Life Support Courses: Are They Effective?

doi:10.1016/S0196-0644(96)70095-1

Annals of Emergency Medicine

Volume 28, Issue 6, December 1996, Pages 690-698

https://doi.org/10.1016/S0196-0644(96)70095-1 Get rights and content

Abstract

Study objective: To determine the effectiveness of life support courses for health care providers on the basis of one of three outcomes: (1) patient mortality and morbidity, (2) retention of knowledge or skills, and (3) change in practice behavior. Methods: English-language articles from 1975 to 1992 were identified through MEDLINE and ERIC searches, bibliographies of articles, and current abstracts. Studies were considered relevant if they included a study population of life support providers, an intervention of any of the identified life support courses, and assessment of at least one of the three listed outcomes. Relevant studies were selected and validity scores were assigned to them by agreement of two independent reviewers, using a structured form to assess validity. Data on setting, methods, participants, intervention, and outcomes were then abstracted and verified. Results: Seventeen of 67 identified studies pertaining to life support courses met the inclusion criteria. (1) All three mortality and morbidity studies indicated a positive impact, with an overall odds ratio of .28 (95% confidence interval [CI], .22 to .37). (2) No net increase in scores was found in 5 of 8 studies of retention of knowledge and in 8 of 9 studies of skills retention. Two of three studies reporting refresher activities yielded positive effects on knowledge retention. Outcomes were not significantly different between groups taught with modular or didactic techniques. (3) Studies assessing behavioral outcome were methodologically weak. Conclusion: Among providers, retention of knowledge and skills acquired by participation in support courses is poor. However, refresher activities increase knowledge retention. Modular courses are as good as lectures for learning course material. There is evidence that use of the Advanced Trauma Life Support course has decreased mortality and morbidity. Further studies of patient outcome and provider behaviors are warranted. [Jabbour M, Osmond MH, Klassen TP: Life support courses: Are they effective? Ann Emerg Med December 1996;28:690-698.]

Section snippets

INTRODUCTION

Life support programs designed to improve outcome of seriously ill or injured patients have been developed and taught since the early 1960s. General acceptance and confidence in these programs has been evidenced by an exponential increase in participation by a variety of caregivers, from lay persons to health care professionals.1, 2, 3, 4 Many health care institutions now require their employees to successfully complete cardiac life support courses.⁵ Similarly, training in pediatric life

MATERIALS AND METHODS

For the purposes of this review, a life support course was defined as any one of the following: Basic Cardiac Life Support (BCLS), Advanced Cardiac Life Support (ACLS), PALS, modified advanced pediatric life support (APLS), ATLS, or the Neonatal Resuscitation Program (NRP).

Original studies were identified through electronic searches of MEDLINE and ERIC English-language articles (search terms available on request). Additional studies were identified through review of citations in the articles

RESULTS

A total of 67 studies pertaining to life support courses were found and evaluated (complete list available on request). No systematic reviews of life support courses were encountered. Although two review articles on BCLS and ACLS programs13, 14 were found, neither was a systematic review of the literature. For assessments of relevance, the reviewing authors agreed on 89% of citations (weighted k, .75; SE, .09). In all, 17 studies were deemed relevant. Of these, three15, 16, 17 examined

DISCUSSION

Although the degree of research in effectiveness of life support programs is greatly overshadowed by their demand, a small number of good studies have been done. This review represents a systematic identification and qualitative assessment of the relevant studies to date that address the issue of life support program effectiveness.

