To the Editor:
The incidence of out of hospital cardiac arrest is unknown in Cuba. In the United Kingdom it is 123 per 100 000 per year1. Starting cardiopulmonary resuscitation (CPR) as soon as possible after an out of hospital cardiac arrest occurrence, significantly increases survival rates2. It is important to train many persons in Basic Life Support (BLS) to provide a satisfactory CPR whenever a cardiac arrest occur. BLS training courses must be: easy to teach, easy to learn, easy to remember and skilled retained. Previous studies have found that after an initial training course CPR skills decline as early as two weeks later3. Commercial centers are visited by thousands people every day, but in our city, shop assistants are not CPR trained. The aim of the present research is to determine the 12 weeks skills retention of the BLS training course given to shop assistants of a commercial center in the city of Sagua la Grande.
A prospective and educational intervention research carried out from December, 2009 to March 2010. The commercial center "La Sirena" was randomised selected over 32 stores in Sagua la Grande city. Informed consent was obtained from the General Manager and all participants in the study. 16 shop assistants were enlisted in the study.
BLS training course: three sessions BLS training course based in the The European Resuscitation Council Guidelines for Resuscitation 2005 4 was developed (Copyright European Resuscitation Council - www.erc.edu - approval 2009/026). The course, the performance of BLS and the evaluation were carried out after the employees finished their daily work. First session: Complete information about the research. Pre-test to evaluate the participants' knowledge about CPR (16 participants). Second session: view and discussion of a BLS course video specially produced in collaboration with Sagua Vision TV channel. Third session: performance under the surveillance of three BLS instructors, manoeuvres to determine vital signs, open airways, chest compressions, mouth to mouth breathing and final rescue positioning of the victim.
A theoretical and practical post test was applied; the evaluation including the observation and evaluation of the CPR manoeuvres performed and the marks of the theoretical test of each participant was recorded (13 subjects). 12 weeks later a final theoretical and practical evaluation was carried out to determine the skills retention (14 subjects). The evaluation by three BLS instructors was consider satisfactory when 70 percent or more of the CPR manoeuvres were carried out without difficulties and the 70 percent or more of the theoretical question were answered correctly.
All participants failed the pre-test in the first session; the third session final practical CPR performance and theoretical test was passed by 11 shop assistants (84,6%); finally, 10 subjects (71,4%) failed the theoretical and practical test set 12 weeks after the Basic Life Support course.
Main finding: Must of the shop assistants involved in the study failed both, practical and theoretical tests 12 weeks after the course.
Strengths and weaknesses of the study: the randomised selection of the commercial center ensured the truthfulness of the main result. All subjects gave the informed consent to participate in the study. The quality of the video used in the course was the best.
Weakness: age, sex and educational level of participants were not taken into account to discriminate the difference between both, successful and failure participants. The observations of the BLS instructors do not detail the rate of chest compressions and the mouth to mouth breathing. Automated external defibrillation training was not given because in the included commercial center this device was not available.
Proposals for future studies: include the variables: age, sex, educational level in the design of future studies. Develop all sessions at the beginning of work of during the remaining days in order to avoid false results in the interpretation of the retention of skills and test marks. Automated external defibrillation training must be given in the course.
The skills of Basic Life Support course given to the shop assistants were not retained during 12 weeks.
1.- Norris RM, UK Heart Attack Study (UKHAS) Collaborative Group. Circumstances of out of hospital cardiac arrest in patients with ischaemic heart disease. Heart 2005;91:1537-1540.
2.- Larsen MP, Eisenberg MS, Cummins RO et al. Predicting survival from out-of-hospital cardiac arrest: a graphic model. Ann Intern Med 1993;22:1652-1658.
3.- Rawlins L, Woollard M, Williams J et al. Effect of listening to Nellie the Elephant during CPR training on performance of chest compressions by lay people: randomised crossover trial. BMJ 2009;339:b4707.
4.- Handley A, Koster R, Monsieurs K, Perkins G, Davies S, and Bossaert L. The European Resuscitation Council Guidelines for Resuscitation 2005. Section 2. Adult basic life support and use of automated external defibrillators. Resuscitation 2005; 67S1: S7-S23
Professor Hector Diaz Aguila
Intensive Care Department
University Hospital of Sagua la Grande.
Sagua la Grande. Villa Clara.
Email: hdiaz @ hospisag.vcl.sld.cu
Recibido 23 de mayo de 2010.
Publicado: 30 de mayo de 2010