American Heart Association Cardiopulmonary Resuscitation Guidelines

Part 16: Education, Implementation, and Teams: 2010 American Heart

Association Guidelines for Cardiopulmonary Resuscitation and Emergency

Cardiovascular Care

Farhan Bhanji, Mary E. Mancini, Elizabeth Sinz, David L. Rodgers, Mary Ann

McNeil, Theresa A. Hoadley, Reylon A. Meeks, Melinda Fiedor Hamilton, Peter A.

Meaney, Elizabeth A. Hunt, Vinay M. Nadkarni and Mary Fran Hazinski

Circulation

2010;122;S920-S933

DOI: 10.1161/CIRCULATIONAHA.110.971135

Circulation is published by the American Heart Association. 7272 Greenville Avenue, Dallas, TX

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by on December 4, 2010

Part 16: Education, Implementation, and Teams

2010 American Heart Association Guidelines for Cardiopulmonary

Resuscitation and Emergency Cardiovascular Care

Farhan Bhanji, Chair; Mary E. Mancini; Elizabeth Sinz; David L. Rodgers; Mary Ann McNeil;

Theresa A. Hoadley; Reylon A. Meeks; Melinda Fiedor Hamilton; Peter A. Meaney;

Elizabeth A. Hunt; Vinay M. Nadkarni; Mary Fran Hazinski

C ardiac arrest occurs in a wide variety of settings, from the unanticipated event in the out-of-hospital setting to anticipated arrests in the intensive care unit. Outcome from cardiac arrest is a function of many factors including the willingness of bystanders to perform cardiopulmonary resuscitation (CPR), the ability of rescuers to integrate knowledge and psychomotor skills, the quality of performance delivered by individual rescuers and teams, and the efficiency and effectiveness of post– cardiac arrest care.

The Chain of Survival is a metaphor used to organize and describe the integrated set of time-sensitive, coordinated actions necessary to maximize survival from cardiac arrest.

The use of evidence-based education and implementation strategies can optimize the links of that chain.

Strengthening the Chain of Survival in the prehospital setting requires focus on prevention and immediate recognition of cardiac arrest, increasing the likelihood of high-quality bystander CPR and early defibrillation, and improving regional systems of care. In the hospital setting, organized efforts targeting early identification and prevention of deterioration in patients at risk can decrease the incidence of cardiac arrest. The challenge for resuscitation programs is twofold: to ensure that providers acquire and maintain the necessary knowledge, skills, and team behavior to maximize resuscitation outcome; and to assist response systems in developing, implementing, and sustaining an evidence-based

Chain of Survival.

Maximizing survival from cardiac arrest requires improvement in resuscitation education and the implementation of systems that support the delivery of high-quality resuscitation and postarrest care, including mechanisms to systematically evaluate resuscitation performance. Well-designed resuscitation education can encourage the delivery of high-quality

CPR. In addition continuous quality improvement processes should close the feedback loop and narrow the gap between ideal and actual performance. Community- and hospitalbased resuscitation programs should systematically monitor cardiac arrests, the level of resuscitation care provided, and outcomes. The cycle of measurement, benchmarking, feedback, and change provides fundamental information necessary to optimize resuscitation care and maximize survival.

This chapter reviews key educational issues that affect the quality of resuscitation performance and describes major implementation and team-related issues shown to improve outcomes. The information is organized into four major categories: willingness to perform CPR, educational design, improving resuscitation quality, and issues related to implementation and outcomes.

While important concepts identified in the 2010 International Liaison Committee on Resuscitation (ILCOR) and

American Heart Association (AHA) evidence evaluation process are applied below,

1,2 this document does not include all education, implementation, and team-related topics contained within the 2010 International Consensus on Cardio-

pulmonary Resuscitation and Emergency Cardiac Care Science With Treatment Recommendations.

1,2

Willingness to Perform

Without immediate initiation of CPR, most victims of cardiac arrest will die. Bystander CPR can significantly improve survival rates from cardiac arrest,

3 but recent evidence indicates that only 15% to 30% of victims of out-of-hospital arrest receive CPR before EMS arrival.

4

Strategies to increase the incidence of bystander-initiated CPR and the use of automated external defibrillators (AEDs) are addressed in this section.

Barriers to Bystander CPR

Commonly cited reasons for reluctance to perform lifesaving maneuvers include concern for injuring the victim,

5–7 fear of performing CPR incorrectly, 6,8 –11 physical limitations, 12 fear of liability,

12 fear of infection,

10 or victim characteristics.

13–16

Opportunities exist to overcome many of these barriers through education and encouragement to perform when the bystander is faced with a victim in cardiac arrest.

In a study of actual bystanders interviewed following a 911 call in which the EMS dispatcher encouraged performance of

CPR, nonresponders most frequently cited panic (37.5%) and

The American Heart Association requests that this document be cited as follows: Bhanji F, Mancini ME, Sinz E, Rodgers DL, McNeil MA, Hoadley

TA, Meeks RA, Hamilton MF, Meaney PA, Hunt EA, Nadkarni VM, Hazinski MF. Part 16: education, implementation, and teams: 2010 American Heart

Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2010;122(suppl 3):S920 –S933.

(Circulation. 2010;122[suppl 3]:S920 –S933.)

© 2010 American Heart Association, Inc.

Circulation is available at http://circ.ahajournals.org

DOI: 10.1161/CIRCULATIONAHA.110.971135

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S920


Bhanji et al Part 16: Education, Implementation, and Teams

S921

fear of hurting the patient (9.1%) as the reasons they were unable to perform.

6 In 2 studies reviewing actual emergencies, bystanders encountered practical and understandable barriers to performance (eg, physical limitations, inability to listen to instructions and perform skills at the same time, and system delays) more often than panic or stress, although both were important factors.

17,18 Because panic can significantly impair a bystander’s ability to perform in an emergency, it may be reasonable for CPR training to address the possibility of panic and encourage learners to consider how they will overcome it (Class IIb LOE C).

Actual bystanders 6 and surveys of the general public report that people more recently trained in CPR techniques expressed greater willingness to attempt resuscitation than those without recent training.

16,19 –21 Short, self-directed video instruction is an effective and cost-efficient strategy for training rescuers.

22–33

Fear of harming the victim or fear of personal injury may reduce willingness to undertake basic life support training or to perform CPR. However infection resulting from CPR performance is extremely rare and limited to a few case reports.

34 – 44 Educating the public about the low risks to the rescuer and victim may increase willingness to perform CPR.

Some rescuers, including healthcare providers, may be more likely to initiate CPR if they have access to barrier devices. Despite the low risk of infections, it is reasonable to teach rescuers about the use of barrier devices emphasizing that CPR should not be delayed for their use (Class IIa, LOE C).

Rescuers who are not willing to perform mouth-to-mouth ventilations may be willing to perform Hands-Only (chest compression-only) CPR.

5,9,10,13,19,21,45– 47

CPR training programs should teach compression-only CPR as an alternative to conventional CPR for rescuers when they are unwilling or unable to provide conventional CPR (Class I, LOE B).

able that participants undertaking CPR training be advised of the vigorous physical activity required during the skills portion of the training program (Class IIa, LOE B).

CPR training and performance are positive experiences for most providers.

69 However, firsthand observation of an actual cardiac arrest and attempting resuscitation can be stressful.

17,55,56,70 Rescuers who suffer postevent adverse psychological effects may benefit from support or psychological counseling.

Barriers to AED Use

Some rescuers may be intimidated by the idea of delivering a shock, but AEDs are safe, 71,72 and adverse events are rare.

55,73–77

Although AEDs can be used effectively with no prior training, even brief training increases the willingness of a bystander to use an AED and improves his or her performance.

78 – 80 To maximize willingness to use an AED, publicaccess defibrillation training should continue to be encouraged for the lay public (Class I, LOE B).

In summary, although the factors influencing willingness to perform CPR are myriad, many obstacles can be overcome with education. Although the precise number of trained volunteers needed to optimize the chance that a specific victim will receive CPR is not known, it is reasonable to assume that maximizing the number of people trained in a community and providing instructions and encouragement at the time an event occurs will improve the odds that a bystander will engage in resuscitation efforts.

Education Design

Evidence-based guidelines for instruction, as well as the development of cost-effective courses, are required to improve training of providers and ultimately improve resuscitation performance and patient outcomes.

Barriers to Recognition of Cardiac Arrest

Victims of out-of-hospital cardiac arrest who are gasping have a higher survival rate compared to victims who are not gasping.

48

Gasping is commonly misinterpreted as a sign of life that may prevent rescuers from initiating resuscitation.

Potential rescuers can be taught to recognize gasping and initiate CPR.

49

Rescuers should be taught to initiate CPR if the adult victim is unresponsive and is not breathing or not breathing normally (eg, only gasping) (Class I, LOE B).

Dispatcher telephone instructions and support has been shown to increase willingness to perform CPR.

16,50,51 In order to increase bystander willingness to perform CPR, dispatchers should provide telephone CPR instructions to callers reporting an adult who is unresponsive and not breathing or not breathing normally (ie, only gasping) (Class I, LOE B).

Physical and Psychological Concerns for Rescuers

Correct performance of chest compressions is physically demanding.

52–54 In the few reports of injuries to CPR providers, most of the injuries are musculoskeletal in nature.

55–59

Case reports have described occasional complaints of shortness of breath 60 – 62 ; other isolated events 63,64 ; hand puncture wound from a sternal wire 65 ; nerve injury 66 ; pneumothorax 67 ; and one death due to a myocardial infarction.

68

It is reason-

Course Design

The appropriate application of learning theories combined with research into program effectiveness has resulted in substantial changes to the AHA Emergency Cardiovascular

Care (ECC) courses over the past quarter century. Since the development of the first ECC Guidelines in 1966,

81 the AHA has established itself as a leader in resuscitation science.

However, the AHA’s involvement in resuscitation education and training programs predates the development of formal

ECC guidelines. In 1973, the AHA first endorsed training of the lay public in CPR.

82

Subsequently, Advanced Cardiac

Life Support (ACLS) was introduced in 1974, 83,84 followed by Pediatric Advanced Life Support (PALS) in 1988.

85

In 2004 the AHA established the ECC Education Subcommittee with members including experts in curriculum and instructional design. Over time, the Education Subcommittee endorsed several educational principles as core concepts (see

Table 1). Consistent with established methodologies for program evaluation,

86 the effectiveness of resuscitation courses should be evaluated (Class I, LOE C). Although participant satisfaction is important, program evaluation should extend beyond this end point and assess learners’ acquisition and retention of knowledge and skills. Evidence that learners integrate what they learn into actual practice and



S922 Circulation

November 2, 2010

Table 1.

Core AHA ECC Educational Concepts

● Simplification - Course content should be simplified in both the presentation of the content and the breadth of content in a single course in order to facilitate accomplishment of course objectives.

22,24,25

● Consistency - Course content and skill demonstrations should be presented in a consistent manner. Video-mediated, practice-while-watching instruction is the preferred method for basic psychomotor skill training because it reduces instructor variability and potential distractions that deviate from the intended course agenda.

22–24,27–29,33

● Objectives-Based - Cognitive,

87 psychomotor, 88 and affective objectives 89 should be included in all courses.

● Hands-on Practice - Substantial hands-on practice is needed to meet psychomotor skill performance objectives.

22,24,26,28,33,90,91

● Contextual - Adult learning principles

92 should be applied to all ECC courses with emphasis on creating relevant training scenarios that can be applied practically to the learners’ real-world setting, such as having hospital-based learners practice CPR on a bed instead of the floor.

● Competency-based - Successful course completion should be based on the ability of the learner to demonstrate achievement of course objectives rather than attendance in a course/program for a specific time period.

27

● Practice to Mastery - Key skills and course content should be repeated with deliberate practice 93 to build toward mastery.

94,95

● Assessment - Evaluative strategies should assess competence and promote learning. Learning objectives 96 must be clear and measurable and serve as the basis of evaluation.

whether that ultimately improves patient outcomes would constitute more robust forms of program evaluation.

ship training have been shown to improve subsequent resuscitation performance in simulation studies 118 –123 and actual clinical performance.

124

As a result teamwork and leadership skills training should be included in advanced life support courses (Class I, LOE B).

Realistic Manikins

Some manikins utilized in resuscitation training have realistic features such as the ability to replicate chest expansion and breath sounds, to provide exhaled carbon dioxide, to generate a pulse and blood pressure, and to speak or make sounds. Two studies reported that training with such manikins improved clinical performance.

125,126 Thirteen studies showed an improvement in end-of-course skills when realistic manikins were used, 49,125,127–137 while six studies showed equal performance with lower technology manikins.

138 –143

Use of more realistic manikins in training may incur substantially higher financial costs.

144

Eight studies showed equal knowledge acquisition with realistic manikins when compared with lower-technology manikins.

128,130,138,142–146 Three studies indicated that learner satisfaction was greater with realistic manikins.

