Self-instruction in CPR - Is less better? Dr Anthony J Handley Chairman, BLS/AED Subcommittee Resuscitation Council (UK) Chairman, BLS/AED International Course Committee European Resuscitation Council

Teaching resuscitation First Aid Workers % Glendon et al BMJ Clin Res 1987; 294: 1182-1183

Teaching resuscitation Lay members of the public Six months after the course only 6.8% of trainees were able to perform safe and effective CPR Morgan et al. BMJ 1996; 313:912-916

Teaching resuscitation Healthcare professionals Six months after training … the physicians’ and nurses’ … skills had deteriorated to near pre-training levels Curry & Gass. Canadian Med Ass J. 1987;137:491-496

‘The problem of poor retention of cardiopulmonary resuscitation skills may lie with the instructor, not the learner or the curriculum’ Kaye et al. Resuscitation 1991; 21:67-87

Video group better at ventilation Video group better at compressions Video group better at sequence Braslow et al. Resuscitation 1997; 34: 207-220

34-min DVD + cardboard manikin Instructor: 4-hr Heartsaver AHA course Todd et al. Ann Emerg Med 1998; 31: 364-369 Todd et al. Ann Emerg Med 1999; 34: 730-737

2-month follow-up: better retention with video Todd et al. Ann Emerg Med 1998; 31: 364-369 Todd et al. Ann Emerg Med 1999; 34: 730-737

Lynch et al. Resuscitation 2005; 67: 31-43

Lynch et al. Resuscitation 2005; 67: 31-43

Follow-up of same group at 2 months % Adequate performance Einspruch et al. Resuscitation 2007; 74: 476-486

8-minute CPR course Jones et al. Resuscitation 2007; 75: 350-356

8-min DVD + use of manikin Instructor: 1-hr HeartStart UK course Assessment immediately after training Jones et al. Resuscitation 2007; 75: 350-356

No difference between instructor & DVD groups: Ventilation rate Ventilation volume Compression rate Hand position Jones et al. Resuscitation 2007; 75: 350-356

Average compression depth: Instructor group = 48mm DVD group = 39mm But both just within guidelines range Jones et al. Resuscitation 2007; 75: 350-356

No previous BLS training 200 cabin and ground staff No previous BLS training Instructor course TEST TEST TEST Group 1 Video Group 2 Control video

Ventilation skills Average ventilation volume (ml)

Similar results for: - compression rate & depth - correct ratio - hands-off time

Video alone is as good as instructor alone Instructor does not add to video

Self-instruction in CPR Does it work ? Self-instructional video + manikin is effective … … it is at least as effective as instructor-led training The video can be a simple demonstration

Self-instruction in CPR Should we use it ? Yes - because it has the potential … ... to teach large numbers ... to improve cost-effectiveness

Self-instruction in CPR Should we use it ? Encourage its monitored and audited use … - prior to instructor-led assessment … … particularly for refresher training - in place of traditional instructor-led courses … … particularly for mass training

Guidelines 2010 Short video / computer self-instruction courses, with minimal or no instructor coaching, combined with hands-on practice can be considered as an effective alternative to instructor-led BLS and AED courses. Such courses should be validated to ensure that they achieve equivalent outcomes to instructor led courses. Resuscitation Council (UK). Resuscitation Guidelines 2010.