1. 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

2. Teaching resuscitation
First Aid Workers %
Glendon et al BMJ Clin Res 1987; 294:

3. 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:

4. 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:

5. ‘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

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

7. 34-min DVD + cardboard manikin
Instructor: 4-hr Heartsaver AHA course
Todd et al. Ann Emerg Med 1998; 31:
Todd et al. Ann Emerg Med 1999; 34:

8. 2-month follow-up: better retention with video
Todd et al. Ann Emerg Med 1998; 31:
Todd et al. Ann Emerg Med 1999; 34:

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

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

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

12. 8-minute CPR course
Jones et al. Resuscitation 2007; 75:

13. 8-min DVD + use of manikin
Instructor: 1-hr HeartStart UK course
Assessment immediately after training
Jones et al. Resuscitation 2007; 75:

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

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

17. 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

18. Ventilation skills
Average ventilation volume (ml)

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

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

21. 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

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

23. 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

24. 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.