130,138,142

There is insufficient evidence to recommend for or against the routine use of more realistic manikins to improve skills performance in actual resuscitations. Realistic manikins may be useful for integrating the knowledge, skills, and behaviors in ALS training (Class IIa, LOE B). Further research is needed to confirm if such technology improves resuscitation performance in the clinical setting and to determine if it can improve survival from cardiac arrest.

Strategies for Basic Life Support (BLS) Courses

Studies have demonstrated that lay rescuer CPR skills can be acquired and retained at least as well (sometimes better) through interactive computer- and video-based synchronous practice instruction when compared with instructor-led courses.

22–33

Short video instruction combined with synchronous hands-on practice is an effective alternative to instructor-led basic life support courses (Class I, LOE A).

AED Training Requirement

Manikin-based studies have demonstrated that AEDs can be correctly operated without prior training.

79,97 Allowing the use of AEDs by untrained bystanders can be beneficial and may be lifesaving (Class IIa, LOE B). Because even minimal training has been shown to improve performance in simulated cardiac arrests,

26,78 – 80,98 training opportunities should be made available and promoted for the lay rescuer (Class I, LOE B).

Course Delivery Formats

Course delivery formats other than the standard 2-day ACLS or PALS provider course may achieve equivalent or better knowledge or skills acquisition. These formats include interactive multimedia courses 99,147,148 ; case-based presentations

149

; integration of ACLS or PALS content into a larger curriculum such as medical student or resident training 137,150,151 ; noncomputer-based, self-directed learning 152 ; problem-based learning

153,154

; or combination of resuscitation courses with other programs such as Advanced Trauma Life

Support (ATLS).

155 It is reasonable to consider alternative course scheduling formats for advanced life support courses

(eg, ACLS or PALS), provided acceptable programmatic evaluation is conducted and learners meet course objectives

(Class IIa, LOE B).

Strategies for Advanced Life Support

(ALS) Courses

Resuscitation and education literature have demonstrated that precourse preparatory strategies including computer-assisted learning tutorials, 99 –104 written self-instructional materials, 105,106 video reviews, 105 preparatory courses, 107,108 textbook reading,

109 and pretests

110,111 enhance knowledge acquisition or reduce classroom time. It is reasonable to include precourse preparatory strategies in advanced life support courses (Class IIa, LOE B).

Teamwork has been reported to impact patient outcomes in a variety of clinical situations.

112–117

Teamwork and leader-

Post-Course Assessment

Studies have shown poor correlation between written tests used in resuscitation courses and clinical skills evaluations.

156 –159 A written test should not be used exclusively to assess learner competence following an advanced life support course (Class I, LOE B).

Assessment used as an instructional tool at the end of resuscitation training has been shown to improve retention of skills at 2 weeks

160 and showed a trend toward improvement at six months.

161 End-of-course assessment may be useful in helping learners retain skills (Class IIb, LOE C).




S923

Training Intervals

Training intervals for AHA basic and advanced life support programs have traditionally been time-specific, with a maximum 2-year interval recommended. The AHA ECC Program

Administration Manual

162 notes that the course completion card “certifies that the individual has successfully completed the objectives and skills evaluations in accordance with the curriculum of the AHA for (course title).”

Reflecting the emerging trends supporting continuous maintenance of competence and continuing professional development in the healthcare professions, 163,164 there is support to move away from a time-related certification standard and toward a more competency-based approach to resuscitation education.

There is substantial evidence that basic and advanced life support skills decay rapidly after initial training. Basic skills have been shown to deteriorate when assessed at 1 to 6 months

24,27,165–167 or 7 to 12 months

168,169 following training.

Advanced life support providers demonstrated similar decays in knowledge or skills when assessed at 3 to 6 months, 165,170 –178 7 to 12 months, 179,180 and more than 12 months.

181 These studies were heterogeneous with respect to participant composition, course length, course format, instructor type, and frequency of participant involvement in actual resuscitations.

The majority reflected teaching methodologies in use prior to the most recent AHA course design updates in 2005.

In one study a 2-hour class was sufficient for participants to acquire and retain BLS skills for an extended time period, provided a brief re-evaluation was performed after 6 months.

182

Four studies showed minimal or no deterioration of skills or knowledge at 6,

79

12,

183,184 or 17 months

185 after course completion.

While the optimal mechanism for maintenance of competence is not known, the need to move toward more frequent assessment and reinforcement of skills is clear. Skill performance should be assessed during the 2-year certification with reinforcement provided as needed (Class I, LOE B). The optimal timing and method for this assessment and reinforcement are not known.

Further research is needed to determine if modifications to initial training will alter the decay curve of CPR skills.

Additional research is also needed to determine what time interval, mechanism of assessment, and method for refresher training will minimize decay in CPR skills. Innovative concepts to reduce the decay of skills and knowledge may include continuous maintenance of competency programs that employ frequent short-duration interactions with content and skills after an initial course, or they may include guided debriefings after real-life events that focus on response improvement.

Instructors and participants should be aware that successful completion of any AHA ECC course is only the first step toward attaining and maintaining competence.

AHA ECC courses should be part of a larger continuing education and continuous quality improvement process that reflects the needs and practices of individuals or systems.

Improving Resuscitation Skills

Checklists/Cognitive Aids

The quality of resuscitation is a major determinant of patient outcome. Simulation studies of basic life support,

186 –190 advanced life support,

191,192 and anesthetic emergencies

193,194 demonstrated improved performance when checklists or cognitive aids were used. However, 1 simulation study demonstrated delayed completion of 2 cycles of CPR 195 when individuals not adept at cell phone operation used a cell phone-based cognitive aid. In clinical practice, physicians perceived checklists to be useful.

196,197

The impact of cognitive aids or checklists on patient outcomes is unknown.

Checklists or cognitive aids, such as the AHA algorithms, may be considered for use during actual resuscitation (Class

IIb, LOE C). Specific checklists and cognitive aids should be evaluated to determine if they achieve the desired effect and do not result in negative consequences such as delayed response. Further research on the optimal design is warranted.

CPR Prompt or Feedback Devices

Training in CPR skills using a feedback device improves learning and/or retention.

167,183,198 –203 The use of a CPR feedback device can be effective for training (Class IIa, LOE A).

The use of feedback devices or prompts, such as metronomes, has consistently improved performance of CPR in manikin-based studies.

204 –215 In clinical practice, the use of feedback devices has resulted in improved CPR performance compared to historic or concurrent nonrandomized controls.

216 –220

However, two manikin-based studies demonstrated variable reliability of feedback devices depending on the support surface (eg, floor or mattress) on which CPR is performed.

221,222 CPR prompt and feedback devices can be useful as part of an overall strategy to improve the quality of

CPR during actual resuscitations (Class IIa, LOE B); effect on patient survival has not been demonstrated.

Debriefing

Debriefing is a learner-focused, nonthreatening technique to assist individual rescuers or teams to reflect on, and improve, performance.

223 In manikin-based studies, debriefing as part of the learning strategy resulted in improved performance in post-debriefing simulated scenarios,

121,203,224 –226 and it improved adherence to resuscitation guidelines in clinical settings.

126

Debriefing as a technique to facilitate learning should be included in all advanced life support courses (Class

I, LOE B).

Debriefing of cardiac arrest events, either in isolation 124 or as part of an organized response system,

227 improves subsequent CPR performance in-hospital and results in higher rate of return of spontaneous circulation (ROSC). Debriefing of actual resuscitation events can be a useful strategy to improve future performance (Class IIa, LOE C). Additional research on how best to teach and implement postevent debriefing is warranted.

Implementation and Outcomes

Systems Approach and Feedback Loop

Organized, cohesive resuscitation programs can improve survival from cardiac arrest by strengthening the links in the





Table 2.

System Components to Prevent or Improve Survival from In-Hospital Cardiac Arrest

System-level components to reduce the incidence of, and improving survival from, in-hospital cardiac arrest may include 231,260 :

● Systematic education on patient deterioration and its detection.

● Frequent monitoring of vital signs and assessment of at-risk hospitalized patients.

● Consistent use of predefined calling criteria or early warning scores.

● A notification system of calling for assistance.

● Rapid and effective clinical response to calls.

● Administrative support for program initiation and continuous quality improvement.

percutaneous coronary intervention

268 –270 has been shown to improve survival from cardiac arrest. Two small studies demonstrated trends toward improved survival that were not statistically significant when comprehensive packages of post– cardiac arrest care were introduced.

271,272

Although there is no direct evidence that regional systems of care for cardiac resuscitation improve outcome, extrapolation from research in other time-sensitive conditions, such as acute coronary syndromes, 273 stroke, 274,275 and trauma, 276 suggests there may be a benefit to such a system. In 2010 the

AHA published a policy statement calling for the development of regional systems of care as a strategy to reduce the variability in survival for out-of-hospital cardiac arrest.

277 It is reasonable that regional systems of care be considered as part of an overall approach to improve survival from cardiac arrest (Class IIa, LOE C).

chain of survival.

228 –230 In this section some of the key systems-based initiatives that may improve patient outcomes are presented.

Rapid Response Teams (RRTs) and Medical

Emergency Teams (METs)

RRTs and METs respond to patients who are deteriorating in noncritical-care settings; such teams may represent one piece of a rapid response system (RRS). A RRS has several components, 231 including an “afferent arm” (ie, event detection and response triggering arm); an “efferent arm” (ie, a planned response arm, such as the RRT); a qualitymonitoring arm; and an administrative support arm.

Some studies have demonstrated a reduction in cardiac arrest rates for adult patients after implementation of various components of a RRS,

232–247 while others have failed to show such a difference.

248 –253

In pediatric settings the implementation of RRSs has resulted in the prevention of respiratory arrest,

254 a decreased total number of arrests, 255,256 better survival from cardiac arrest, 256 –258 and reduction in hospital-wide mortality.

256,257,259 Implementation of a pediatric MET/RRT may be beneficial in facilities where children with high-risk illnesses are present on general inpatient units (Class IIa, LOE B).

Although conflicting evidence exists, expert consensus recommends the systematic identification of patients at risk of cardiac arrest, an organized response to such patients, and evaluation of outcomes to foster continuous quality improvement (Class I, LOE C). System components that are potentially important in reducing the incidence of, and improving survival from, in-hospital cardiac arrest are summarized in

Table 2.

Resuscitation Training in

Limited-Resource Communities

Many AHA instructors are involved in training in limitedresource environments in the United States and throughout the world. The vast majority of participants enjoy training and feel more comfortable after educational programs regardless of the type of training provided.

278 –290

Improvements in provider performance and patient outcomes following training in resource-limited environments are inconsistent, and important characteristics of students and training environment, as well as outcomes (cognitive, psychomotor skills, operational performance, patient outcome, and cost-effectiveness), are inconsistently measured. Resuscitation training, when appropriately adapted to the local providers’ clinical environment and resources, has significantly reduced mortality in developing countries.

284,291–294

The evidence from the trauma education is most compelling, and less clear with neonatal 295,296 and adult cardiac resuscitation training programs.

297 Patient outcome studies were often limited by study design, but 1 large, multicenter trial failed to show improvement in neonatal survival after newborn resuscitation training.

298

There is no strong evidence to support any specific instruction method as preferable for all clinical environments and training subject experience. There is anecdotal evidence that successful resuscitation training in developing countries requires local adaptation to clinical environments, 280,299 –301 utilizing existing and sustainable resources for both care and training, 282,300 –302 and a dedicated local infrastructure.

289,299

Regional Systems of (Emergency)

Cardiovascular Care

There is wide variability in survival to hospital discharge, one-month survival, and length of critical-care stay among hospitals caring for patients after resuscitation from cardiac arrest.

261–267

Hospitals with larger patient volumes (

⬎50 ICU cardiac arrest admissions/year) had a better survival to hospital discharge than low-volume centers (

⬍20 ICU– cardiac arrest admissions/yr) for patients treated for either inor out-of-hospital cardiac arrest.

265

Implementation of comprehensive packages of post– cardiac arrest care that included therapeutic hypothermia and

Summary

Optimizing the links in the Chain of Survival improves outcomes and saves lives. The use of evidence-based education and implementation strategies will allow organizations and communities to strengthen these links in the most effective and efficient manner.

Acknowledgments

The writing group would like to thank the members of the Education

Subcommittee of American Heart Association Emergency Cardiovascular Care for their valuable contributions in the development of this manuscript.




S925

Disclosures

Guidelines Part 16: Education Implementation and Teams Writing Group Disclosures

Writing

Group

Member

Farhan

Bhanji

Mary E.

Mancini

Employment

Montreal Children’s Hospital,

McGill University–Assistant

Professor of Pediatrics

University of Texas at

Arlington—Professor

Research Grant

None

None

Other Research

Support

None

None

Speakers’

Bureau/Honoraria

None

Elizabeth

Sinz

None None

*In the past two years have received honoraria from

Datascope for presentations at two national teaching institutes for the

American Association of Critical Care Nurses and Emergency

Nursing

Association–Topic

⫽

Improving The Chain of

Survival.

