The European guidelines for cardiopulmonary resuscitation published by the European Resuscitation Council (ERC) in 2005 introduced some changes related to the tidal volume of artificial breaths, position and depth of chest compressions and number of resuscitation cycles [1]. Our observations show that not all the medical workers know the latest guidelines; therefore, the objective of the present study was to assess the resuscitation skills of the medical personnel of a paediatric hospital.

METHODS

The study was conducted on a voluntary basis amongst physicians and nurses who gave their consent. Anaesthesiologists were excluded. The research tool was a practical test assessing the cardiopulmonary resuscitation (CPR) skills and a self-assessment questionnaire. The practical test was carried out on adult, child and infant AMBU manikins. The restoration of patent airways (particularly the position of hands/fingers and head manoeuvres), checking the breathing (restoration of patent airways, position of a rescuer’s head), delivery of ventilation (restoration of patent airways, tidal volume, presence/absence of air in the stomach), chest compressions (placement of wrists, position of a rescuer, depth and frequency) were assessed.

The results were statistically analysed using the Pearson χ2 test. P<0.05 was considered statistically significant.

RESULTS

The study involved 118 nurses and physicians. The demographic data and professional profiles were listed in Table 1. According to their specialities and employment, the participants were allocated into four groups: N – nurses, SN – surgical nurses, P – physicians, S – surgeons.

The skills to deliver resuscitation to adults were rather good amongst both nurses and physicians. The quality of its relevant elements, however, i.e. restoration of patent airways, checking the breathing or using proper volumes during ventilation, was found to be much worse amongst nurses. Chest compressions were applied correctly, although their most important elements, e.g. depth and frequency were improper (Table 2).

During resuscitation of children, both physicians and nurses delivered too slow and too shallow chest compressions (Table 3).

Infant manikins were resuscitated quite correctly by both groups, although some problems related to the depth and frequency of chest compressions were observed (Table 4).

In the questionnaire filled, about 50% of respondents admitted lack of skills to perform the cardiopulmonary resuscitation of adults, children and infants (Table 5).

DISCUSSION

The skills to perform CPR were higher, although still unsatisfactory, during practical tests compared to the questionnaire findings [2]. The restoration of patent airways in adults according to the ERC guidelines posed great problems; not all the participants remembered about tilting the head back and simultaneous elevation of the mandible. Only 53.6-71.9% properly restored the patent airways and 50-85.7% observed the chest movements to control the effectiveness of artificial lung ventilation.

In the mouth-to-mouth method of lung ventilation, proper tidal volumes in adults (400-600 mL) were provided by only 45% of nurses. The majority of physicians carried out this procedure much better; however, proper tidal volumes delivered by them filled the stomach, probably due to too high pressures generated during inspirations.  The mistakes observed during child and infant CPRs were similar among nurses and physicians.

The places of chest compressions in adults were properly chosen by the majority of participants; however, proper placement of wrists was observed significantly rarely. Not all the participants remembered about the proper position during compressions (upper limbs over  the chest and straighten elbows). The biggest differences were found in relation to the recommended depth (4.5 cm) and frequency (100 min -1) of chest compressions. In most cases, the compressions were too shallow and too slow, although these two elements are essential to maintain the blood flow in victims during CPR [1].

Similar inadequacies were observed during chest compressions in children and infants. More than 50% of participants delivered too shallow and slow chest compressions, which may be accounted for by insufficient frequency of performing such procedures, which affects the skills of rescuers. The CPR skills were described to be worse in the group of medical students and employees; the results were similar to our findings [3, 4]. The studies on CPR knowledge and skills amongst students stress that earlier acquired skills are forgotten with time [5].

Many resuscitation courses for laymen, nurses and physicians are organized under the auspices of ERC [6, 7, 8]. The completion of such courses means that necessary CPR skills were acquired.  It was shown, however, that knowledge and skills are not retained [9, 10]. According to the Utstein guidelines, practical classes should be repeated and CPR knowledge refreshed every 6 months [11].

The study participants were also asked to self-assess their CPR skills in adults, children and infants. The answers were surprising. About half of them admitted inadequate skills. Similar questionnaire studies conducted amongst students showed extremely high self-assessment, which was not confirmed during practical sessions [5]. The group of medical workers assessed during the present study was characterized by opposite attitudes; self-assessment was cautious while the actual skills were not so bad.

CONCLUSION

1. The medical personnel of a paediatric hospital were found to have insufficient knowledge of CPR standards and inadequate practical skills.

2. Medical personnel should participate in regular practical trainings in resuscitation.

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REFERENCES

1.    European Resuscitation Council Guidelines for Resuscitation 2005. Resuscitation 2005; 67S: 1-189.

2.    Grześkowiak M,  Bartkowska-Śniatkowska A, Rosada-Kurasińska J, Puklińska K: Personel medyczny szpitala pediatrycznego nie ma wystarczającej wiedzy dotyczącej prowadzenia bezprzyrządowej resuscytacji krążeniowo-oddechowej. Anaesthesiol Intensive Ther 2009; 41: 155-158.

3.    Fossel M, Kiskaddon Rt, Sternbach GL: Retention of cardiopulmonary resuscitation skills by medical students. J Med Educ 1983; 58: 568–575.

4.    Seraj MA, Naguib M: Cardiopulmonary resuscitation skills of medical professionals. Resuscitation 1990; 20: 31-39.

5.    Grześkowiak M: The effects of teaching basic cardiopulmonary resuscitation – a comparison between first and sixth year medical students. Resuscitation 2006, 68: 391-397.

6.    Handley AJ, Swain A: Advanced life support manual. Resuscitation Council (UK), London 1992.

7.    Nolan J: Advanced life support training. Resuscitation 2001; 50: 9-11.

8.    Phillips BM, Mackway-Jones K, Jewkes F: The European Resuscitation Council’s Paediatric Life Support Course ‘Advanced Paediatric Life Support’. Resuscitation 2000; 47: 329-334.

9.    Wenzel V, Lehmkuhl P, Kubilis PS, Idris AH, Pichlmayr I: Poor correlation of mouth-to-mouth ventilation skills after basic life support training and 6 month later. Resuscitation 1997; 35: 129-134.

10.    Gass DA, Curry L: Physicians’ and nurses’ retention of knowledge and skill after training in cardiopulmonary resuscitation. CMAJ 1983;  28: 550-551.

11.    Chamberlain DA, Hazinski MF: Education in resuscitation: an ILCOR symposium: Utstein Abbey: Stavanger, Norway: June 22-24, 2001. Circulation 2003; 108: 2575-2594.

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Address:

*Małgorzata Grześkowiak
Zakład Dydaktyki Anestezjologii i Intensywnej Terapii
UM im. Karola Marcinkowskiego w Poznaniu
ul. Św. Marii Magdaleny 14, 61-861 Poznań
tel. 0-61 668 78 36, fax. 0-61 668 78 66
e-mail: mgrzesko@ump.edu.pl

Received: 22.05.2009
Accepted: 20.07.2009