Knowledge and Skills in Cardiopulmonary Resuscitation and Effect of Simulation Training on it among Healthcare Workers in a Tertiary Care Center in India
Ayush Agarwal, Upendra Baitha, Piyush Ranjan, Neeraj K Swarnkar, Gyaninder P Singh, Dalim K Baidya, Rakesh Garg, Nishkarsh Gupta, Arindam Choudhury, Arvind Kumar, Ambuj Roy, Nitish Naik, Maroof Ahmed Khan, Naveet Wig
Keywords :
Cardiopulmonary resuscitation, Healthcare workers, Knowledge, Skills training
Citation Information :
Agarwal A, Baitha U, Ranjan P, Swarnkar NK, Singh GP, Baidya DK, Garg R, Gupta N, Choudhury A, Kumar A, Roy A, Naik N, Khan MA, Wig N. Knowledge and Skills in Cardiopulmonary Resuscitation and Effect of Simulation Training on it among Healthcare Workers in a Tertiary Care Center in India. Indian J Crit Care Med 2024; 28 (4):336-342.
Aim and background: High-quality cardiopulmonary resuscitation (CPR) is associated with improved patient outcomes, but healthcare workers (HCWs) may be frequently undertrained. This study aimed to assess baseline knowledge and skills among HCWs about basic and advanced life support and the effect of simulation-based training on it. Methods: It was a single-center prospective quasi-interventional study among resident doctors and nurses at a Tertiary Center in New Delhi, India. A questionnaire-based assessment was done to assess baseline knowledge. The participants then underwent simulation-based training followed by questionnaire-based knowledge assessment and skill assessment. A repeat questionnaire-based assessment was done 6 months post-training to assess knowledge retention. Results: A total of 82 HCWs (54 doctors and 28 nurses) were enrolled. The participants scored 22.28 ± 6.06 out of 35 (63.65%) in the pre-training knowledge assessment, with low scores in post-cardiac arrest care, advanced life support, and defibrillation. After the training, there was a significant rise in scores to 28.32 ± 4.08 out of 35 (80.9%) (p < 0.01). The retention of knowledge at 6 months was 68.87% (p < 0.01). The participants scored 92.61 ± 4.75% marks in skill assessment with lower scores in chest compressions and team leadership roles. There was a positive correlation (r = 0.35) between knowledge and skills scores (p < 0.01). Conclusion: There is a progressive decrease in baseline knowledge of HCWs with the further steps in the adult chain of survival. The simulation training program had a positive impact on the knowledge of HCWs. The training programs should focus on defibrillation, advanced life support, post-cardiac arrest care, and leadership roles.
Meaney PA, Topjian AA, Chandler HK, Botha M, Soar J, Ber RA, et al. Resuscitation training in developing countries: A systematic review. Resuscitation 2010;81(11):1462–1472. DOI: 10.1016/j.resuscitation.2010.06.024.
Price CSG, Bell SF, Janes SEJ, Ardagh M. Cardio-pulmonary resuscitation training, knowledge and attitudes of newly-qualified doctors in New Zealand in 2003. Resuscitation 2006;68(2):295–299. DOI: 10.1016/j.resuscitation.2005.07.002.
Silverplats J, Södersved Källestedt M-L, Wagner P, Ravn-Fischer A, Äng B, Strömsöe A. Theoretical knowledge and self-assessed ability to perform cardiopulmonary resuscitation: A survey among 3044 healthcare professionals in Sweden. Eur J Emerg Med 2020;27(5): 368–372. DOI: 10.1097/MEJ.0000000000000692.
Jensen ML, Hesselfeldt R, Rasmussen MB, Mogensen SS, Frost T, Jensen MK, et al. Newly graduated doctors’ competence in managing cardiopulmonary arrests assessed using a standardized Advanced Life Support (ALS) assessment. Resuscitation 2008;77(1):63–68. DOI: 10.1016/j.resuscitation.2007.10.022.
Ghauri SK, Javaeed A, Shah F, Ghani MUH. Dismal situation of cardio pulmonary resuscitation knowledge and skills among junior doctors in twin cities of Pakistan. Pak J Med Sci 2019;35(5):1295–1300. DOI: 10.12669/pjms.35.5.785.
Baldi E. Lack of cardiopulmonary resuscitation knowledge among young medical doctors: A Worldwide Issue. Indian J Crit Care Med 2021;25(1):106. DOI: 10.5005/jp-journals-10071-23701.
Chandran KV, Abraham SV. Basic life support: Need of the hour – A study on the knowledge of basic life support among young doctors in India. Indian J Crit Care Med 2020;24(5):332–335. DOI: 10.5005/jp-journals-10071-23442.
Agarwal A, Ranjan P, Rohilla P, Saikaustubh Y, Sahu A, Dwivedi SN, et al. Development and validation of a questionnaire to assess preventive practices against COVID-19 pandemic in the general population. Prev Med Rep 2021;22:101339. DOI: 10.1016/j.pmedr.2021.101339.
Agarwal A, Ranjan P, Saikaustubh Y, Rohilla P, Kumari A, Prasad I, et al. Development and validation of a questionnaire for assessing preventive practices and barriers among health care workers in COVID-19 pandemic. Indian J Med Microbiol 2021;39(2):200–211. DOI: 10.1016/j.ijmmb.2021.03.006.
Panchal AR, Bartos JA, Cabañas JG, Donnino MW, Drennan IR, Hirsch KG, et al. Part 3: Adult basic and advanced life support: 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 2020;142(16_suppl_2):S366–S468. DOI: 10.1161/CIR.0000000000000916.