None Penn State Hershey Medical

Center–Professor of

Anesthesiology and

Neurosurgery; *American

Heart Association; Associate

Science Editor

David L.

Rodgers

Mary Ann

McNeil

Clinical Educator, the Center for Simulation, Advanced

Education and Innovation,

Children’s Hospital of

Philadelphia

None

None

None

None

None

Theresa

A. Hoadley

Reylon A.

Meeks

Melinda

Fiedor

Hamilton

Peter A.

Meaney

University of Minnesota

Medical school- Director,

Department of Emergency

Medicine

OSF St Francis College of

Nursing; Assist. Professor;

Proctor Hosp-TC coordinator

Blank Children’s

Hosp./Pleasant Hill

FD/Southwest CC, DMACC


Pittsburgh of

UPMC–Assistant Professor of

CCM and Pediatrics

University of Pennsylvania,


Philadelphia– Assistant

Professor

None

None

None

None

None

None

None

None

None

None

Elizabeth

A. Hunt

*Laerdal Foundation, Research grant

⬙Development and

Validation of a Quantitative

Measurement Device to Assess

Technical Basic Life Support

Skills in Resource Limited

Settings.

⬙ No direct support to investigator Operation Smile,

Educational development grant,

⬙Pilot Training Proposal: Acute

Care Training for the

Peri-Operative Pediatrician

⬙. No direct support to investigator

None

*Laerdal Corporation,

Research equipment

(study mankins) for

⬙Development and

Validation of a

Quantitative

Measurement Device to Assess Technical

Basic Life Support

Skills in Resource

Limited Settings.

⬙ No direct support to investigator

None None

Vinay M.

Nadkarni

Johns Hopkins University

School of Medicine–

Director, Johns Hopkins

Medicine Simulation Center

University of Pennsylvania

School of Medicine,


Philadelphia– Attending

Physician, Anesthesia,

Critical Care and Pediatrics

†AHRQ: Agency for Healthcare,

Research and Quality: PI, Grant for Evaluation of Safety of

Pediatric Tracheal Intubation and Just in Time Simulation

Education Intervention

None None

Ownership

Interest

None

*I am listed on a patent held by my

University for a sensing device that could be used for CPR.

Device has not been produced. I receive no royalties.

None

None

None

None

None

None

None

None

None

Consultant/Advisory

Board

None

None

None

None

None

None

None

None

None

None

None

Other

None

None

None

†Spouse (Robin Roberts) is an employee of the

American Heart

Association.

None

None

None

None

None

None

None

(Continued)





Guidelines Part 16: Education Implementation and Teams Writing Group Disclosures, Continued

Writing

Group

Member

Mary Fran

Hazinski

Employment

Vanderbilt Univ. School of

Nursing—Professor; AHA

ECC Product

Development—Senior

Science Editor

†I receive significant compensation as a consultant and senior science editor for the AHA

ECC Product Development

Research Grant

None

Other Research

Support

None

Speakers’

Bureau/Honoraria

None

Ownership

Interest

None

Consultant/Advisory

Board

None

Other

None

This table represents the relationships of writing group members that may be perceived as actual or reasonably perceived conflicts of interest as reported on the

Disclosure Questionnaire, which all members of the writing group are required to complete and submit. A relationship is considered to be “significant” if (a) the person receives $10 000 or more during any 12-month period, or 5% or more of the person’s gross income; or (b) the person owns 5% or more of the voting stock or share of the entity, or owns $10 000 or more of the fair market value of the entity. A relationship is considered to be “modest” if it is less than “significant” under the preceding definition.

*Modest.

†Significant.

References

1. Morley PT, Atkins DL, Billi JE, Bossaert L, Callaway CW, de Caen AR,

Deakin CD, Eigel B, Hazinski MF, Hickey RW, Jacobs I, Kleinman ME,

Koster RW, Mancini ME, Montgomery WH, Morrison LJ, Nadkarni

VM, Nolan JP, O’Connor RE, Perlman JM, Sayre MR, Semenko TI,

Shuster M, Soar J, Wyllie J, Zideman D. Part 3: evidence evaluation process: 2010 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment

Recommendations. Circulation. 2010;122(suppl 2):S283–S290.

2. Hazinski MF, Nolan JP, Billi JE, Böttiger BW, Bossaert L, De Caen AR,

Deakin CD, Drajer S, Eigel B, Hickey RW, Jacobs I, Kleinman ME,

Kloeck W, Koster RW, Lim SH, Mancini ME, Montgomery WH,

Morley PT, Morrison LJ, Nadkarni VM, O’Connor RE, Okada K,

Perlman JM, Sayre MR, Shuster M, Soar J, Sunde K, Travers AH,

Wyllie J, Zideman D. Part 1: executive summary: 2010 International

Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. Circulation.

2010;122(suppl 2):S250 –S275.

3. Sasson C, Rogers MA, Dahl J, Kellermann AL. Predictors of survival from out-of-hospital cardiac arrest: a systematic review and meta-analysis. Circ Cardiovasc Qual Outcomes. 2010;3:63– 81.

4. Abella BS, Aufderheide TP, Eigel B, Hickey RW, Longstreth WT Jr,

Nadkarni V, Nichol G, Sayre MR, Sommargren CE, Hazinski MF.

Reducing barriers for implementation of bystander-initiated cardiopulmonary resuscitation: a scientific statement from the American Heart

Association for healthcare providers, policymakers, and community leaders regarding the effectiveness of cardiopulmonary resuscitation.

Circulation. 2008;117:704 –709.

5. Hubble MW, Bachman M, Price R, Martin N, Huie D. Willingness of high school students to perform cardiopulmonary resuscitation and automated external defibrillation. Prehosp Emerg Care. 2003;7:

219 –224.

6. Swor R, Khan I, Domeier R, Honeycutt L, Chu K, Compton S. CPR training and CPR performance: do CPR-trained bystanders perform

CPR? Acad Emerg Med. 2006;13:596 – 601.

7. Moser DK, Dracup K, Doering LV. Effect of cardiopulmonary resuscitation training for parents of high-risk neonates on perceived anxiety, control, and burden. Heart Lung. 1999;28:326 –333.

8. Omi W, Taniguchi T, Kaburaki T, Okajima M, Takamura M, Noda T,

Ohta K, Itoh H, Goto Y, Kaneko S, Inaba H. The attitudes of Japanese high school students toward cardiopulmonary resuscitation. Resuscitation.

2008;78:340 –345.

9. Shibata K, Taniguchi T, Yoshida M, Yamamoto K. Obstacles to bystander cardiopulmonary resuscitation in Japan. Resuscitation. 2000;

44:187–193.

10. Taniguchi T, Omi W, Inaba H. Attitudes toward the performance of bystander cardiopulmonary resuscitation in Japan. Resuscitation. 2007;

75:82– 87.

11. Dwyer T. Psychological factors inhibit family members’ confidence to initiate CPR. Prehosp Emerg Care. 2008;12:157–161.

12. Coons SJ, Guy MC. Performing bystander CPR for sudden cardiac arrest: behavioral intentions among the general adult population in

Arizona. Resuscitation. 2009;80:334 –340.

13. Caves ND, Irwin MG. Attitudes to basic life support among medical students following the 2003 SARS outbreak in Hong Kong. Resuscitation.

2006;68:93–100.

14. Johnston TC, Clark MJ, Dingle GA, FitzGerald G. Factors influencing

Queenslanders’ willingness to perform bystander cardiopulmonary resuscitation. Resuscitation. 2003;56:67–75.

15. Boucek CD, Phrampus P, Lutz J, Dongilli T, Bircher NG. Willingness to perform mouth-to-mouth ventilation by health care providers: a survey. Resuscitation. 2009;80:849 – 853.

16. Axelsson A, Thoren A, Holmberg S, Herlitz J. Attitudes of trained

Swedish lay rescuers toward CPR performance in an emergency: a survey of 1012 recently trained CPR rescuers. Resuscitation. 2000;44:

27–36.

17. Riegel B, Mosesso VN, Birnbaum A, Bosken L, Evans LM, Feeny D,

Holohan J, Jones CD, Peberdy MA, Powell J. Stress reactions and perceived difficulties of lay responders to a medical emergency. Resuscitation. 2006;

70:98 –106.

18. Lerner EB, Sayre MR, Brice JH, White LJ, Santin AJ, Billittier AJ IV,

Cloud SD. Cardiac arrest patients rarely receive chest compressions before ambulance arrival despite the availability of pre-arrival CPR instructions. Resuscitation. 2008;77:51–56.

19. Donohoe RT, Haefeli K, Moore F. Public perceptions and experiences of myocardial infarction, cardiac arrest and CPR in London. Resuscitation.

2006;71:70 –79.

20. Kuramoto N, Morimoto T, Kubota Y, Maeda Y, Seki S, Takada K,

Hiraide A. Public perception of and willingness to perform bystander

CPR in Japan. Resuscitation. 2008;79:475– 481.

21. Jelinek GA, Gennat H, Celenza T, O’Brien D, Jacobs I, Lynch D.

Community attitudes towards performing cardiopulmonary resuscitation in Western Australia. Resuscitation. 2001;51:239 –246.

22. Lynch B, Einspruch EL, Nichol G, Becker LB, Aufderheide TP, Idris A.

Effectiveness of a 30-min CPR self-instruction program for lay responders: a controlled randomized study. Resuscitation. 2005;67:

31– 43.

23. Todd KH, Braslow A, Brennan RT, Lowery DW, Cox RJ, Lipscomb LE,

Kellermann AL. Randomized, controlled trial of video self-instruction versus traditional CPR training. Ann Emerg Med. 1998;31:364 –369.

24. Einspruch EL, Lynch B, Aufderheide TP, Nichol G, Becker L. Retention of CPR skills learned in a traditional AHA Heartsaver course versus

30-min video self-training: a controlled randomized study. Resuscitation.

2007;74:476 – 486.

25. Todd KH, Heron SL, Thompson M, Dennis R, O’Connor J, Kellermann

AL. Simple CPR: a randomized, controlled trial of video selfinstructional cardiopulmonary resuscitation training in an African

American church congregation. Ann Emerg Med. 1999;34:730 –737.

26. Reder S, Cummings P, Quan L. Comparison of three instructional methods for teaching cardiopulmonary resuscitation and use of an automatic external defibrillator to high school students. Resuscitation.

2006;69:443– 453.




S927

27. Roppolo LP, Pepe PE, Campbell L, Ohman K, Kulkarni H, Miller R,

Idris A, Bean L, Bettes TN, Idris AH. Prospective, randomized trial of the effectiveness and retention of 30-min layperson training for cardiopulmonary resuscitation and automated external defibrillators: the

American Airlines Study. Resuscitation. 2007;74:276 –285.

28. Batcheller AM, Brennan RT, Braslow A, Urrutia A, Kaye W. Cardiopulmonary resuscitation performance of subjects over forty is better following half-hour video self-instruction compared to traditional four-hour classroom training. Resuscitation. 2000;43:101–110.

29. Isbye DL, Rasmussen LS, Lippert FK, Rudolph SF, Ringsted CV.

Laypersons may learn basic life support in 24 min using a personal resuscitation manikin. Resuscitation. 2006;69:435– 442.

30. Moule P, Albarran JW, Bessant E, Brownfield C, Pollock J. A nonrandomized comparison of e-learning and classroom delivery of basic life support with automated external defibrillator use: a pilot study. Int

J Nurs Pract. 2008;14:427– 434.

31. Liberman M, Golberg N, Mulder D, Sampalis J. Teaching cardiopulmonary resuscitation to CEGEP students in Quebec: a pilot project.

Resuscitation. 2000;47:249 –257.

32. Jones I, Handley AJ, Whitfield R, Newcombe R, Chamberlain D. A preliminary feasibility study of a short DVD-based distance-learning package for basic life support. Resuscitation. 2007;75:350 –356.

33. Braslow A, Brennan RT, Newman MM, Bircher NG, Batcheller AM,

Kaye W. CPR training without an instructor: development and evaluation of a video self-instructional system for effective performance of cardiopulmonary resuscitation. Resuscitation. 1997;34:207–220.

34. Ahmad F, Senadhira DCA, Charters J, Acquilla S. Transmission of salmonella via mouth-to-mouth resuscitation. Lancet. 1990;335:

787–788.

35. Chalumeau M, Bidet P, Lina G, Mokhtari M, Andre MC, Gendrel D,

Bingen E, Raymond J. Transmission of Panton-Valentine leukocidinproducing Staphylococcus aureus to a physician during resuscitation of a child. Clin Infect Dis. 2005;41:e29 – e30.

