis for working-out of both basic pediatric CPR training and set of tests for evaluation of its effectiveness. We have developed a base of paper tests same both for initial and fi nal testing of students for cardiopulmonary resuscitation (CPR) skills. Total number of tests was 24 short questions with single answer choice out of 4 proposed answers. These tests were chosen out of 40 free available tests on offi cial AHA website. Set of 24 tests consisted of 12 questions on PBLS (6 of basic CPR, 6 of fi rst aid) and 12 questions on ALS (5 of advanced cardiovascular life support including AED use and 7 of PALS). Students of specialty “Medical Psychology” in small groups participated in 1,5 hours training instructor-led course in the specially equipped classroom, a series of videos and simulated pediatric emergencies were used in order to reinforce the important concepts of a systematic approach to pediatric assessment, basic life support, management algorithms, effective resuscitation and team dynamics. The goal of the basic CPR and PBLS course was to improve the quality of initial care provided to injured children, except neonates. The tasks of the course were to master high-quality child CPR AED and infant CPR, to recognize patients who do and do not require immediate intervention, to recognize cardiopulmonary arrest early and application of CPR within 10 seconds in order to pass successfully the 1- and 2-rescuer child BLS with awareness of AED use and 1- and 2-rescuer infant BLS skills. Testing was implemented before and after training course, every attempt lasted up to 10 min. Only fi rst 12 tests were used to evaluate the effectiveness of basic CPR training, while the rest 12 questions were used as control set. Current and fi nal academic achievements and results of test anxiety testing were used for association assessment. The results of initial total testing was average of 12,4±2,2 correct answers (minmax: 11-16) or 51,7% and fi nally there was an improvement up to average 16,4±2,2 (p<0,0001) of the sum of initially correct and corrected for proper answers (min-max: 14-22) or 68,3%. Taking into account gain of correct answers and loss due to wrong corrections of initially true answers 60% of students had improved initial results and 40% of participants have not changed them. PBLS testing was average of 6,0±1,2 correct answers (min-max: 5-8) or 50,0% and fi nally there was an improvement up to average 7,2±1,3 of correct answers (minmax: 6-9) (p<0,17) or 60% (min-max: 50-75%). PALS testing was average of 6,4±1,5 correct answers (min-max: 5-8) or 53% with exactly the same fi nal results (p>0,05). There was almost signifi cant difference in gain of correct answers of PBLS versus PALS – 1,2±0,5 versus 0±1,2 correspondingly (p<0,08). All 100% of students have improved their initial results in the PBLS set of tests. 35 “Досвід та проблеми підготовки студентів на додипломному етапі” The best fi nal results with non-signifi cant gain were demonstrated in basic CPR testing: 3,2±1,3 of correct answers (min-max: 2-5) or 53% with improvement up to 3,6±1,0 (p<0,54) of correct answers (min-max: 3-5) or 60%. Signifi cant gain of correct answers was observed in fi rst aid set of tests: 2,8±0,5 of correct answers (min-max: 2-3) or 47% with improvement up to 3,6±1,0 (p<0,04) of correct answers (min-max: 3-4) or 60%. Results of PALS testing have not changed in dynamics: 3,6±1,3 of correct answers (min-max: 2-5) initially and 3,6±1,5 of correct answers (min-max: 1-5) fi nally or 51,4% (p>0,05), as well as results of advanced cardiovascular life support including AED: 2,8±0,8 of correct answers (min-max: 2-4) initially and 2,8±1,1 of correct answers (min-max: 1-4) fi nally or 56% (p>0,05). According to correlation analysis the fi nal results of total testing signifi cantly associated with initial basic CPR testing results (r=0,93; p<0,02), anxiety testing results (r=0,93; p<0,03), and the gain of fi nal CPR testing signifi cantly associated with improvement in step II testing results in Pediatrics (r=0,88; p<0,05). Conclusions. According to fi nal BLS skills testing in order to improve students’ basic pediatric CPR skills the AED simulator is to be added to the equipment for the training with manikins. Effectiveness of the basic CPR training was approved by the significant increase in correct answers of final total testing as compared to initial testing due to set of testing of pediatric BLS and first aid skills.