The three types of studies vary in their usefulness for determining changes in patient outcome as a result of life support training. Studies of mortality and

References (39)

JE Billi et al.
Education in adult Advanced Cardiac Life Support training programs: Changing the paradigm
Ann Emerg Med
(1993)
JM Atkins
Training in resuscitation: Is it worthwhile?
Chest
(1986)
JE Billi
The educational direction of the ACLS Training Program
Ann Emerg Med
(1993)
JS Seidel et al.
Education in pediatric basic and advanced life support
Ann Emerg Med
(1993)
W Kaye et al.
The problem of poor retention of cardiopulmonary resuscitation skills may lie with the instructor, not the learner or the curriculum
Resuscitation
(1991)
JA Vestrup et al.
Impact of Advanced Trauma Life Support training on early trauma management
Am J Surg
(1988)
M Nelson et al.
CPR instruction: Modular versus lecture course
Ann Emerg Med
(1984)
AS O'Marcaigh et al.
Cessation of unsuccessful pediatric resuscitation: How long is too long?
Mayo Clin Proc
(1993)
J Ali et al.
The Advanced Trauma Life Support program in Manitoba: A 5-year review
Can J Surgery
(1993)
PE Collicott
Advanced Trauma Life Support (ATLS): Past, present, future
J Trauma
(1992)

MS Kramer et al.

The biostatistics of concordance

Clin Pharmacol Ther

(1981)

The Standards of Reporting Trials Group

A proposal for structured reporting of randomized controlled trials

JAMA

(1994)

AR Feinstein

Clinical Epidemiology

MB Bracken

Statistical methods for analysis of effects of treatment in overviews of randomized trials

The Cochrane Collaboration

Guide to Using the Cochrane Review Manager Software (RevMan), Version 1.04

(1994)

R Peto

Why do we need systematic reviews of randomized trials?

Stat Med

(1987)

ME Mancini et al.

Educational issues in basic and advanced cardiac life support

J Cardiovasc Nursing

(1988)

J Ali et al.

Trauma outcome improves following the Advanced Trauma Life Support program in a developing country

J Trauma

(1993)

WJ Messick et al.

The association of advanced life support training and decreased per capita trauma death rates: An analysis of 12,417 trauma deaths

J Trauma

(1992)

Cited by (79)