36. Christian MD, Loutfy M, McDonald LC, Martinez KF, Ofner M, Wong

T, Wallington T, Gold WL, Mederski B, Green K, Low DE. Possible

SARS coronavirus transmission during cardiopulmonary resuscitation.

Emerg Infect Dis. 2004;10:287–293.

37. Feldman HA. Some recollections of the meningococcal diseases: the first Harry F. Dowling lecture. JAMA. 1972;220:1107–1112.

38. Finkelhor RS, Lampman JH. Herpes simplex infection following cardiopulmonary resuscitation. JAMA. 1980;243:650.

39. Heilman KM, Muschenheim C. Primary cutaneous tuberculosis resulting from mouth-to-mouth respiration. N Engl J Med. 1965;273:

1035–1036.

40. Hendricks AA, Shapiro EP. Primary herpes simplex infection following mouth-to-mouth resuscitation. JAMA. 1980;243:257–258.

41. Todd MA, Bell JS. Shigellosis from cardiopulmonary resuscitation.

JAMA. 1980;243:331.

42. Valenzuela TD, Hooton TM, Kaplan EL, Schlievert P. Transmission of

“toxic strep” syndrome from an infected child to a firefighter during

CPR. Ann Emerg Med. 1991;20:90 –92.

43. Neiman R. Post manikin resuscitation stomatitis. J Ky Med Assoc.

1982;80:813– 814.

44. Nicklin G. Manikin tracheitis. JAMA. 1980;244:2046 –2047.

45. Lam KK, Lau FL, Chan WK, Wong WN. Effect of severe acute respiratory syndrome on bystander willingness to perform cardiopulmonary resuscitation (CPR): is compression-only preferred to standard CPR?

Prehosp Disaster Med. 2007;22:325–329.

46. Locke CJ, Berg RA, Sanders AB, Davis MF, Milander MM, Kern KB,

Ewy GA. Bystander cardiopulmonary resuscitation: concerns about mouth-to-mouth contact. Arch Intern Med. 1995;155:938 –943.

47. Hamasu S, Morimoto T, Kuramoto N, Horiguchi M, Iwami T,

Nishiyama C, Takada K, Kubota Y, Seki S, Maeda Y, Sakai Y, Hiraide

A. Effects of BLS training on factors associated with attitude toward

CPR in college students. Resuscitation. 2009;80:359 –364.

48. Bobrow BJ, Zuercher M, Ewy GA, Clark L, Chikani V, Donahue D,

Sanders AB, Hilwig RW, Berg RA, Kern KB. Gasping during cardiac arrest in humans is frequent and associated with improved survival.

Circulation. 2008;118:2550 –2554.

49. Perkins GD, Walker G, Christensen K, Hulme J, Monsieurs KG.

Teaching recognition of agonal breathing improves accuracy of diagnosing cardiac arrest. Resuscitation. 2006;70:432– 437.

50. Culley LL, Clark JJ, Eisenberg MS, Larsen MP. Dispatcher-assisted telephone CPR: common delays and time standards for delivery. Ann

Emerg Med. 1991;20:362–366.



51. Vaillancourt C, Stiell IG, Wells GA. Understanding and improving low bystander CPR rates: a systematic review of the literature. CJEM.

2008;10:51– 65.

52. Van Hoeyweghen RJ, Verbruggen G, Rademakers F, Bossaert LL. The physiologic response of CPR training. Ann Emerg Med. 1991;20:

279 –282.

53. Lonergan JH, Youngberg JZ, Kaplan JA. Cardiopulmonary resuscitation: physical stress on the rescuer. Crit Care Med. 1981;9:793–795.

54. Tsou JY, Chi CH, Hsu RM, Wu HF, Su FC. Mechanical loading of the low back during cardiopulmonary resuscitation. Resuscitation. 2009;80:

1181–1186.

55. Peberdy MA, Ottingham LV, Groh WJ, Hedges J, Terndrup TE, Pirrallo

RG, Mann NC, Sehra R. Adverse events associated with lay emergency response programs: the Public Access Defibrillation Trial experience.

Resuscitation. 2006;70:59 – 65.

56. Hallstrom AP, Ornato JP, Weisfeldt M, Travers A, Christenson J,

McBurnie MA, Zalenski R, Becker LB, Schron EB, Proschan M. Publicaccess defibrillation and survival after out-of-hospital cardiac arrest.

N Engl J Med. 2004;351:637– 646.

57. Cheung W, Gullick J, Thanakrishnan G, Jacobs R, Au W, Uy J, Fick M,

Narayan P, Ralston S, Tan J. Injuries occurring in hospital staff attending medical emergency team (MET) calls: a prospective, observational study. Resuscitation. 2009;80:1351–1356.

58. Jones AY. Can cardiopulmonary resuscitation injure the back?

Resuscitation. 2004;61:63– 67.

59. Jones AY, Lee RY. Cardiopulmonary resuscitation and back injury in ambulance officers. Int Arch Occup Environ Health. 2005;78:332–336.

60. Thierbach AR, Piepho T, Kunde M, Wolcke BB, Golecki N, Kleine-

Weischede B, Werner C. Two-rescuer CPR results in hyperventilation in the ventilating rescuer. Resuscitation. 2005;65:185–190.

61. Thierbach AR, Wolcke BB, Krummenauer F, Kunde M, Janig C, Dick

WF. Artificial ventilation for basic life support leads to hyperventilation in first aid providers. Resuscitation. 2003;57:269 –277.

62. Walker GM, Liddle R. Prolonged two-man basic life support may result in hypocarbia in the ventilating rescuer. Resuscitation. 2001;50:

179 –183.

63. Greenberg M. CPR: a report of observed medical complications during training. Ann Emerg Med. 1983;12:194 –195.

64. Macauley CA, Todd CT. Physical disability among cardiopulmonary resuscitation students. Occup Health Nurs. 1978;26:17–19.

65. Steinhoff JP, Pattavina C, Renzi R. Puncture wound during CPR from sternotomy wires: case report and discussion of periresuscitation infection risks. Heart Lung. 2001;30:159 –160.

66. Shimokawa A, Tateyama S, Shimizu Y, Muramatsu I, Takasaki M.

Anterior interosseous nerve palsy after cardiopulmonary resuscitation in a resuscitator with undiagnosed muscle anomaly. Anesth Analg. 2001;

93:290 –291.

67. Sullivan F, Avstreih D. Pneumothorax during CPR training: case report and review of the CPR literature. Prehosp Disaster Med. 2000;15:

64 – 69.

68. Memon AM, Salzer JE, Hillman EC Jr, Marshall CL. Fatal myocardial infarct following CPR training: the question of risk. Ann Emerg Med.

1982;11:322–323.

69. Axelsson A, Herlitz J, Ekstrom L, Holmberg S. Bystander-initiated cardiopulmonary resuscitation out-of-hospital: a first description of the bystanders and their experiences. Resuscitation. 1996;33:3–11.

70. Gamble M. A debriefing approach to dealing with the stress of CPR attempts. Prof Nurse. 2001;17:157–160.

71. Lyster T, Jorgenson D, Morgan C. The safe use of automated external defibrillators in a wet environment. Prehosp Emerg Care. 2003;7:

307–311.

72. Lloyd MS, Heeke B, Walter PF, Langberg JJ. Hands-on defibrillation: an analysis of electrical current flow through rescuers in direct contact with patients during biphasic external defibrillation. Circulation. 2008;

117:2510 –2514.

73. Capucci A, Aschieri D, Piepoli MF. Improving survival with early defibrillation. Cardiol Rev. 2003;20:12–14.

74. Page RL, Joglar JA, Kowal RC, Zagrodzky JD, Nelson LL, Ramaswamy

K, Barbera SJ, Hamdan MH, McKenas DK. Use of automated external defibrillators by a U.S. airline. N Engl J Med. 2000;343:1210 –1216.

75. Jorgenson DB, Skarr T, Russell JK, Snyder DE, Uhrbrock K. AED use in businesses, public facilities and homes by minimally trained first responders. Resuscitation. 2003;59:225–233.

76. Hoke RS, Heinroth K, Trappe HJ, Werdan K. Is external defibrillation an electric threat for bystanders? Resuscitation. 2009;80:395– 401.



77. Schratter A, Weihs W, Holzer M, Janata A, Behringer W, Losert UM,

Ohley WJ, Schock RB, Sterz F. External cardiac defibrillation during wet-surface cooling in pigs. Am J Emerg Med. 2007;25:420 – 424.

78. Beckers S, Fries M, Bickenbach J, Derwall M, Kuhlen R, Rossaint R.

Minimal instructions improve the performance of laypersons in the use of semiautomatic and automatic external defibrillators. Crit Care. 2005;

9:R110 –R116.

79. Beckers SK, Fries M, Bickenbach J, Skorning MH, Derwall M, Kuhlen

R, Rossaint R. Retention of skills in medical students following minimal theoretical instructions on semi and fully automated external defibrillators. Resuscitation. 2007;72:444 – 450.

80. Mitchell KB, Gugerty L, Muth E. Effects of brief training on use of automated external defibrillators by people without medical expertise.

Hum Factors. 2008;50:301–310.

81. Cardiopulmonary resuscitation. JAMA. 1966;198:372–379.

82. Paraskos JA. History of CPR and the role of the national conference.

Ann Emerg Med. 1993;22(part 2):275–280.

83. Carveth S. Standards for cardiopulmonary resuscitation and emergency cardiac care. JAMA. 1974;227:796 –797. Editorial.

84. Carveth SW, Burnap TK, Bechtel J, McIntyre K, Donegan J, Buchman

RJ, Reese HE. Training in advanced cardiac life support. JAMA. 1976;

235:2311–2315.

85. Chameides L, ed. Textbook of Pediatric Advanced Life Support. Dallas,

Tex: American Heart Association; 1988.

86. Kirkpatrick D, Kirkpatrick J. Implementing the Four Levels: A Practical

Guide for the Evaluation of Training Programs. San Francisco, Calif:

Berrett-Koehler; 2007.

87. Bloom B, Englehart M, et al. Taxonomy of Educational Objectives: The

Classification of Educational Goals. Handbook I: Cognitive Domain.

New York, NY: Longmans; 1956.

88. Dave RH. Developing and Writing Behavioral Objectives. Tucson, Ariz:

Educational Innovators Press; 1970.

89. Krathwohl DR, Bloom B, et al. Taxonomy of Educational Objectives,

the Classification of Educational Goals: Handbook II: Affective

Domain. New York, NY: David McKay Co; 1964.

90. Nishiyama C, Iwami T, Kawamura T, Ando M, Kajino K, Yonemoto N,

Fukuda R, Yuasa H, Yokoyama H, Nonogi H. Effectiveness of simplified chest compression-only CPR training program with or without preparatory self-learning video: a randomized controlled trial. Resuscitation. 2009;80:

1164 –1168.

91. Monsieurs KG, Vogels C, Bossaert LL, Meert P, Manganas A, Tsiknakis

M, Leisch E, Calle PA, Giorgini F. Learning effect of a novel interactive basic life support CD: the JUST system. Resuscitation. 2004;62:

159 –165.

92. Knowles MS, Holton EF III, et al. The Adult Learner. Woburn, Mass:

Butterworth-Heinemann; 1998.

93. Ericsson KA. Deliberate practice and the acquisition and maintenance of expert performance in medicine and related domains. Acad Med. 2004;

79(suppl):S70 –S81.

94. Bloom BS. Mastery Learning. New York, NY: Holt Rinehart &

Winston; 1971.

95. Ericsson K, Krampe RT, Tesch-Ro¨mer C. The role of deliberate practice in the acquisition of expert performance. Psychol Rev. 1993;100:

363– 406.

96. Mager RF. Preparing Instructional Objectives: A Critical Tool in the

Development of Effective Instruction. 3rd ed. Atlanta, Ga: Center for

Effective Performance; 1997.

97. Gundry JW, Comess KA, DeRook FA, Jorgenson D, Bardy GH. Comparison of naive sixth-grade children with trained professionals in the use of an automated external defibrillator. Circulation. 1999;100:

1703–1707.

98. Mattei LC, McKay U, Lepper MW, Soar J. Do nurses and physiotherapists require training to use an automated external defibrillator?

Resuscitation. 2002;53:277–280.

99. Clark LJ, Watson J, Cobbe SM, Reeve W, Swann IJ, Macfarlane PW.

CPR ’98: a practical multimedia computer-based guide to cardiopulmonary resuscitation for medical students. Resuscitation. 2000;44:

109 –117.

100. Hudson JN. Computer-aided learning in the real world of medical education: does the quality of interaction with the computer affect student learning? Med Educ. 2004;38:887– 895.

101. Jang KS, Hwang SY, Park SJ, Kim YM, Kim MJ. Effects of a

Web-based teaching method on undergraduate nursing students’ learning of electrocardiography. J Nurs Educ. 2005;44:35–39.

102. Leong SL, Baldwin CD, Adelman AM. Integrating Web-based computer cases into a required clerkship: development and evaluation. Acad Med.

