Implementation of high-performance CPR by basic life support (BLS) personnel: a pilot study in Thailand

Area of Science:

• Emergency Medicine
• Public Health
• Cardiovascular Research

Background:

• High-performance cardiopulmonary resuscitation (HP-CPR), a structured pit-crew resuscitation model, enhances advanced life support (ALS) but its effectiveness in volunteer basic life support (BLS) settings is unclear.
• This study addresses the applicability of HP-CPR in volunteer-based BLS systems.

Purpose of the Study:

• To implement and evaluate HP-CPR training for BLS personnel in Bangkok, Thailand.
• To assess the impact of HP-CPR training on BLS performance using video-based process indicators.
• To analyze patient- and system-level characteristics before and after the HP-CPR intervention.

Main Methods:

• A single-center, before-and-after study was conducted at the Siriraj EMS Centre from July 2022 to January 2025.
• HP-CPR training was delivered to BLS personnel over five months.
• BLS performance was evaluated using video review of process indicators for adult non-traumatic out-of-hospital cardiac arrest (OHCA) cases.

Main Results:

• Significant improvements were noted in "counting during CPR" (0.0% vs. 66.7%) and the "hover technique" (0.0% vs. 62.5%) post-training (p < 0.01).
• Other indicators like uninterrupted CPR, AED use, and data handover showed improvement but not statistical significance.
• No significant differences were found in secondary outcomes, including AED use, CPR initiation, return of spontaneous circulation (ROSC), and survival rates.

Conclusions:

• HP-CPR training led to improvements in specific BLS process indicators within a volunteer-based EMS system.
• Larger sample sizes and further research are necessary to determine the long-term impact of HP-CPR training in volunteer EMS settings.