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Training hospital providers in basic CPR skills in Botswana: acquisition, retention and impact of novel training
Peter A Meaney1, Robert M Sutton, Billy Tsima
1Department of Anesthesia and Critical Care, Children's Hospital of Philadelphia, Philadelphia, PA, United States. meaney@email.chop.edu
Insights
Healthcare providers in resource-limited settings frequently perform cardiopulmonary resuscitation (CPR) with limited training. Both traditional and novel CPR training methods improve skills, but many providers still need remediation.
Area of Science:
- Medical Education
- Emergency Medicine
- Public Health
Background:
- Cardiovascular diseases cause one-third of global deaths annually.
- Effective cardiopulmonary resuscitation (CPR) instruction is crucial, especially in resource-limited settings.
- Evidence supporting specific CPR training methods in these areas is lacking.
Purpose of the Study:
- To evaluate the impact of existing and novel CPR training programs on hospital-based healthcare providers (HCP) in Botswana.
- To compare different CPR training modalities: instructor-led, limited instructor with manikin feedback, and self-directed learning.
Main Methods:
- Prospective randomized study involving 214 HCP in Botswana.
- Data collection at baseline, immediately post-training, and at 3 and 6 months.
- Defined "Excellent CPR" by five key characteristics; used GEE for analysis.
Main Results:
- Significant improvement in CPR skill acquisition and retention for both infant and adult CPR.
- No significant difference in skill performance based on the training method used.
- Low cognitive scores and need for remediation, not training method, impacted CPR skill performance.
Conclusions:
- HCP in resource-limited settings perform CPR frequently but often lack adequate training.
- Existing CPR training enables skill acquisition and retention, though remediation is often necessary.
- Novel training techniques did not demonstrate superior outcomes compared to traditional instruction.
Objective:
Globally, one third of deaths each year are from cardiovascular diseases, yet no strong evidence supports any specific method of CPR instruction in a resource-limited setting. We hypothesized that both existing and novel CPR training programs significantly impact skills of hospital-based healthcare providers (HCP) in Botswana.
Methods:
HCP were prospectively randomized to 3 training groups: instructor led, limited instructor with manikin feedback, or self-directed learning. Data was collected prior to training, immediately after and at 3 and 6 months. Excellent CPR was prospectively defined as having at least 4 of 5 characteristics: depth, rate, release, no flow fraction, and no excessive ventilation. GEE was performed to account for within subject correlation.
Results:
Of 214 HCP trained, 40% resuscitate ≥ 1/month, 28% had previous formal CPR training, and 65% required additional skills remediation to pass using AHA criteria. Excellent CPR skill acquisition was significant (infant: 32% vs. 71%, p<0.01; adult 28% vs. 48%, p<0.01). Infant CPR skill retention was significant at 3 (39% vs. 70%, p<0.01) and 6 months (38% vs. 67%, p<0.01), and adult CPR skills were retained to 3 months (34% vs. 51%, p=0.02). On multivariable analysis, low cognitive score and need for skill remediation, but not instruction method, impacted CPR skill performance.
Conclusions:
HCP in resource-limited settings resuscitate frequently, with little CPR training. Using existing training, HCP acquire and retain skills, yet often require remediation. Novel techniques with increased student: instructor ratio and feedback manikins were not different compared to traditional instruction.
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