2003;78:295–301.

103. Rosser JC, Herman B, Risucci DA, Murayama M, Rosser LE, Merrell

RC. Effectiveness of a CD-ROM multimedia tutorial in transferring cognitive knowledge essential for laparoscopic skill training. Am J Surg.

2000;179:320 –324.

104. Schwid HA, Rooke GA, Ross BK, Sivarajan M. Use of a computerized advanced cardiac life support simulator improves retention of advanced cardiac life support guidelines better than a textbook review. Crit Care

Med. 1999;27:821– 824.

105. Flynn ER, Wolf ZR, McGoldrick TB, Jablonski RA, Dean LM, McKee

EP. Effect of three teaching methods on a nursing staff’s knowledge of medication error risk reduction strategies. J Nurs Staff Dev. 1996;12:

19 –26.

106. Goldrick B, Appling-Stevens S, Larson E. Infection control programmed instruction: an alternative to classroom instruction in baccalaureate nursing education. J Nurs Educ. 1990;29:20 –25.

107. Eliot CR, Williams KA, Woolf BP. An intelligent learning environment for advanced cardiac life support. Proc AMIA Annu Fall Symp.

1996;7–11.

108. Patterson NG. Preparation techniques for ACLS exam. Dimens Crit

Care Nurs. 1989;8:244 –249.

109. Kim JH, Kim WO, Min KT, Yang JY, Nam YT. Learning by computer simulation does not lead to better test performance than textbook study in the diagnosis and treatment of dysrhythmias. J Clin Anesth. 2002;14:

395– 400.

110. Denton GD, Durning SJ, Wimmer AP, Pangaro LN, Hemmer PA. Is a faculty developed pretest equivalent to pre-third year GPA or USMLE step 1 as a predictor of third-year internal medicine clerkship outcomes?

Teach Learn Med. 2004;16:329 –332.

111. Woodworth KW, Markwell LG. Bored, yawning residents falling asleep during orientation? Wake ’em up with a test! Med Ref Serv Q. 2005;

24:77–91.

112. Weaver SJ, Rosen MA, DiazGranados D, Lazzara EH, Lyons R, Salas

E, Knych SA, McKeever M, Adler L, Barker M, King HB. Does teamwork improve performance in the operating room? A multilevel evaluation. Jt Comm J Qual Patient Saf. 2010;36:133–142.

113. Shetty P, Cohen T, Patel B, Patel VL. The cognitive basis of effective team performance: features of failure and success in simulated cardiac resuscitation. AMIA Annu Symp Proc. 2009;2009:599 – 603.

114. Shea-Lewis A. Teamwork: crew resource management in a community hospital. J Healthc Qual. 2009;31:14 –18.

115. Stead K, Kumar S, Schultz TJ, Tiver S, Pirone CJ, Adams RJ, Wareham

CA. Teams communicating through STEPPS. Med J Aust. 2009;

190(suppl):S128 –S132.

116. Salas E, DiazGranados D, Klein C, Burke CS, Stagl KC, Goodwin GF,

Halpin SM. Does team training improve team performance? A metaanalysis. Hum Factors. 2008;50:903–933.

117. Mazzocco K, Petitti DB, Fong KT, Bonacum D, Brookey J, Graham S,

Lasky RE, Sexton JB, Thomas EJ. Surgical team behaviors and patient outcomes. Am J Surg. 2009;197:678 – 685.

118. Hunziker S, Buhlmann C, Tschan F, Balestra G, Legeret C, Schumacher

C, Semmer NK, Hunziker P, Marsch S. Brief leadership instructions improve cardiopulmonary resuscitation in a high-fidelity simulation: a randomized controlled trial. Crit Care Med. 2010;38:1086 –1091.

119. Thomas EJ, Taggart B, Crandell S, Lasky RE, Williams AL, Love LJ,

Sexton JB, Tyson JE, Helmreich RL. Teaching teamwork during the

Neonatal Resuscitation Program: a randomized trial. J Perinatol. 2007;

27:409 – 414.

120. Gilfoyle E, Gottesman R, Razack S. Development of a leadership skills workshop in paediatric advanced resuscitation. Med Teach. 2007;29: e276 – e283.

121. DeVita MA, Schaefer J, Lutz J, Wang H, Dongilli T. Improving medical emergency team (MET) performance using a novel curriculum and a computerized human patient simulator. Qual Saf Health Care. 2005;14:

326 –331.

122. Makinen M, Aune S, Niemi-Murola L, Herlitz J, Varpula T, Nurmi J,

Axelsson AB, Thoren AB, Castren M. Assessment of CPR-D skills of nurses in Goteborg, Sweden and Espoo, Finland: teaching leadership makes a difference. Resuscitation. 2007;72:264 –269.

123. Morey JC, Simon R, Jay GD, Wears RL, Salisbury M, Dukes KA, Berns

SD. Error reduction and performance improvement in the emergency department through formal teamwork training: evaluation results of the

MedTeams project. Health Serv Res. 2002;37:1553–1581.




S929

124. Edelson DP, Litzinger B, Arora V, Walsh D, Kim S, Lauderdale DS,

Vanden Hoek TL, Becker LB, Abella BS. Improving in-hospital cardiac arrest process and outcomes with performance debriefing. Arch Intern

Med. 2008;168:1063–1069.

125. Mayo PH, Hackney JE, Mueck JT, Ribaudo V, Schneider RF. Achieving house staff competence in emergency airway management: results of a teaching program using a computerized patient simulator. Crit Care

Med. 2004;32:2422–2427.

126. Wayne DB, Didwania A, Feinglass J, Fudala MJ, Barsuk JH, McGaghie

WC. Simulation-based education improves quality of care during cardiac arrest team responses at an academic teaching hospital: a casecontrol study. Chest. 2008;133:56 – 61.

127. Donoghue AJ, Durbin DR, Nadel FM, Stryjewski GR, Kost SI, Nadkarni

VM. Effect of high-fidelity simulation on Pediatric Advanced Life

Support training in pediatric house staff: a randomized trial. Pediatr

Emerg Care. 2009;25:139 –144.

128. Owen H, Mugford B, Follows V, Plummer JL. Comparison of three simulation-based training methods for management of medical emergencies. Resuscitation. 2006;71:204 –211.

129. Wayne DB, Butter J, Siddall VJ, Fudala MJ, Linquist LA, Feinglass J,

Wade LD, McGaghie WC. Simulation-based training of internal medicine residents in advanced cardiac life support protocols: a randomized trial. Teach Learn Med. 2005;17:210 –216.

130. Campbell DM, Barozzino T, Farrugia M, Sgro M. High-fidelity simulation in neonatal resuscitation. Paediatr Child Health. 2009;14:19 –23.

131. Hunt EA, Vera K, Diener-West M, Haggerty JA, Nelson KL, Shaffner

DH, Pronovost PJ. Delays and errors in cardiopulmonary resuscitation and defibrillation by pediatric residents during simulated cardiopulmonary arrests. Resuscitation. 2009;80:819 – 825.

132. Rodgers D, Securro SJ, Pauley R. The effect of high-fidelity simulation on educational outcomes in an Advanced Cardiovascular Life Support course. Simul Healthc. 2009;4:200 –206.

133. Barsuk D, Ziv A, Lin G, Blumenfeld A, Rubin O, Keidan I, Munz Y,

Berkenstadt H. Using advanced simulation for recognition and correction of gaps in airway and breathing management skills in prehospital trauma care. Anesth Analg. 2005;100:803– 809.

134. Kory PD, Eisen LA, Adachi M, Ribaudo VA, Rosenthal ME, Mayo PH.

Initial airway management skills of senior residents: simulation training compared with traditional training. Chest. 2007;132:1927–1931.

135. Marshall RL, Smith JS, Gorman PJ, Krummel TM, Haluck RS, Cooney

RN. Use of a human patient simulator in the development of resident trauma management skills. J Trauma. 2001;51:17–21.

136. Wayne DB, Siddall VJ, Butter J, Fudala MJ, Wade LD, Feinglass J,

McGaghie WC. A longitudinal study of internal medicine residents’ retention of advanced cardiac life support skills. Acad Med. 2006;

81(suppl):S9 –S12.

137. Wayne DB, Butter J, Siddall VJ, Fudala MJ, Wade LD, Feinglass J,

McGaghie WC. Mastery learning of advanced cardiac life support skills by internal medicine residents using simulation technology and deliberate practice. J Gen Intern Med. 2006;21:251–256.

138. Cherry RA, Williams J, George J, Ali J. The effectiveness of a human patient simulator in the ATLS shock skills station. J Surg Res. 2007;

139:229 –235.

139. Schwartz LR, Fernandez R, Kouyoumjian SR, Jones KA, Compton S. A randomized comparison trial of case-based learning versus human patient simulation in medical student education. Acad Emerg Med.

2007;14:130 –137.

140. Wang XP, Martin SM, Li YL, Chen J, Zhang YM. Effect of emergency care simulator combined with problem-based learning in teaching of cardiopulmonary resuscitation [in Chinese]. Zhonghua Yi Xue Za Zhi.

2008;88:1651–1653.

141. Friedman Z, You-Ten KE, Bould MD, Naik V. Teaching lifesaving procedures: the impact of model fidelity on acquisition and transfer of cricothyrotomy skills to performance on cadavers. Anesth Analg. 2008;

107:1663–1669.

142. Curran VR, Aziz K, O’Young S, Bessell C. Evaluation of the effect of a computerized training simulator (ANAKIN) on the retention of neonatal resuscitation skills. Teach Learn Med. 2004;16:157–164.

143. Hoadley TA. Learning advanced cardiac life support: a comparison study of the effects of low- and high-fidelity simulation. Nurs Educ

Perspect. 2009;30:91–95.

144. Iglesias-Vazquez JA, Rodriguez-Nunez A, Penas-Penas M, Sanchez-

Santos L, Cegarra-Garcia M, Barreiro-Diaz MV. Cost-efficiency assessment of Advanced Life Support (ALS) courses based on the comparison of advanced simulators with conventional manikins. BMC

Emerg Med. 2007;7:18.

145. Cavaleiro AP, Guimaraes H, Calheiros F. Training neonatal skills with simulators? Acta Paediatr. 2009;98:636 – 639.

146. Knudson MM, Khaw L, Bullard MK, Dicker R, Cohen MJ, Staudenmayer K, Sadjadi J, Howard S, Gaba D, Krummel T. Trauma training in simulation: translating skills from SIM time to real time.

J Trauma. 2008;64:255–263.

147. Christenson J, Parrish K, Barabe S, Noseworthy R, Williams T, Geddes

R, Chalmers A. A comparison of multimedia and standard advanced cardiac life support learning. Acad Emerg Med. 1998;5:702–708.

148. Gerard JM, Scalzo AJ, Laffey SP, Sinks G, Fendya D, Seratti P.

Evaluation of a novel Web-based pediatric advanced life support course.

Arch Pediatr Adolesc Med. 2006;160:649 – 655.

149. Crocco TJ, Moreno R, Jauch EC, Racine AN, Pio BJ, Liu T, Kothari RU.

Teaching ACLS stroke objectives to prehospital providers: a case-based approach. Prehosp Emerg Care. 2003;7:229 –234.

150. Dagnone JD, McGraw RC, Pulling CA, Patteson AK. Interprofessional resuscitation rounds: a teamwork approach to ACLS education. Med

Teach. 2008;30:e49 – e54.

151. Dyche WJ, Walsh JH, Nelson JA. An ACLS laboratory rotation for undergraduate medical students. Ann Emerg Med. 1983;12:208 –211.

152. Herrin TJ, Norman PF, Hill C, Crosby R. Modular approach to CPR training. South Med J. 1980;73:742–744.

153. Kim HS, Hwang SY, Oh EG, Lee JE. Development and evaluation of a

PBL-based continuing education for clinical nurses: a pilot study.

Taehan Kanho Hakhoe Chi. 2006;36:1308 –1314.

154. Polglase RF, Parish DC, Buckley RL, Smith RW, Joiner TA.

Problem-based ACLS instruction: a model approach for undergraduate emergency medical education. Ann Emerg Med. 1989;18:997–1000.

155. Mehne PR, Allison EJ Jr, Williamson JE, Landis SS, Brinson HM. A required, combined ACLS/ATLS provider course for senior medical students at East Carolina University. Ann Emerg Med. 1987;16:

666 – 668.

156. Nadel FM, Lavelle JM, Fein JA, Giardino AP, Decker JM, Durbin DR.

Assessing pediatric senior residents’ training in resuscitation: fund of knowledge, technical skills, and perception of confidence. Pediatr

Emerg Care. 2000;16:73–76.

157. Napier F, Davies RP, Baldock C, Stevens H, Lockey AS, Bullock I,

Perkins GD. Validation for a scoring system of the ALS cardiac arrest simulation test (CASTest). Resuscitation. 2009;80:1034 –1038.