The initiative for medical equity and global health (IMEGH) resuscitation training program: A model for resuscitation training courses in Africa
2024, African Journal of Emergency Medicine
In high-income countries, outcomes following in hospital cardiac arrest have improved over the last two decades due to the introduction of rapid response teams, cardiac arrest teams, and advanced resuscitation training. However, in low-income countries, such as Rwanda, outcomes are still poor. This is due to multiple factors including lack of adequate resuscitation training, few trainers, and lack of equipment.
To address this issue, the Initiative for Medical Equity and Global Health Equity (IMEGH), a training organization founded in 2018 by 5 local anesthesiologists has regularly taught resuscitation courses such as Basic Life Support, Advanced Cardiac Life Support, and Pediatric Advanced Life Support in hospitals throughout Rwanda. The aims of the organization include developing a sustainable model to offer context relevant resuscitation training courses, building a cadre of local instructors to teach on the courses, as well as engaging funding partners to help support the effort. From October 2018 until September 2022, 31 courses were run in 11 hospitals across Rwanda training 1,060 healthcare providers (mainly of non-physician anesthetists, nurses, midwives, and general practitioners). Ongoing challenges include lack of local protocols, inability to tracking resuscitation outcomes, and continued inaccessibility by many healthcare providers. Despite these challenges, the IMEGH program is an example of a successful context-relevant model and has potential to inform the design of resuscitation programs in other similar settings. This article describes the development of the IMEGH program, accomplishments as well as lessons learned, challenges, and next steps for expansion.
Resuscitation team training in Rwanda: A mixed method study exploring the combination of the VAST course with Advanced Cardiac Life Support training
2023, Resuscitation Plus
The influence of non-technical skills training on resuscitation performance in low-resource settings is unknown. This study investigates combining the Vital Anaesthesia Simulation Training Course with Advanced Cardiac Life Support training on resuscitation performance in Rwanda.
Participants in this mixed method study are members of resuscitation teams in three district hospitals in Rwanda. The intervention was participation in a 2-day Advanced Cardiac Life Support course followed by the 3-day Vital Anaesthesia Simulation Training Course. Quantitative primary endpoints were time to initiation of cardiopulmonary resuscitation, time to epinephrine administration, and time to defibrillation. Qualitative data on workplace implementation were gathered during focus groups held 3-months post-intervention.
Forty-seven participants were recruited. Quantitative data showed a statistically significant decrease in time to cardiopulmonary resuscitation, epinephrine administration, and defibrillation from pre- to post-Advanced Cardiac Life Support, with times of [43.3 (49.7) seconds] versus [16.5 (20) sec], p = <0.001; [137.3 (108.9) sec] versus [51.3 (37.9)], p = <0.001; and [218.5 (105.8) sec] versus [110.8 (87.1) sec], p = <0.001; respectively. These improvements were maintained following the Vital Anaesthesia Simulation Training Course, and at 3-month retention testing. Qualitative analysis highlighted five key themes: ability to initiate cardiopulmonary resuscitation; team coordination for task allocation; empowerment; desire for training and mentorship; and advocacy for system improvement.
A modified 2-day Advanced Cardiac Life Support course improved resuscitation time indicators with retention 3-months later. Combining the Vital Anaesthesia Simulation Training Course and Advanced Cardiac Life Support led to better team coordination, empowerment to act, and advocacy for system improvement. This pairing of courses has promise for improving Advanced Cardiac Life Support skills amongst healthcare workers in low-resource settings.
ClinicalTrials.gov Identifier: NCT05278884.
Neonatal resuscitation training for midwives in Uganda: Strengthening skill and knowledge retention
2017, Midwifery
The objective of this project was to improve birth outcomes for babies in a regional referral hospital in Uganda by strengthening factors that influence the retention and application of neonatal resuscitation skills. Initial training in neonatal resuscitation is not enough on its own. In order to better understand the gap between training and effective practice, an evaluation of a neonatal resuscitation program was carried out. This included practical skill testing of local midwives using a neonatal resuscitation doll pre- and post-training, as well as follow up testing at 1 month and 12 months, followed by focus groups and interviews. Test scores revealed that participants’ knowledge grew significantly immediately following the workshop, and remained high after 1 month, but fell by 12 months post-training. Interviews with hospital staff revealed a number of facilitators and barriers to practice, namely knowledge retention and skill application. The most important barrier identified is the lack of refresher training post-workshop. Importantly, the findings demonstrated a need not for refresher training alone, but for improved organizational and administrative support for the newly assigned trainers.
Burn Care on Cruise Ships—Epidemiology, international regulations, risk situation, disaster management and qualification of the ship's doctor
2016, Burns
With the increasing numbers of passengers and crew on board vessels that are becoming larger and larger, the demand for ship's doctors who can adequately treat burns on board has also increased. In the cruise ship industry it is usually those doctor's with internal and general medical training who are recruited from an epidemiological point of view. Training content or recommendations for the treatment of thermal lesions with the limited options available in ship's hospitals and where doctors with no surgical training operate do not yet exist. The guidelines recommended by the Cruise Lines International Association (CLIA) regarding medical staff have only included physicians with minor surgical skills until now. With the introduction of the ATLS^® course developed by the American College of Surgeons, the requirements for the qualification of the ship's doctor on board cruise ships shall change from January 2017. The article discusses the question of whether having completed the ATLS^® course, the ship's doctor is trained to adequately treat thermal lesions or severe burns persons on-board, and presents the current discussion on the training content for ship's doctors within the International Maritime Health Association (IMHA). It also provides an overview of existing international regulatory frameworks, the risks presented by a fire on board, the problem of treating burns victims out of reach of coastal rescue services, and alternative training concepts for ship's doctors regarding the therapy of thermal lesions on-board.
The development and assessment of an evaluation tool for pediatric resident competence in leading simulated pediatric resuscitations
2012, Resuscitation
It is critical that competency in pediatric resuscitation is achieved and assessed during residency or post graduate medical training. The purpose of this study was to create and evaluate a tool to measure all elements of pediatric resuscitation team leadership competence.
An initial set of items, derived from a literature review and a brainstorming session, were refined to a 26 item assessment tool through the use of Delphi methodology. The tool was tested using videos of standardized resuscitations. A psychometric assessment of the evidence for instrument validity and reliability was undertaken.
The performance of 30 residents on two videotaped scenarios was assessed by 4 pediatricians using the tool, with 12 items assessing ‘leadership and communication skills’ (LCS) and 14 items assessing ‘knowledge and clinical skills’ (KCS). The instrument showed evidence of reliability; the Cronbach's alpha and generalizability co-efficients for the overall instrument were α = 0.818 and Ep² = 0.76, for LCS were α = 0.827 and Ep² = 0.844, and for KCS were α = 0.673 and Ep² = 0.482. While validity was initially established through literature review and brainstorming by the panel of experts, it was further built through the high strength of correlation between global scores and scores for overall performance (r = 0.733), LCS (r = 0.718) and KCS (r = 0.662) as well as the factor analysis which accounted for 40.2% of the variance.
The results of the study demonstrate that the instrument is a valid and reliable tool to evaluate pediatric resuscitation team leader competence.
Helping Babies Breathe: Global neonatal resuscitation program development and formative educational evaluation
2012, Resuscitation
To develop an educational program designed to train health care providers in resource limited settings to carry out neonatal resuscitation. We analyzed facilitator and learner perceptions about the course, examined skill performance, and assessed the quality of instruments used for learner evaluation as part of the formative evaluation of the educational program Helping Babies Breathe.
Multiple stakeholders and a Delphi panel contributed to program development. Training of facilitators and learners occurred in global field test sites. Course evaluations and focus groups provided data on facilitator and learner perceptions. Knowledge and skill assessments included pre/post scores from multiple choice questions (MCQ) and post-training assessment of bag and mask skills, as well as 2 objective structured clinical evaluations (OSCE).
Two sites (Kenya and Pakistan) trained 31 facilitators and 102 learners. Participants expressed high satisfaction with the program and high self-efficacy with respect to neonatal resuscitation. Assessment of participant knowledge and skills pre/post-program demonstrated significant gains; however, the majority of participants could not demonstrate mastery of bag and mask ventilation on the post-training assessment without additional practice.
Participants in a program for neonatal resuscitation in resource-limited settings demonstrated high satisfaction, high self-efficacy and gains in knowledge and skills. Mastery of ventilation skills and integration of skills into case management may not be achievable in the classroom setting without additional practice, continued learning, and active mentoring in the workplace. These findings were used to revise program structure, materials and assessment tools.

