CPR: Time to move beyond the card?
A review of recent peer-reviewed literature surrounding the efficacy of CPR training programs for EMS providers
By Christopher Boyer
The 2015 updates to the AHA CPR guidelines include an increased emphasis on high-quality chest compressions throughout the cardiac arrest . The AHA has taken steps to help ensure quality chest compressions are delivered in the updated guidelines, such as clarifying the compression rate (100-120 compressions/minute) and tailoring the scenarios for the updated courses to include an increased focus on provider level.
The goal, of course, is to increase the efficacy of the health care provider's response to the cardiac arrest. A new study attempted to determine if the current structure of CPR courses provides adequate preparation for the prehospital response to the Out of Hospital Cardiac Arrest.
Study overview and design
"Comparison of two training programs on paramedic-delivered CPR performance" examined the efficacy of CPR delivered by paramedics after a CPR training course . The authors noted that previous research has demonstrated that CPR delivered by paramedics is typically inadequate and rarely falls in line with established resuscitation guidelines and recommended CPR training tailored to the provider scope of practice and work environment.
In order to explore the validity of this recommendation, the authors designed a CPR training course specifically for the paramedics working at the Hamas Medical Corporation in Qatar.
Eighty-six paramedics were enrolled in a new CPR training program that was tailored to the organization (the experimental group). This course included mandatory pre-course work, more frequent evaluations during the program, and theoretical scenarios surrounding the administration of CPR to various populations such as pregnant women, geriatric patients, hypothermic patients and other exceptional cases.
To compare the efficacy of this new course, 63 paramedics participated in a traditional CPR course (the control group).
Other than randomly being assigned to a CPR course, all participants received the same operational and clinical skills introductions consistent with the organizations established training process.
Results and limitations
Following the completion of the CPR course, the participants where brought back to the training center to participate in a simulated cardiac arrest. They were evaluated using a standardized rating system as they participated in a scenario using equipment from the primary response vehicle and a static CPR mannequin connected to a rhythm generator.
The researchers found that 70.9 percent of those in the experimental group (61/86) scored competent while only 7.9 percent from the control group (5/63) received a satisfactory score.
While this study yields some striking and surprising results, the fact that it was only offered in a single system in Qatar, the mannequin utilized does not provide diagnostic data about the quality of CPR, and the small sample size all serve as limitations.
Future research is needed to attempt to verify the findings of this study.
Memorable quotes from the researchers
"Tailoring CPR training to the operational role of a health care practitioner within a health care systems response to OHCA, the practitioner's clinical scope of practice, educational background and learner characteristics would likely ensure improved acquisition and retention of CPR performance during a simulated OHCA assessment."
"While new resuscitation guidelines appear to have improved the process of CPR, overall performance following traditional CPR training, as evaluated in a simulated OHCA assessment, remains poor."
"The inclusion of the tailored CPR training program of a short locally developed and custom-made video appears to have been successful in reinforcing the sequence of steps and the quality standard of CPR that the experimental group was expected to perform at."
Key takeaways for EMS providers and educators
- CPR training appears to be much more effective if performed in a manner that is consistent with the manner in which codes are conducted in the field.
- Consistent feedback throughout the CPR course is critical to identifying problem areas.
- CPR training is best done on a system-wide level that incorporates the entire response team with the course tailored to the organization.
- Expectations should be tailored to the provider level and local protocol and providers should train with other agencies who routinely respond with their agency on cardiac arrest calls.
- Training officers need to ensure all providers in their organization are afforded the opportunity to practice the response to the OHCA.
- The inclusion of a custom-made video that highlights local response protocols increases the likelihood that providers will perform as expected.
About the author
Chris Boyer, NRP, FP-C., M.A., M.P.A. functions as a lead instructor and the simulation coordinator in the paramedic program at Delaware Technical Community College. He has been an EMS provider since 1999, and has worked in the prehospital and Air Medical Environments. He is a 2003 graduate of the Pennsylvania College of Technology’s Paramedic Program and is currently pursuing the Doctor of Business Administration degree at Wilmington University. You can contact him at email@example.com
1. The American Heart Association. CPR and ECC Guidelines 2015. Dallas, Tx: The American Heart Association, 2015.
2. Comparison of two training programmes on paramedic-delivered CPR performance. Govender, Kevin, et al. London: Emergency Medicine Journal, UK.