158. Rodgers DL, Bhanji F, McKee BR. Written evaluation is not a predictor for skills performance in an Advanced Cardiovascular Life Support course. Resuscitation. 2010;81:453– 456.

159. White JR, Shugerman R, Brownlee C, Quan L. Performance of advanced resuscitation skills by pediatric housestaff. Arch Pediatr

Adolesc Med. 1998;152:1232–1235.

160. Kromann CB, Jensen ML, Ringsted C. The effect of testing on skills learning. Med Educ. 2009;43:21–27.

161. Kromann CB, Bohnstedt C, Jensen ML, Ringsted C. The testing effect on skills learning might last 6 months. Adv Health Sci Educ Theory

Pract. Published online before print October 17, 2009. doi:10.1007/ s10459-009-9207-x. Available at: http://www.springerlink.com/content/

168g5v75v55r0207/.

162. Program Administration Manual. 4th ed. Dallas, Tex: American Heart

Association; 2008.

163. Weiss KB. Future of board certification in a new era of public accountability. J Am Board Fam Med. 2010;23(suppl 1):S32–S39.

164. Miles PV. Maintenance of certification: the role of the American Board of Pediatrics in improving children’s health care. Pediatr Clin North Am.

2009;56:987–994.

165. Smith KK, Gilcreast D, Pierce K. Evaluation of staff’s retention of

ACLS and BLS skills. Resuscitation. 2008;78:59 – 65.

166. Woollard M, Whitfeild R, Smith A, Colquhoun M, Newcombe RG,

Vetteer N, Chamberlain D. Skill acquisition and retention in automated external defibrillator (AED) use and CPR by lay responders: a prospective study. Resuscitation. 2004;60:17–28.

167. Spooner BB, Fallaha JF, Kocierz L, Smith CM, Smith SC, Perkins GD.

An evaluation of objective feedback in basic life support (BLS) training.

Resuscitation. 2007;73:417– 424.

168. Berden HJ, Willems FF, Hendrick JM, Pijls NH, Knape JT. How frequently should basic cardiopulmonary resuscitation training be repeated to maintain adequate skills? BMJ. 1993;306:1576 –1577.





169. Woollard M, Whitfield R, Newcombe RG, Colquhoun M, Vetter N,

Chamberlain D. Optimal refresher training intervals for AED and CPR skills: a randomised controlled trial. Resuscitation. 2006;71:237–247.

170. Duran R, Aladag N, Vatansever U, Kucukugurluoglu Y, Sut N, Acunas

B. Proficiency and knowledge gained and retained by pediatric residents after neonatal resuscitation course. Pediatr Int. 2008;50:644 – 647.

171. Anthonypillai F. Retention of advanced cardiopulmonary resuscitation knowledge by intensive care trained nurses. Intensive Crit Care Nurs.

1992;8:180 –184.

172. Boonmak P, Boonmak S, Srichaipanha S, Poomsawat S. Knowledge and skill after brief ACLS training. J Med Assoc Thai. 2004;87:1311–1314.

173. Kaye W, Wynne G, Marteau T, Dubin HG, Rallis SF, Simons RS, Evans

TR. An advanced resuscitation training course for preregistration house officers. J R Coll Physicians Lond. 1990;24:51–54.

174. Skidmore MB, Urquhart H. Retention of skills in neonatal resuscitation.

Paediatr Child Health. 2001;6:31–35.

175. Semeraro F, Signore L, Cerchiari EL. Retention of CPR performance in anaesthetists. Resuscitation. 2006;68:101–108.

176. Trevisanuto D, Ferrarese P, Cavicchioli P, Fasson A, Zanardo V, Zacchello F. Knowledge gained by pediatric residents after neonatal resuscitation program courses. Paediatr Anaesth. 2005;15:944 –947.

177. Young R, King L. An evaluation of knowledge and skill retention following an in-house advanced life support course. Nurs Crit Care.

2000;5:7–14.

178. Duran R, Sen F, N A, Vatansever U, Acunaçs B. Knowledge gained and retained by neonatal nurses following neonatal resuscitation program course. Turk Pediatr Ars. 2007;42:153–155.

179. Grant EC, Marczinski CA, Menon K. Using pediatric advanced life support in pediatric residency training: does the curriculum need resuscitation? Pediatr Crit Care Med. 2007;8:433– 439.

180. O’Steen DS, Kee CC, Minick MP. The retention of advanced cardiac life support knowledge among registered nurses. J Nurs Staff Dev. 1996;12:

66 –72.

181. Hammond F, Saba M, Simes T, Cross R. Advanced life support: retention of registered nurses’ knowledge 18 months after initial training. Aust Crit Care. 2000;13:99 –104.

182. Andresen D, Arntz HR, Grafling W, Hoffmann S, Hofmann D, Kraemer R,

Krause-Dietering B, Osche S, Wegscheider K. Public access resuscitation program including defibrillator training for laypersons: a randomized trial to evaluate the impact of training course duration. Resuscitation. 2008;76:

419 – 424.

183. Wik L, Myklebust H, Auestad BH, Steen PA. Twelve-month retention of CPR skills with automatic correcting verbal feedback. Resuscitation.

2005;66:27–30.

184. Christenson J, Nafziger S, Compton S, Vijayaraghavan K, Slater B,

Ledingham R, Powell J, McBurnie MA. The effect of time on CPR and automated external defibrillator skills in the Public Access Defibrillation

Trial. Resuscitation. 2007;74:52– 62.

185. Riegel B, Nafziger SD, McBurnie MA, Powell J, Ledingham R, Sehra

R, Mango L, Henry MC. How well are cardiopulmonary resuscitation and automated external defibrillator skills retained over time? Results from the Public Access Defibrillation (PAD) Trial. Acad Emerg Med.

2006;13:254 –263.

186. Choa M, Park I, Chung HS, Yoo SK, Shim H, Kim S. The effectiveness of cardiopulmonary resuscitation instruction: animation versus dispatcher through a cellular phone. Resuscitation. 2008;77:87–94.

187. Choa M, Cho J, Choi YH, Kim S, Sung JM, Chung HS. Animationassisted CPRII program as a reminder tool in achieving effective oneperson-CPR performance. Resuscitation. 2009;80:680 – 684.

188. Ertl L, Christ F. Significant improvement of the quality of bystander first aid using an expert system with a mobile multimedia device. Resuscitation.

2007;74:286 –295.

189. Ward P, Johnson LA, Mulligan NW, Ward MC, Jones DL. Improving cardiopulmonary resuscitation skills retention: effect of two checklists designed to prompt correct performance. Resuscitation. 1997;34:

221–225.

190. Merchant RM, Abella BS, Abotsi EJ, Smith TM, Long JA, Trudeau ME,

Leary M, Groeneveld PW, Becker LB, Asch DA. Cell telephone cardiopulmonary resuscitation: audio instructions when needed by lay rescuers: a randomized, controlled trial. Ann Emerg Med. 2010;55:

538 –543.e1.

191. Lerner C, Gaca AM, Frush DP, Hohenhaus S, Ancarana A, Seelinger

TA, Frush K. Enhancing pediatric safety: assessing and improving resident competency in life-threatening events with a computer-based interactive resuscitation tool. Pediatr Radiol. 2009;39:703–709.



192. Schneider AJ, Murray WB, Mentzer SC, Miranda F, Vaduva S.

“Helper”: a critical events prompter for unexpected emergencies. J Clin

Monit. 1995;11:358 –364.

193. Berkenstadt H, Yusim Y, Ziv A, Ezri T, Perel A. An assessment of a point-of-care information system for the anesthesia provider in simulated malignant hyperthermia crisis. Anesth Analg. 2006;102:530 –532.

194. Harrison TK, Manser T, Howard SK, Gaba DM. Use of cognitive aids in a simulated anesthetic crisis. Anesth Analg. 2006;103:551–556.

195. Zanner R, Wilhelm D, Feussner H, Schneider G. Evaluation of M-AID, a first aid application for mobile phones. Resuscitation. 2007;74:

487– 494.

196. Mills PD, DeRosier JM, Neily J, McKnight SD, Weeks WB, Bagian JP.

A cognitive aid for cardiac arrest: you can’t use it if you don’t know about it. Jt Comm J Qual Saf. 2004;30:488 – 496.

197. Neily J, DeRosier JM, Mills PD, Bishop MJ, Weeks WB, Bagian JP.

Awareness and use of a cognitive aid for anesthesiology. Jt Comm J

Qual Patient Saf. 2007;33:502–511.

198. Beckers SK, Skorning MH, Fries M, Bickenbach J, Beuerlein S, Derwall

M, Kuhlen R, Rossaint R. CPREzy improves performance of external chest compressions in simulated cardiac arrest. Resuscitation. 2007;72:

100 –107.

199. Monsieurs KG, De Regge M, Vogels C, Calle PA. Improved basic life support performance by ward nurses using the CAREvent Public Access

Resuscitator (PAR) in a simulated setting. Resuscitation. 2005;67:

45–50.

200. Sutton RM, Donoghue A, Myklebust H, Srikantan S, Byrne A, Priest M,

Zoltani Z, Helfaer MA, Nadkarni V. The voice advisory manikin

(VAM): an innovative approach to pediatric lay provider basic life support skill education. Resuscitation. 2007;75:161–168.

201. Wik L, Thowsen J, Steen PA. An automated voice advisory manikin system for training in basic life support without an instructor: a novel approach to CPR training. Resuscitation. 2001;50:167–172.

202. Wik L, Myklebust H, Auestad BH, Steen PA. Retention of basic life support skills 6 months after training with an automated voice advisory manikin system without instructor involvement. Resuscitation. 2002;52:

273–279.

203. Dine CJ, Gersh RE, Leary M, Riegel BJ, Bellini LM, Abella BS.

Improving cardiopulmonary resuscitation quality and resuscitation training by combining audiovisual feedback and debriefing. Crit Care

Med. 2008;36:2817–2822.

204. Boyle AJ, Wilson AM, Connelly K, McGuigan L, Wilson J, Whitbourn

R. Improvement in timing and effectiveness of external cardiac compressions with a new non-invasive device: the CPR-Ezy. Resuscitation.

2002;54:63– 67.

205. Elding C, Baskett P, Hughes A. The study of the effectiveness of chest compressions using the CPR-plus. Resuscitation. 1998;36:169 –173.

206. Handley AJ, Handley SA. Improving CPR performance using an audible feedback system suitable for incorporation into an automated external defibrillator. Resuscitation. 2003;57:57– 62.

207. Jantti H, Silfvast T, Turpeinen A, Kiviniemi V, Uusaro A. Influence of chest compression rate guidance on the quality of cardiopulmonary resuscitation performed on manikins. Resuscitation. 2009;80:453– 457.

208. Noordergraaf GJ, Drinkwaard BW, van Berkom PF, van Hemert HP,

Venema A, Scheffer GJ, Noordergraaf A. The quality of chest compressions by trained personnel: the effect of feedback, via the CPREzy, in a randomized controlled trial using a manikin model. Resuscitation.

2006;69:241–252.

209. Oh JH, Lee SJ, Kim SE, Lee KJ, Choe JW, Kim CW. Effects of audio tone guidance on performance of CPR in simulated cardiac arrest with an advanced airway. Resuscitation. 2008;79:273–277.

210. Perkins GD, Augre C, Rogers H, Allan M, Thickett DR. CPREzy: an evaluation during simulated cardiac arrest on a hospital bed. Resusci-

tation. 2005;64:103–108.

211. Thomas SH, Stone CK, Austin PE, March JA, Brinkley S. Utilization of a pressure-sensing monitor to improve in-flight chest compressions.

Am J Emerg Med. 1995;13:155–157.

212. Williamson LJ, Larsen PD, Tzeng YC, Galletly DC. Effect of automatic external defibrillator audio prompts on cardiopulmonary resuscitation performance. Emerg Med J. 2005;22:140 –143.

213. Kern KB, Stickney RE, Gallison L, Smith RE. Metronome improves compression and ventilation rates during CPR on a manikin in a randomized trial. Resuscitation. 2010;81:206 –210.

214. Peberdy MA, Silver A, Ornato JP. Effect of caregiver gender, age, and feedback prompts on chest compression rate and depth. Resuscitation.

2009;80:1169 –1174.


S931

215. Rawlins L, Woollard M, Williams J, Hallam P. 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.

216. Abella BS, Edelson DP, Kim S, Retzer E, Myklebust H, Barry AM,

O’Hearn N, Hoek TL, Becker LB. CPR quality improvement during in-hospital cardiac arrest using a real-time audiovisual feedback system.

Resuscitation. 2007;73:54 – 61.

217. Chiang WC, Chen WJ, Chen SY, Ko PC, Lin CH, Tsai MS, Chang WT,

Chen SC, Tsan CY, Ma MH. Better adherence to the guidelines during cardiopulmonary resuscitation through the provision of audio-prompts.