View all citing articles on Scopus

^☆: From the Department of Pediatrics, University of Ottawa, Ottawa Canada

^☆☆: Address for reprints: Mona Jabbour, MD, Division of Emergency Medicine, Children's Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, Ontario Canada K1H 8L1, 613-737-2318, Fax 613-738-4852

^★: Reprint no. 47/1/77455

View full text

Life Support Courses: Are They Effective?☆,☆☆,★

Abstract

Section snippets

INTRODUCTION

MATERIALS AND METHODS

RESULTS

DISCUSSION

Ann Emerg Med

Chest

Ann Emerg Med

Ann Emerg Med

Resuscitation

Am J Surg

Ann Emerg Med

Mayo Clin Proc

The Advanced Trauma Life Support program in Manitoba: A 5-year review

Can J Surgery

Advanced Trauma Life Support (ATLS): Past, present, future

J Trauma

The biostatistics of concordance

Clin Pharmacol Ther

A proposal for structured reporting of randomized controlled trials

JAMA

Clinical Epidemiology

Statistical methods for analysis of effects of treatment in overviews of randomized trials

Guide to Using the Cochrane Review Manager Software (RevMan), Version 1.04

Why do we need systematic reviews of randomized trials?

Stat Med

Educational issues in basic and advanced cardiac life support

J Cardiovasc Nursing

Trauma outcome improves following the Advanced Trauma Life Support program in a developing country

J Trauma

The association of advanced life support training and decreased per capita trauma death rates: An analysis of 12,417 trauma deaths

J Trauma