Wolfe Heather, Maltese Matthew R, Niles Dana E, Fischman Elizabeth, Legkobitova Veronika, Leffelman Jessica, Berg Robert A, Nadkarni Vinay M, Sutton Robert M
From the Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, PA.
Pediatr Emerg Care. 2015 Nov;31(11):743-7. doi: 10.1097/PEC.0000000000000394.
Brief, intermittent cardiopulmonary resuscitation (CPR) training sessions, "Booster Trainings," improve CPR skill acquisition and short-term retention. The objective of this study was to incorporate arterial blood pressure (ABP) tracings into Booster Trainings to improve CPR skill retention. We hypothesized that ABP-directed CPR "Booster Trainings" would improve intensive care unit (ICU) provider 3-month retention of excellent CPR skills without need for interval retraining.
A CPR manikin creating a realistic relationship between chest compression depth and ABP was used for training/testing. Thirty-six ICU providers were randomized to brief, bedside ABP-directed CPR manikin skill retrainings: (1) Booster Plus (ABP visible during training and testing) versus (2) Booster Alone (ABP visible only during training, not testing) versus (3) control (testing, no intervention). Subjects completed skill tests pretraining (baseline), immediately after training (acquisition), and then retention was assessed at 12 hours, 3 and 6 months. The primary outcome was retention of excellent CPR skills at 3 months. Excellent CPR was defined as systolic blood pressure of 100 mm Hg or higher and compression rate 100 to 120 per minute.
Overall, 14 of 24 (58%) participants acquired excellent CPR skills after their initial training (Booster Plus 75% vs 50% Booster Alone, P = 0.21). Adjusted for age, ABP-trained providers were 5.2× more likely to perform excellent CPR after the initial training (95% confidence interval [95% CI], 1.3-21.2; P = 0.02), and to retain these skills at 12 hours (adjusted odds ratio, 4.4; 95% CI, 1.3-14.9; P = 0.018) and 3 months (adjusted odds ratio, 4.1; 95% CI, 1.2-13.9; P = 0.023) when compared to baseline performance.
The ABP-directed CPR booster trainings improved ICU provider 3-month retention of excellent CPR skills without the need for interval retraining.
简短的间歇性心肺复苏（CPR）培训课程，即“强化培训”，可提高CPR技能的掌握程度和短期记忆。本研究的目的是将动脉血压（ABP）描记图纳入强化培训，以提高CPR技能的记忆。我们假设以ABP为导向的CPR“强化培训”将提高重症监护病房（ICU）医护人员在3个月内保持优秀CPR技能的能力，而无需进行间隔再培训。
使用一种能在胸外按压深度和ABP之间建立现实关系的CPR人体模型进行培训/测试。36名ICU医护人员被随机分为简短的床边以ABP为导向的CPR人体模型技能再培训组：（1）强化加组（培训和测试期间ABP可见）与（2）单纯强化组（仅培训期间ABP可见，测试期间不可见）与（3）对照组（测试，无干预）。受试者在培训前（基线）、培训后立即（掌握）完成技能测试，然后在12小时、3个月和6个月时评估记忆情况。主要结局是3个月时保持优秀CPR技能。优秀CPR定义为收缩压100mmHg或更高且按压频率为每分钟100至120次。
总体而言，24名参与者中有14名（58%）在初次培训后掌握了优秀的CPR技能（强化加组为75%，单纯强化组为50%，P = 0.21）。在对年龄进行校正后，接受ABP培训的医护人员在初次培训后进行优秀CPR的可能性高出5.2倍（95%置信区间[95%CI]，1.3 - 21.2；P = 0.02），并且与基线表现相比，在12小时（校正比值比，4.4；95%CI，1.3 - 14.9；P = 0.018）和3个月时（校正比值比，4.1；95%CI，1.2 - 13.9；P = 0.023）保持这些技能的可能性更高。
以ABP为导向的CPR强化培训提高了ICU医护人员在3个月内保持优秀CPR技能的能力，而无需进行间隔再培训。
