Low survival rates following out-of-hospital cardiac arrest (OHCA) remain a serious health concern internationally. Early bystander cardiopulmonary resuscitation (CPR) and rapid defibrillation can increase the chances of survival dramatically. However, the number of OHCA patients who receive these interventions remains low. This study sought to characterize Canadian public knowledge, attitudes and willingness to perform both traditional and chest-compression-only CPR using a two-phase, mixed methods approach. Twenty-one qualitative interviews were conducted, the results of which informed an online, scenario-based, Canada-wide survey. Significant knowledge gaps regarding recognition of cardiac arrest, the precise steps of CPR and perceived survival rate were identified and common to both phases. A larger proportion of survey respondents demonstrated a willingness to perform chest-compression-only CPR compared to traditional CPR in general, and specifically in situations involving strangers and unkempt individuals. Knowledge gaps and misconceptions seem to dominate the public perspective, leading to the recommendation for a tailored knowledge translation solution.

Low survival rates following out-of-hospital cardiac arrest (OHCA) remain a serious health concern internationally. Early bystander cardiopulmonary resuscitation (CPR) and rapid defibrillation can increase the chances of survival dramatically. However, the number of OHCA patients who receive these interventions remains low. This study sought to characterize Canadian public knowledge, attitudes and willingness to perform both traditional and chest-compression-only CPR using a two-phase, mixed methods approach. Twenty-one qualitative interviews were conducted, the results of which informed an online, scenario-based, Canada-wide survey. Significant knowledge gaps regarding recognition of cardiac arrest, the precise steps of CPR and perceived survival rate were identified and common to both phases. A larger proportion of survey respondents demonstrated a willingness to perform chest-compression-only CPR compared to traditional CPR in general, and specifically in situations involving strangers and unkempt individuals. Knowledge gaps and misconceptions seem to dominate the public perspective, leading to the recommendation for a tailored knowledge translation solution.

Submitted by PPG Medicina e Ci?ncias da Sa?de (medicina-pg@pucrs.br) on 2018-07-13T12:02:18Z No. of bitstreams: 1 DAVID_PONCIANO_DE_SENA.pdf: 7136289 bytes, checksum: 63e5ded0ad929d80daf354b846f5dd28 (MD5) / Approved for entry into archive by Sheila Dias (sheila.dias@pucrs.br) on 2018-07-18T12:59:17Z (GMT) No. of bitstreams: 1 DAVID_PONCIANO_DE_SENA.pdf: 7136289 bytes, checksum: 63e5ded0ad929d80daf354b846f5dd28 (MD5) / Made available in DSpace on 2018-07-18T13:04:40Z (GMT). No. of bitstreams: 1 DAVID_PONCIANO_DE_SENA.pdf: 7136289 bytes, checksum: 63e5ded0ad929d80daf354b846f5dd28 (MD5) Previous issue date: 2018-04-12 / Coordena??o de Aperfei?oamento de Pessoal de N?vel Superior - CAPES / Aim of the Study: The purpose of this study was to develop and validate a serious game for mobile platforms comparing with a video-assisted self-learning method to assist in the teaching and learning process of cardiopulmonary resuscitation (CPR) maneuvers. In a traditional training, CPR is based on learning by doing using a simulated model with the assistance of an instructor. However, this model presents an overall higher cost and less accessibility, provoking the need for cheaper and more accessible alternative methods. Methods: Forty-five volunteer first-year medical students completed a written multiple choice and practical pretest about CPR maneuvers skills and were randomly allocated into two groups. During a period of 20 minutes, the video self-learning group with 22 students was exposed to a video-based training about CPR, while the video game group with 23 students used a serious game simulating a cardiac arrest scenario where the student should perform virtual CPR to keep playing the game. Each group then performed, a written multiple choice score and practical post-test on a CPR training model while being evaluated by three blinded emergency doctors based on 2015 AHA-BLS (American Heart Association - Basic Life Support) protocol. Both groups were also evaluated about how long they kept interested on each self-learning system. Results: The video group had superior performance as confirmed by a written multiple choice score 7.56+-0.21 against 6.51+-0,21 for a video game (p=0. 001) and practical scores 9.67+-0.21 against 8.40+-0,21 for a video game (p<0. 001). The video game group stayed longer using the method as confirmed by 18.57+- 0,66 minutes for video game group and 7.41+-0,43 for the video group (p<0. 001), demonstrating greater interest in the video game method. Conclusions: The group that used a video game as a self-training method in a short period of exposure had a lower performance than the video group in both the theoretical and practical tests regarding cardiorespiratory resuscitation. However, there was a clear preference for students to use games rather than videos as a form of self-training. / Objetivo do estudo: O objetivo deste estudo foi desenvolver e validar um jogo s?rio para plataformas m?veis em compara??o com um m?todo de autoaprendizagem assistido por v?deo para auxiliar no processo de ensino e aprendizagem das manobras de ressuscita??o cardiopulmonar (RCP). Em um treinamento tradicional, a RCP ? baseada no aprendizado pela pr?tica, utilizando um modelo simulado com a ajuda de um instrutor. No entanto, este modelo apresenta um custo global mais elevado e de menor acessibilidade, despertando a necessidade de m?todos alternativos mais baratos e pratic?veis. M?todos: Quarenta e cinco volunt?rios, estudantes de medicina do primeiro ano, completaram um pr?-teste de m?ltipla escolha escrito e um pr?-teste pr?tico sobre RCP e foram alocados aleatoriamente em dois grupos. Durante um per?odo de 20 minutos, o grupo de autoaprendizagem v?deo, composto por 22 alunos, foi exposto a um v?deo de treinamento sobre a RCP, enquanto o grupo videogame, composto por 23 estudantes, utilizou um jogo s?rio, simulando um cen?rio de parada card?aca, onde o aluno deveria executar uma RCP virtual para continuar jogando. Ao t?rmino do treinamento, cada grupo foi submetido a um p?s-teste escrito de m?ltipla escolha e um p?s-teste pr?tico em um modelo de treinamento de RCP, sendo avaliados de forma cegada, por tr?s m?dicos com experi?ncia em atendimento de emerg?ncia, com base no protocolo 2015 AHA-BLS (American Heart Association - Basic Life Support). Ambos os grupos tamb?m foram avaliados quanto a quantidade de tempo que eles permaneciam interessados em cada sistema de autoaprendizagem. Resultados: O grupo v?deo apresentou desempenho superior confirmado por uma maior pontua??o no teste escrito de m?ltipla escolha, 7.56 + -0.21 contra 6.51 + -0,21 para videogame (p = 0. 001) e pontua??o no teste de avalia??o pr?tica 9,67 + -0,21 contra 8,40 + -0,21 para videogame (p <0. 001). O grupo videogame permaneceu mais tempo utilizando o m?todo, 18,57 + - 0,66 minutos para o grupo videogame e 7,41 + -0,43 para o grupo v?deo (p <0. 001), demonstrando maior interesse no m?todo do videogame. Conclus?es: O grupo que usou o jogo s?rio (grupo videogame) como um m?todo de autotreinamento em um curto per?odo de exposi??o teve um desempenho pior do que o grupo v?deo nos testes te?ricos e pr?ticos em rela??o ? ressuscita??o cardiopulmonar. No entanto, houve uma clara prefer?ncia por parte dos alunos em utilizar jogos em rela??o aos v?deos como forma de autotreinamento.