Wyckoff MH, Singletary EM, Soar J, Olasveengen TM, Greif R, Liley HG, et al. 2021 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with treatment recommendations: Summary from the basic life support; Advanced life support; Neonatal life support; Education, implementation, and teams; First aid task forces; and the COVID-19 working group. Resuscitation 2021;169:229–311. DOI: 10.1016/j.resuscitation.2021.10.040.
Soar J, Böttiger BW, Carli P, Couper K, Deakin CD, Djarv T, et al. European Resuscitation Council Guidelines 2021: Adult advanced life support. Resuscitation 2021;161:115–151. DOI: 10.1016/j.resuscitation.2021.02.010.
Olasveengen TM, Semeraro F, Ristagno G, Castren M, Handley A, Kuzovlev A, et al. European Resuscitation Council Guidelines 2021: Basic Life Support. Resuscitation 2021;161:98–114. DOI: 10.1016/j.resuscitation.2021.02.009.
Garg R, Ahmed SM, Kapoor MC, Rao SC, Mishra BB, Kalandoor MV, et al. Comprehensive cardiopulmonary life support (CCLS) for cardiopulmonary resuscitation by trained paramedics and medics inside the hospital. Indian J Anaesth 2017;61(11):883–894. DOI: 10.4103/ija.IJA_664_17.
Bhatnagar V, Tandon U, Jinjil K, Dwivedi D, Kiran S, Verma R. Cardiopulmonary resuscitation: Evaluation of knowledge, efficacy, and retention in young doctors joining postgraduation program. Anesth Essays Res 2017;11(4):842–846. DOI: 10.4103/aer.AER_239_16.
Lum ME, Galletly DC. Resuscitation skills of first year postgraduate doctors. N Z Med J 1989;102(873):406–408. PMID: 2761878.
Lowenstein SR, Hansbrough JF, Libby LS, Hill DM, Mountain RD, Scoggin CH. Cardiopulmonary resuscitation by medical and surgical house-officers. Lancet 1981;318(8248):679–681. DOI: 10.1016/s0140-6736(81)91008-4.
Amien N, Bresick G, Evans K. Preparedness for paediatric cardiopulmonary resuscitation amongst medical doctors working in primary health care facilities in Cape Town, South Africa. S Afr Fam Pract (2004), 2022;64(1):e1–e8. DOI: 10.4102/safp.v64i1.5323.
Gebremedhn EG, Gebregergs GB, Anderson BB. The knowledge level of final year undergraduate health science students and medical interns about cardiopulmonary resuscitation at a university teaching hospital of Northwest Ethiopia. World J Emerg Med 2014;5(1):29–34. DOI: 10.5847/wjem.j.issn.1920-8642.2014.01.005.
Roshana S, Kh B, Rm P, Mw S. Basic life support: Knowledge and attitude of medical/paramedical professionals. World J Emerg Med 2012;3(2):141–145. DOI: 10.5847/wjem.j.issn.1920-8642.2012.02.011.
Majid A, Jamali M, Ashrafi MM, Ul Haq Z, Irfan R, Memon MM, et al. Knowledge and attitude towards cardiopulmonary resuscitation among doctors of a tertiary care hospital in Karachi. Cureus 2019;11(3):e4182. DOI: 10.7759/cureus.4182.
Sunde K, Pytte M, Jacobsen D, Mangschau A, Jensen LP, Smedsrud C, et al. Implementation of a standardised treatment protocol for post resuscitation care after out-of-hospital cardiac arrest. Resuscitation 2007;73(1):29–39. DOI: 10.1016/j.resuscitation.2006.08.016.
Au K, Lam D, Garg N, Chau A, Dzwonek A, Walker B, et al. Improving skills retention after advanced structured resuscitation training: A systematic review of randomized controlled trials. Resuscitation 2019;138:284–296. DOI: 10.1016/j.resuscitation.2019.03.031.
Suseel A, Panchu P, Abraham SV, Varghese S, George T, Joy L. An analysis of the efficacy of different teaching modalities in imparting adult cardiopulmonary resuscitation skills among first-year medical students: A pilot study. Indian J Crit Care Med 2019;23(11):509–512. DOI: 10.5005/jp-journals-10071-23284.
Yeung J, Meeks R, Edelson D, Gao F, Soar J, Perkins GD. The use of CPR feedback/prompt devices during training and CPR performance: A systematic review. Resuscitation 2009;80(7):743–751. DOI: 10.1016/j.resuscitation.2009.04.012.
Abolfotouh MA, Alnasser MA, Berhanu AN, Al-Turaif DA, Alfayez AI. Impact of basic life-support training on the attitudes of health-care workers toward cardiopulmonary resuscitation and defibrillation. BMC Health Serv Res 2017;17(1):674. DOI: 10.1186/s12913-017-2621-5.
Sodhi K, Singla MK, Shrivastava A. Impact of advanced cardiac life support training program on the outcome of cardiopulmonary resuscitation in a tertiary care hospital. Indian J Crit Care Med 2011;15(4):209–212. DOI: 10.4103/0972-5229.92070.
Enweronu-Laryea C, Engmann C, Osafo A, Bose C. Evaluating the effectiveness of a strategy for teaching neonatal resuscitation in West Africa. Resuscitation 2009;80(11):1308–1311. DOI: 10.1016/j.resuscitation.2009.08.005.