Breckwoldt Jan, Cheng Adam, Lauridsen Kasper G, Lockey Andrew, Yeung Joyce, Greif Robert
Institute of Anesthesiology, Zurich University Hospital, University of Zurich, Zurich, Switzerland.
Departments of Pediatrics and Emergency Medicine, University of Calgary, Calgary, Canada.
Resusc Plus. 2023 Aug 28;16:100457. doi: 10.1016/j.resplu.2023.100457. eCollection 2023 Dec.
To compare the effectiveness of Peyton's four-step approach for teaching resuscitation skills with alternative approaches.
For this systematic review, we followed the PICOST format (population, intervention, comparison, outcome, study design, timeframe) using Peyton's four-step approach as the standard. We included all studies analyzing skills training related to resuscitation and First Aid in any educational setting. Eligible were randomized controlled trials (RCTs) and non-randomized studies (non-randomized controlled trials, interrupted time series, controlled before-and-after studies, cohort studies, published conference abstracts, and case series where ≥ 5). We excluded unpublished results (e.g. trial protocols), commentaries, editorials, reviews. Medline, Embase, PsycINFO, ERIC, CINAHL, and Cochrane were searched from inception until November 10, 2020 (updated November 25, 2022) for publications in all languages as long as there was an English abstract. Titles and abstracts of the papers retrieved were screened, and eligible publications were analysed in full text. From the final set of papers, data were extracted into a spreadsheet, subsequently risk of bias assessment was performed (using RoB2 and ROBINS-I), and the certainty of evidence (using GRADE) for each paper was assessed. Screening of studies, data extraction, risk-of-bias assessment, and assessment of certainty of evidence were all performed by two independent researchers. This review was conducted in adherence with PRISMA standards and was registered with PROSPERO (CRD42023377398).
Overall, the search identified 2,574 studies from which 17 were included in the final analysis (14 RCTs, and 3 non-RCTs). The studies involved a total of 2,906 participants from various populations (from lay persons to health care professionals) and analysed nine different resuscitation skills being taught (ranging from chest compressions to needle cricotomy). The alternative teaching approaches ranged from two-steps to five-steps with various modifications of single steps. High methodological and clinical heterogeneity precluded a meta-analysis from being conducted. The risk of bias assessment showed considerable variation between the studies ranging from 'low' to 'serious'. Across all studies, certainty of evidence was rated as very low due to imprecision and inconsistency. Overall, 14 out of 17 studies showed no difference in skill acquisition or retention when comparing Peyton's four steps to other stepwise approaches.
Very low certainty evidence suggest that Peyton's four-step approach was not more effective in resuscitation skills training compared to alternative approaches.
None.
比较佩顿四步法与其他方法在心肺复苏技能教学中的有效性。
在本系统评价中，我们采用佩顿四步法作为标准，遵循PICOST格式（人群、干预措施、对照、结局、研究设计、时间范围）。我们纳入了所有分析在任何教育环境中与心肺复苏和急救相关技能培训的研究。符合条件的有随机对照试验（RCT）和非随机研究（非随机对照试验、中断时间序列、前后对照研究、队列研究、已发表的会议摘要以及≥5例的病例系列）。我们排除未发表的结果（如试验方案）、评论、社论、综述。检索了Medline、Embase、PsycINFO、ERIC、CINAHL和Cochrane数据库，从建库至2020年11月10日（2022年11月25日更新），检索所有语言的出版物，只要有英文摘要即可。对检索到的论文标题和摘要进行筛选，对符合条件的出版物进行全文分析。从最终的论文集中，将数据提取到电子表格中，随后进行偏倚风险评估（使用RoB2和ROBINS - I），并对每篇论文的证据确定性（使用GRADE）进行评估。研究筛选、数据提取、偏倚风险评估和证据确定性评估均由两名独立研究人员进行。本评价遵循PRISMA标准进行，并在PROSPERO（CRD42023377398）注册。
总体而言，检索共识别出2574项研究，其中17项纳入最终分析（14项RCT和3项非RCT）。这些研究共涉及来自不同人群（从普通民众到医疗保健专业人员）的2906名参与者，并分析了所教授的九种不同的心肺复苏技能（从胸外按压到环甲膜切开术）。替代教学方法从两步法到五步法，单一步骤有各种不同的变体。方法学和临床异质性较高，无法进行荟萃分析。偏倚风险评估显示，各研究之间存在很大差异，从“低”到“严重”不等。在所有研究中，由于不精确性和不一致性，证据确定性被评为非常低。总体而言，17项研究中有14项表明，将佩顿四步法与其他逐步方法进行比较时，在技能获得或保留方面没有差异。
证据确定性非常低表明，与其他方法相比，佩顿四步法在心肺复苏技能培训中并不更有效。
无。