Background: It has been proved that bystander cardiopulmonary resuscitation (CPR) saves lives; however, which training method in CPR is most instructive and whether survival is affected by the training level of the bystander have not yet been fully described. Aim: To identify the factors that may affect 7th grade students’ acquisition of CPR skills during CPR training and their willingness to act, and to describe 30-day survival from outof- hospital cardiac arrest (OHCA) after bystander CPR and the actions performed by laymen versus off-duty medically educated personnel. Methods: Studies I–III investigate a CPR training intervention given to students in 7th grade during 2013–2014. The classes were randomized to the main intervention: the mobile phone application (app) or DVD-based training. Some of the classes were randomized to one or several additional interventions: a practical test with feedback, reflection, a web course, a visit from elite athletes and automated external defibrillator (AED) training. The students’ practical skills, willingness to act and knowledge of stroke symptoms, symptoms of acute myocardial infarction (AMI) and lifestyle factors were assessed directly after training and at 6 months using the Laerdal PC SkillReporting system (and entered into a modified version of the Cardiff test scoring sheet) and a questionnaire. The Cardiff test resulted in a total score of 12–48 points, and the questionnaire resulted in a total score of 0–7 points for stroke symptoms, 0–9 points for symptoms of AMI and 0– 6 points on lifestyle factors. Study IV is based on retrospective data from the national quality register, the Swedish registry of cardiopulmonary resuscitation, 2010-2014. Results: A total of 1339 students were included in the CPR training intervention. The DVD-based group was superior to the app-based group in CPR skills, with a total score of 35 (SD 4.o) vs 33 (SD 4.2) points directly after training (p&lt;0.001) and 33 (SD 4.0) vs 31 (SD 4.2) points at six months (p&lt;0.001). Of the additional interventions, the practical test with feedback had the greatest influence regarding practical skills: at six months the intervention group scored 32 (SD 3.9) points and the control group (CPR only) scored 30 (SD 4.0) points (p&lt;0.001). Reflection, the web course, visits from elite athletes and AED training did not further increase the students’ acquisition of practical CPR skills. The students who completed the web course Help-Brain-Heart received a higher total score for theoretical knowledge in comparison with the control group, directly after training: stroke 3.8 (SD 1.8) vs 2.7 (SD 2.0) points (p&lt;0.001); AMI 4.0 (SD 2.0) vs 2.5 (SD 2.0) points (p&lt;0.001); lifestyle factors 5.4 (SD 1.2) vs 4.5 (SD 2.0) points p&lt;0.001. Most of the students (77% at 6 months), regardless of the intervention applied, expressed that they would perform both chest compressions and ventilations in a cardiac arrest (CA) situation involving a relative. If a stranger had CA, a significantly lower proportion of students (32%; p&lt;0.001) would perform both compressions and ventilations. In this case, however, many would perform compressions only. In most cases of bystander-witnessed OHCA, CPR was performed by laymen. Off-duty health care personnel bystanders initiated CPR within 1 minute vs 2 minutes for laymen (p&lt;0.0001). Thirty-day survival was 14.7% among patients who received CPR from laymen and 17.2% (p=0.02) among patients who received bystander CPR from off-duty health care personnel. Conclusions: The DVD-based method was superior to the app-based method in terms of teaching practical CPR skills to 7th grade students. Of the additional interventions, a practical test with feedback was the most efficient intervention to increase learning outcome. The additional interventions, reflection, web course, visit from elite athletes and AED did not increase CPR skills further. However, the web course Help-Brain-Heart improved the students’ acquisition of theoretical knowledge regarding stroke, AMI and lifestyle factors. For OHCA, off-duty health care personnel bystanders initiated CPR earlier and 30-day survival was higher compared with laymen bystanders.