Department of Anesthesia and Critical Care, Children's Hospital of Philadelphia, Philadelphia, PA, United States.
Resuscitation. 2012 Dec;83(12):1484-90. doi: 10.1016/j.resuscitation.2012.04.014. Epub 2012 May 3.
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.
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.
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.
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.
全球每年有三分之一的人死于心血管疾病，但在资源有限的情况下，没有强有力的证据支持任何特定的心肺复苏（CPR）教学方法。我们假设现有的和新的 CPR 培训计划都会对博茨瓦纳的医院医护人员（HCP）的技能产生重大影响。
HCP 被前瞻性随机分为 3 个培训组：讲师主导、有限讲师加人体模型反馈或自主学习。在培训前、培训后立即以及 3 个月和 6 个月时收集数据。前瞻性地将优秀的 CPR 定义为至少有 4 个以下 5 个特征：深度、速率、释放、无气流分数和无过度通气。使用广义估计方程（GEE）来解释组内相关性。
在 214 名接受培训的 HCP 中，40%的人每月至少进行 1 次复苏，28%的人之前接受过正式的 CPR 培训，65%的人需要根据 AHA 标准进行额外的技能纠正才能通过。优秀的 CPR 技能获得具有显著意义（婴儿：32%对 71%，p<0.01；成人：28%对 48%，p<0.01）。婴儿 CPR 技能保留在 3 个月（39%对 70%，p<0.01）和 6 个月（38%对 67%，p<0.01）时具有显著意义，成人 CPR 技能保留至 3 个月（34%对 51%，p=0.02）。在多变量分析中，低认知评分和需要技能纠正，而不是教学方法，影响了 CPR 技能表现。
资源有限环境中的 HCP 经常进行复苏，但接受的 CPR 培训很少。使用现有的培训，HCP 可以获得和保留技能，但通常需要纠正。与传统教学相比，具有增加学生与教师比例和反馈人体模型的新技术并没有不同。