Resuscitation. 2005;64:297–301.

218. Fletcher D, Galloway R, Chamberlain D, Pateman J, Bryant G,

Newcombe RG. Basics in advanced life support: a role for download audit and metronomes. Resuscitation. 2008;78:127–134.

219. Kramer-Johansen J, Myklebust H, Wik L, Fellows B, Svensson L,

Sorebo H, Steen PA. Quality of out-of-hospital cardiopulmonary resuscitation with real time automated feedback: a prospective interventional study. Resuscitation. 2006;71:283–292.

220. Niles D, Nysaether J, Sutton R, Nishisaki A, Abella BS, Arbogast K,

Maltese MR, Berg RA, Helfaer M, Nadkarni V. Leaning is common during in-hospital pediatric CPR, and decreased with automated corrective feedback. Resuscitation. 2009;80:553–557.

221. Nishisaki A, Nysaether J, Sutton R, Maltese M, Niles D, Donoghue A,

Bishnoi R, Helfaer M, Perkins GD, Berg R, Arbogast K, Nadkarni V.

Effect of mattress deflection on CPR quality assessment for older children and adolescents. Resuscitation. 2009;80:540 –545.

222. Perkins GD, Boyle W, Bridgestock H, Davies S, Oliver Z, Bradburn S,

Green C, Davies RP, Cooke MW. Quality of CPR during advanced resuscitation training. Resuscitation. 2008;77:69 –74.

223. O’Donnell J, Rodgers D, Lee W, Edelson D, Haag J, Hamilton M,

Hoadley T, McCullough A, Meeks R. Structured and Supported

Debriefing. Dallas, Tex: American Heart Association; 2009.

224. Savoldelli GL, Naik VN, Park J, Joo HS, Chow R, Hamstra SJ. Value of debriefing during simulated crisis management: oral versus videoassisted oral feedback. Anesthesiology. 2006;105:279 –285.

225. Morgan PJ, Tarshis J, LeBlanc V, Cleave-Hogg D, DeSousa S, Haley

MF, Herold-McIlroy J, Law JA. Efficacy of high-fidelity simulation debriefing on the performance of practicing anaesthetists in simulated scenarios. Br J Anaesth. 2009;103:531–537.

226. Falcone RA Jr, Daugherty M, Schweer L, Patterson M, Brown RL,

Garcia VF. Multidisciplinary pediatric trauma team training using highfidelity trauma simulation. J Pediatr Surg. 2008;43:1065–1071.

227. Weng TI, Huang CH, Ma MH, Chang WT, Liu SC, Wang TD, Chen WJ.

Improving the rate of return of spontaneous circulation for out-ofhospital cardiac arrests with a formal, structured emergency resuscitation team. Resuscitation. 2004;60:137–142.

228. Nichol G, Thomas E, Callaway CW, Hedges J, Powell JL, Aufderheide

TP, Rea T, Lowe R, Brown T, Dreyer J, Davis D, Idris A, Stiell I.

Regional variation in out-of-hospital cardiac arrest incidence and outcome. JAMA. 2008;300:1423–1431.

229. White RD, Bunch TJ, Hankins DG. Evolution of a community-wide early defibrillation programme experience over 13 years using police/fire personnel and paramedics as responders. Resuscitation. 2005;

65:279 –283.

230. Neumar RW, Nolan JP, Adrie C, Aibiki M, Berg RA, Bottiger BW,

Callaway C, Clark RS, Geocadin RG, Jauch EC, Kern KB, Laurent I,

Longstreth WT Jr, Merchant RM, Morley P, Morrison LJ, Nadkarni V,

Peberdy MA, Rivers EP, Rodriguez-Nunez A, Sellke FW, Spaulding C,

Sunde K, Vanden Hoek T. Post-cardiac arrest syndrome: epidemiology, pathophysiology, treatment, and prognostication: a consensus statement from the International Liaison Committee on Resuscitation (American

Heart Association, Australian and New Zealand Council on Resuscitation, European Resuscitation Council, Heart and Stroke Foundation of

Canada, InterAmerican Heart Foundation, Resuscitation Council of

Asia, and the Resuscitation Council of Southern Africa); the American

Heart Association Emergency Cardiovascular Care Committee; the

Council on Cardiovascular Surgery and Anesthesia; the Council on

Cardiopulmonary, Perioperative, and Critical Care; the Council on

Clinical Cardiology; and the Stroke Council. Circulation. 2008;118:

2452–2483.

231. Devita MA, Bellomo R, Hillman K, Kellum J, Rotondi A, Teres D,

Auerbach A, Chen WJ, Duncan K, Kenward G, Bell M, Buist M, Chen

J, Bion J, Kirby A, Lighthall G, Ovreveit J, Braithwaite RS, Gosbee J,

Milbrandt E, Peberdy M, Savitz L, Young L, Harvey M, Galhotra S.



Findings of the first consensus conference on medical emergency teams.

Crit Care Med. 2006;34:2463–2478.

232. Baxter AD, Cardinal P, Hooper J, Patel R. Medical emergency teams at

The Ottawa Hospital: the first two years. Can J Anaesth. 2008;55:

223–231.

233. Bellomo R, Goldsmith D, Uchino S, Buckmaster J, Hart GK, Opdam H,

Silvester W, Doolan L, Gutteridge G. A prospective before-and-after trial of a medical emergency team. Med J Aust. 2003;179:283–287.

234. Benson L, Mitchell C, Link M, Carlson G, Fisher J. Using an advanced practice nursing model for a rapid response team. Jt Comm J Qual

Patient Saf. 2008;34:743–747.

235. Bertaut Y, Campbell A, Goodlett D. Implementing a rapid-response team using a nurse-to-nurse consult approach. J Vasc Nurs. 2008;26:

37– 42.

236. Buist MD, Moore GE, Bernard SA, Waxman BP, Anderson JN, Nguyen

TV. Effects of a medical emergency team on reduction of incidence of and mortality from unexpected cardiac arrests in hospital: preliminary study. BMJ. 2002;324:387–390.

237. Buist M, Harrison J, Abaloz E, Van Dyke S. Six year audit of cardiac arrests and medical emergency team calls in an Australian outer metropolitan teaching hospital. BMJ. 2007;335:1210 –1212.

238. Chamberlain B, Donley K, Maddison J. Patient outcomes using a rapid response team. Clin Nurse Spec. 2009;23:11–12.

239. Dacey MJ, Mirza ER, Wilcox V, Doherty M, Mello J, Boyer A, Gates

J, Brothers T, Baute R. The effect of a rapid response team on major clinical outcome measures in a community hospital. Crit Care Med.

2007;35:2076 –2082.

240. DeVita MA, Braithwaite RS, Mahidhara R, Stuart S, Foraida M,

Simmons RL. Use of medical emergency team responses to reduce hospital cardiopulmonary arrests. Qual Saf Health Care. 2004;13:

251–254.

241. Gould D. Promoting patient safety: the rapid medical response team.

Perm J. 2007;11:26 –34.

242. Hatler C, Mast D, Bedker D, Johnson R, Corderella J, Torres J, King D,

Plueger M. Implementing a rapid response team to decrease emergencies outside the ICU: one hospital’s experience. Medsurg Nurs. 2009;18:

84 –90, 126.

243. Jolley J, Bendyk H, Holaday B, Lombardozzi KA, Harmon C. Rapid response teams: do they make a difference? Dimens Crit Care Nurs.

2007;26:253–260.

244. Jones D, Bellomo R, Bates S, Warrillow S, Goldsmith D, Hart G,

Opdam H, Gutteridge G. Long term effect of a medical emergency team on cardiac arrests in a teaching hospital. Crit Care. 2005;9:R808 –R815.

245. Jones D, Bellomo R, Bates S, Warrillow S, Goldsmith D, Hart G,

Opdam H. Patient monitoring and the timing of cardiac arrests and medical emergency team calls in a teaching hospital. Intensive Care

Med. 2006;32:1352–1356.

246. Moldenhauer K, Sabel A, Chu ES, Mehler PS. Clinical triggers: an alternative to a rapid response team. Jt Comm J Qual Patient Saf.

2009;35:164 –174.

247. Offner PJ, Heit J, Roberts R. Implementation of a rapid response team decreases cardiac arrest outside of the intensive care unit. J Trauma.

2007;62:1223–1227.

248. Chan PS, Khalid A, Longmore LS, Berg RA, Kosiborod M, Spertus JA.

Hospital-wide code rates and mortality before and after implementation of a rapid response team. JAMA. 2008;300:2506 –2513.

249. Hillman K, Chen J, Cretikos M, Bellomo R, Brown D, Doig G, Finfer

S, Flabouris A. Introduction of the medical emergency team (MET) system: a cluster-randomised controlled trial. Lancet. 2005;365:

2091–2097.

250. Kenward G, Castle N, Hodgetts T, Shaikh L. Evaluation of a medical emergency team one year after implementation. Resuscitation. 2004;61:

257–263.

251. King E, Horvath R, Shulkin DJ. Establishing a rapid response team

(RRT) in an academic hospital: one year’s experience. J Hosp Med.

2006;1:296 –305.

252. McFarlan SJ, Hensley S. Implementation and outcomes of a rapid response team. J Nurs Care Qual. 2007;22:307–313.

253. Rothschild JM, Woolf S, Finn KM, Friedberg MW, Lemay C, Furbush

KA, Williams DH, Bates DW. A controlled trial of a rapid response system in an academic medical center. Jt Comm J Qual Patient Saf.

2008;34:417– 425, 365.

254. Hunt EA, Zimmer KP, Rinke ML, Shilkofski NA, Matlin C, Garger C,

Dickson C, Miller MR. Transition from a traditional code team to a



medical emergency team and categorization of cardiopulmonary arrests in a children’s center. Arch Pediatr Adolesc Med. 2008;162:117–122.

255. Brilli RJ, Gibson R, Luria JW, Wheeler TA, Shaw J, Linam M, Kheir J,

McLain P, Lingsch T, Hall-Haering A, McBride M. Implementation of a medical emergency team in a large pediatric teaching hospital prevents respiratory and cardiopulmonary arrests outside the intensive care unit.

Pediatr Crit Care Med. 2007;8:236 –246.

256. Sharek PJ, Parast LM, Leong K, Coombs J, Earnest K, Sullivan J,

Frankel LR, Roth SJ. Effect of a rapid response team on hospital-wide mortality and code rates outside the ICU in a children’s hospital. JAMA.

2007;298:2267–2274.

257. Tibballs J, Kinney S. Reduction of hospital mortality and of preventable cardiac arrest and death on introduction of a pediatric medical emergency team. Pediatr Crit Care Med. 2009;10:306 –312.

258. Tibballs J, Kinney S, Duke T, Oakley E, Hennessy M. Reduction of paediatric in-patient cardiac arrest and death with a medical emergency team: preliminary results. Arch Dis Child. 2005;90:1148 –1152.

259. Chan PS, Jain R, Nallmothu BK, Berg RA, Sasson C. Rapid response teams: a systematic review and meta-analysis. Arch Intern Med. 2010;

170:18 –26.

260. DeVita MA, Smith GB, Adam SK, Adams-Pizarro I, Buist M, Bellomo

R, Bonello R, Cerchiari E, Farlow B, Goldsmith D, Haskell H, Hillman

K, Howell M, Hravnak M, Hunt EA, Hvarfner A, Kellett J, Lighthall

GK, Lippert A, Lippert FK, Mahroof R, Myers JS, Rosen M, Reynolds

S, Rotondi A, Rubulotta F, Winters B. “Identifying the hospitalised patient in crisis”: a consensus conference on the afferent limb of rapid response systems. Resuscitation. 2010;81:375–382.

261. Engdahl J, Abrahamsson P, Bang A, Lindqvist J, Karlsson T, Herlitz J.

Is hospital care of major importance for outcome after out-of-hospital cardiac arrest? Experience acquired from patients with out-of-hospital cardiac arrest resuscitated by the same Emergency Medical Service and admitted to one of two hospitals over a 16-year period in the municipality of Goteborg. Resuscitation. 2000;43:201–211.

262. Langhelle A, Tyvold SS, Lexow K, Hapnes SA, Sunde K, Steen PA.

In-hospital factors associated with improved outcome after out-ofhospital cardiac arrest: a comparison between four regions in Norway.

Resuscitation. 2003;56:247–263.

263. Carr BG, Goyal M, Band RA, Gaieski DF, Abella BS, Merchant RM,

Branas CC, Becker LB, Neumar RW. A national analysis of the relationship between hospital factors and post-cardiac arrest mortality.

Intensive Care Med. 2009;35:505–511.

264. Liu JM, Yang Q, Pirrallo RG, Klein JP, Aufderheide TP. Hospital variability of out-of-hospital cardiac arrest survival. Prehosp Emerg

Care. 2008;12:339 –346.

265. Carr BG, Kahn JM, Merchant RM, Kramer AA, Neumar RW. Interhospital variability in post-cardiac arrest mortality. Resuscitation. 2009;

80:30 –34.

266. Herlitz J, Engdahl J, Svensson L, Angquist KA, Silfverstolpe J,

Holmberg S. Major differences in 1-month survival between hospitals in

Sweden among initial survivors of out-of-hospital cardiac arrest. Resus-

citation. 2006;70:404 – 409.

267. Keenan SP, Dodek P, Martin C, Priestap F, Norena M, Wong H.

Variation in length of intensive care unit stay after cardiac arrest: where you are is as important as who you are. Crit Care Med. 2007;35:

836 – 841.

268. Oddo M, Schaller MD, Feihl F, Ribordy V, Liaudet L. From evidence to clinical practice: effective implementation of therapeutic hypothermia to improve patient outcome after cardiac arrest. Crit Care Med. 2006;34:

1865–1873.

269. Sunde K, Pytte M, Jacobsen D, Mangschau A, Jensen LP, Smedsrud C,

Draegni T, Steen PA. Implementation of a standardised treatment protocol for post resuscitation care after out-of-hospital cardiac arrest.

Resuscitation. 2007;73:29 –39.

270. Knafelj R, Radsel P, Ploj T, Noc M. Primary percutaneous coronary intervention and mild induced hypothermia in comatose survivors of ventricular fibrillation with ST-elevation acute myocardial infarction.

Resuscitation. 2007;74:227–234.

271. Wolfrum S, Pierau C, Radke PW, Schunkert H, Kurowski V. Mild therapeutic hypothermia in patients after out-of-hospital cardiac arrest due to acute ST-segment elevation myocardial infarction undergoing immediate percutaneous coronary intervention. Crit Care Med. 2008;

36:1780 –1786.

272. Gaieski DF, Band RA, Abella BS, Neumar RW, Fuchs BD, Kolansky

DM, Merchant RM, Carr BG, Becker LB, Maguire C, Klair A, Hylton

J, Goyal M. Early goal-directed hemodynamic optimization combined


by on December 4, 2010 with therapeutic hypothermia in comatose survivors of out-of-hospital cardiac arrest. Resuscitation. 2009;80:418 – 424.

273. Bradley EH, Herrin J, Wang Y, Barton BA, Webster TR, Mattera JA,

Roumanis SA, Curtis JP, Nallamothu BK, Magid DJ, McNamara RL,

Parkosewich J, Loeb JM, Krumholz HM. Strategies for reducing the door-to-balloon time in acute myocardial infarction. N Engl J Med.

2006;355:2308 –2320.

274. LaMonte MP, Bahouth MN, Magder LS, Alcorta RL, Bass RR, Browne

BJ, Floccare DJ, Gaasch WR. A regional system of stroke care provides thrombolytic outcomes comparable with the NINDS stroke trial. Ann

Emerg Med. 2009;54:319 –327.

275. Organised inpatient (stroke unit) care for stroke. Cochrane Database

Syst Rev. 2007 Oct 17;CD000197.

276. MacKenzie EJ, Rivara FP, Jurkovich GJ, Nathens AB, Frey KP,

Egleston BL, Salkever DS, Scharfstein DO. A national evaluation of the effect of trauma-center care on mortality. N Engl J Med. 2006;354:

366 –378.

277. Nichol G, Aufderheide TP, Eigel B, Neumar RW, Lurie KG, Bufalino

VJ, Callaway CW, Menon V, Bass RR, Abella BS, Sayre M, Dougherty

CM, Racht EM, Kleinman ME, O’Connor RE, Reilly JP, Ossmann EW,

Peterson E. Regional systems of care for out-of-hospital cardiac arrest: a policy statement from the American Heart Association. Circulation.

2010;121:709 –729.

278. Ali J, Adam R, Stedman M, Howard M, Williams J. Cognitive and attitudinal impact of the Advanced Trauma Life Support program in a developing country. J Trauma. 1994;36:695–702.

279. Bergman S, Deckelbaum D, Lett R, Haas B, Demyttenaere S, Munthali

V, Mbembati N, Museru L, Razek T. Assessing the impact of the trauma team training program in Tanzania. J Trauma. 2008;65:879 – 883.

280. Bhat BV, Biswal N, Bhatia BD, Nalini P. Undergraduate training in neonatal resuscitation: a modified approach. Indian J Matern Child

Health. 1993;4:87– 88.

281. Carlo WA, Wright LL, Chomba E, McClure EM, Carlo ME, Bann CM,

Collins M, Harris H. Educational impact of the neonatal resuscitation program in low-risk delivery centers in a developing country. J Pediatr.

2009;154:504 –508.e5.

282. Couper ID, Thurley JD, Hugo JF. The neonatal resuscitation training project in rural South Africa. Rural Remote Health. 2005;5:459.

283. Ergenekon E, Koc E, Atalay Y, Soysal S. Neonatal resuscitation course experience in Turkey. Resuscitation. 2000;45:225–227.

284. Husum H, Gilbert M, Wisborg T. Training pre-hospital trauma care in low-income countries: the “Village University” experience. Med Teach.

2003;25:142–148.

285. Jabir MM, Doglioni N, Fadhil T, Zanardo V, Trevisanuto D. Knowledge and practical performance gained by Iraqi residents after participation to a neonatal resuscitation program course. Acta Paediatr. 2009;98:

1265–1268.

286. Kimura A, Okada K, Kobayashi K, Inaka A, Hagiwara Y, Sakamoto T,

Sugimoto N, Nakamura M, Nakamura K, Horiuchi K, Hujii Y, Murota

C, Emoto M. Introductory adult cardiac life support course for Vietnamese healthcare workers. Resuscitation. 2008;79:511–512.

287. McClure EM, Carlo WA, Wright LL, Chomba E, Uxa F, Lincetto O,

Bann C. Evaluation of the educational impact of the WHO Essential

Newborn Care course in Zambia. Acta Paediatr. 2007;96:1135–1138.

288. Trevisanuto D, Ibrahim SA, Doglioni N, Salvadori S, Ferrarese P,

Zanardo V. Neonatal resuscitation courses for pediatric residents: comparison between Khartoum (Sudan) and Padova (Italy). Paediatr

Anaesth. 2007;17:28 –31.

289. Urbano J, Matamoros MM, Lopez-Herce J, Carrillo AP, Ordonez F,

Moral R, Mencia S. A paediatric cardiopulmonary resuscitation training project in Honduras. Resuscitation. 2010;81:472– 476.

290. Zaeem ul H, Qureshi F, Hafeez A, Zafar S, Mohamud BK, Southal DP.

Evidence for improvement in the quality of care given during emergencies in pregnancy, infancy and childhood following training in lifesaving skills: a postal survey. J Pak Med Assoc. 2009;59:22–26.

291. Ali J, Adam R, Butler AK, Chang H, Howard M, Gonsalves D, Pitt-

Miller P, Stedman M, Winn J, Williams JI. Trauma outcome improves following the advanced trauma life support program in a developing country. J Trauma. 1993;34:890 – 898.

292. Ali J, Adam RU, Gana TJ, Williams JI. Trauma patient outcome after the Prehospital Trauma Life Support program. J Trauma. 1997;42:

1018 –1021.

293. Arreola-Risa C, Mock C, Herrera-Escamilla AJ, Contreras I, Vargas J.

Cost-effectiveness and benefit of alternatives to improve training for


S933

prehospital trauma care in Mexico. Prehosp Disaster Med. 2004;19:

318 –325.

294. Husum H, Gilbert M, Wisborg T, Van Heng Y, Murad M. Rural prehospital trauma systems improve trauma outcome in low-income countries: a prospective study from North Iraq and Cambodia. J Trauma.

2003;54:1188 –1196.

295. Chomba E, McClure EM, Wright LL, Carlo WA, Chakraborty H, Harris

H. Effect of WHO newborn care training on neonatal mortality by education. Ambul Pediatr. 2008;8:300 –304.

296. Zhu XY, Fang HQ, Zeng SP, Li YM, Lin HL, Shi SZ. The impact of the

Neonatal Resuscitation Program Guidelines (NRPG) on the neonatal mortality in a hospital in Zhuhai, China. Singapore Med J. 1997;38:

485– 487.

297. Moretti MA, Cesar LA, Nusbacher A, Kern KB, Timerman S, Ramires

JA. Advanced cardiac life support training improves long-term survival from in-hospital cardiac arrest. Resuscitation. 2007;72:458 – 465.

298. Carlo WA, Goudar SS, Jehan I, Chomba E, Tshefu A, Garces A, Parida

S, Althabe F, McClure EM, Derman RJ, Goldenberg RL, Bose C, Krebs

NF, Panigrahi P, Buekens P, Chakraborty H, Hartwell TD, Wright LL.

Newborn-care training and perinatal mortality in developing countries.

N Engl J Med. 2010;362:614 – 623.

299. Smith MK, Ross C. Teaching cardiopulmonary resuscitation in a developing country: using Nicaragua as a model. Crit Care Nurs Q.

1997;20:15–21.

300. Tennant C. Resuscitation training in Uganda. Emerg Nurse. 2000;8:

10 –14.

301. Young S, Hutchinson A, Nguyen VT, Le TH, Nguyen DV, Vo TK.

Teaching paediatric resuscitation skills in a developing country: introduction of the Advanced Paediatric Life Support course into Vietnam.

Emerg Med Australas. 2008;20:271–275.

302. Zafar S, Hafeez A, Qureshi F, Arshad N, Southall D. Structured training in the management of emergencies in mothers, babies and children in a poorly resourced health system: logbooks to document skill use. Resuscitation. 2009;80:449 – 452.

K

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: cardiopulmonary resuscitation



American Heart Association Cardiopulmonary Resuscitation Guidelines

Assistant Bot

Part 16: Education, Implementation, and Teams: 2010 American Heart

Association Guidelines for Cardiopulmonary Resuscitation and Emergency

Cardiovascular Care

Farhan Bhanji, Mary E. Mancini, Elizabeth Sinz, David L. Rodgers, Mary Ann

McNeil, Theresa A. Hoadley, Reylon A. Meeks, Melinda Fiedor Hamilton, Peter A.

Meaney, Elizabeth A. Hunt, Vinay M. Nadkarni and Mary Fran Hazinski

Circulation

2010;122;S920-S933

DOI: 10.1161/CIRCULATIONAHA.110.971135

Circulation is published by the American Heart Association. 7272 Greenville Avenue, Dallas, TX

72514

Copyright © 2010 American Heart Association. All rights reserved. Print ISSN: 0009-7322. Online

ISSN: 1524-4539

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Reprints: Information about reprints can be found online at http://www.lww.com/reprints

Part 16: Education, Implementation, and Teams

2010 American Heart Association Guidelines for Cardiopulmonary

Resuscitation and Emergency Cardiovascular Care

Farhan Bhanji, Chair; Mary E. Mancini; Elizabeth Sinz; David L. Rodgers; Mary Ann McNeil;

Theresa A. Hoadley; Reylon A. Meeks; Melinda Fiedor Hamilton; Peter A. Meaney;

Elizabeth A. Hunt; Vinay M. Nadkarni; Mary Fran Hazinski

Willingness to Perform

Barriers to Bystander CPR

Bhanji et al Part 16: Education, Implementation, and Teams

Barriers to AED Use

Education Design

Barriers to Recognition of Cardiac Arrest

Physical and Psychological Concerns for Rescuers

Course Design

November 2, 2010

Realistic Manikins

Strategies for Basic Life Support (BLS) Courses

AED Training Requirement

Course Delivery Formats

Strategies for Advanced Life Support

(ALS) Courses

Post-Course Assessment

Bhanji et al Part 16: Education, Implementation, and Teams

Training Intervals

Improving Resuscitation Skills

Checklists/Cognitive Aids

CPR Prompt or Feedback Devices

Debriefing

Implementation and Outcomes

Systems Approach and Feedback Loop

November 2, 2010

Rapid Response Teams (RRTs) and Medical

Emergency Teams (METs)

Resuscitation Training in

Limited-Resource Communities

Regional Systems of (Emergency)

Cardiovascular Care

Summary

Acknowledgments

Bhanji et al Part 16: Education, Implementation, and Teams

Disclosures

November 2, 2010

References

Bhanji et al Part 16: Education, Implementation, and Teams

November 2, 2010

Bhanji et al Part 16: Education, Implementation, and Teams

November 2, 2010

Bhanji et al Part 16: Education, Implementation, and Teams

November 2, 2010

Bhanji et al Part 16: Education, Implementation, and Teams

Key Features

Frequently Answers and Questions

What is the Chain of Survival?

What are some strategies to improve bystander CPR?

What are the key features of a successful resuscitation program?

How can I learn more about CPR?

What is the role of regional systems of care in cardiac arrest survival?

Related manuals

Peoria Area EMS