The surveys assessing the effectiveness of teaching cardiopulmonary resuscitation (CPR) have been conducted for many years. Recently, such a survey was carried out among the medical personnel of a paediatric hospital showing lack of knowledge of resuscitation guidelines [1]. Observations during mandatory courses organized for residents in anaesthesiology and intensive therapy suggest that the knowledge of CPR in this group is also far from satisfactory. The resuscitation guidelines are periodically updated and should be systematically refreshed and implemented into clinical practice.

The objective of the survey was to assess the knowledge of resuscitation guidelines amongst residents – future specialists in anaesthesiology and intensive therapy.

METHODS

The survey was conducted among residents from different regions of Poland participating in the basic course (BC) on principles of anaesthesiology and intensive therapy or advanced paediatric course (ADC). The control group consisted of interns from Great Poland taking part in the mandatory life support course (LSC). The survey was voluntary and respondents gave their consent.

The research tool was an open test completed at the beginning and at the end of the course assessing the knowledge of CRP for adults and children/infants. The questionnaire was based on the guidelines of the European Resuscitation Council of 2005 [2]. The questions concerned the age borderline between an adult and a child, the CPR sequence in adults, and its possible modifications, indications for chest compression  irrespective of ventilation, first-line drugs and their intravenous doses in cases of ventricular fibrillation and asystole. Moreover, respondents were asked about potentially reversible causes of cardiac arrest.

The results were statistically analysed. The Fischer χ2 and Fisher-Freeman-Halton tests were applied. P< 0.05 was considered statistically significant.

RESULTS

The questionnaire was completed by 56 physicians: 13 in group BC, 13 in group ADC and 30 in group LSC. The majority of respondents were women – 62% in BC, 62% in ADC and 76% in LSC. The largest group consisted of respondents aged 24-30 years. In the population specializing in anaesthesiology and intensive therapy, 62% of group BC were employed in the regional hospital, 69% of group ADC in the county hospital. Twelve respondents in group BC started their speciality during the last 2 years; half of those in group ADC were employed for more than 2 years.

The physicians` knowledge of resuscitation guidelines before the courses was not satisfactory. The highest number of wrong answers concerned the age borderline between an adult and a child, the CPR sequence in children and its modifications as well as paediatric drugs and their dosage. The majority of respondents did not know all potentially reversible causes of cardiac arrest.

The survey conducted at the end of courses showed markedly wider knowledge of resuscitation guideless in all the groups studied. Nevertheless, the biggest problems regarded the dosage of lidocaine in ventricular fibrillation in adults and children (Table 1).

After the course, 11 respondents in group BC and 9 in group ADC considered mandatory specialization courses satisfactory. All the respondents found mandatory courses well grounded. All the residents in group BC confirmed that the choice of anaesthesiology and intensive therapy was appropriate whereas in group ADC two respondents were not satisfied with their decision.    

DISCUSSION

In the group of physicians studied, knowledge of resuscitation guidelines before the course was not complete and deficits concerned both the basic and advanced resuscitation procedures. In some questions, the percentage of correct answers amongst interns was higher than that in the group of physicians specializing in anaesthesiology and intensive therapy. This is in agreement with the results of the study demonstrating that interns described the algorithm of ventricular fibrillation therapy much better compared to specialists; only 17% of anaesthesiologists gave corrects answers [3]. This is alarming as anaesthesiologists, being in charge of resuscitation activities (according to the legally binding regulations) should know resuscitation guidelines best.

Our findings demonstrated that more than 50% of physicians in speciality training did not know the age borderline between an adult and a child, meaning that in practice they would not be able to qualify patients to appropriate groups and administer suitable resuscitation procedures. Less than 25% of respondents were capable of indicating when the chest compression-inspiration ratios may be changed during paediatric resuscitation. Among participants of the paediatric course, only 69% of respondents knew the intravenous dose of adrenaline administered to adults and less than half the dose used in children. Questionnaires completed by physicians in speciality training also revealed unsatisfactory knowledge of the remaining resuscitation agents administered to adults; not all the respondents named amiodarone in the therapy of ventricular fibrillation and defined its dose whereas less than 50% stated that they would use lignocaine for this purpose. Moreover, not all the respondents knew the dose of atropine admini
stered in asystole.

Substantial deficits of knowledge of resuscitation guidelines (55±14% of correct answers) among anaesthetic residents were also demonstrated in other studies [4]. The percentage of correct answers about drugs was 39±22% and their correctness increased with successive years of specializing. According to another study, a marked decrease in knowledge in the group of 47 anaesthesiologists was observed already 6 months after the completion of course on basic resuscitation procedures [5]. Moreover, it was found that the decay of theoretical knowledge started already 6 weeks after the course completion and progressed with time [6, 7, 8, 9]. To counteract this, repeated refresher courses concerning resuscitation should be organized.

In comparison with the findings of other authors, our results show that the respondents had much lower knowledge about the drugs used in adults and children, both in cases of ventricular fibrillation and asystole. In the American study performed among anaesthesiologists (85% of them completed paediatric anaesthesiology courses and 71% anaesthetized children on everyday basis), the percentage of correct answers, although still not satisfactory, was 89% [10]. The dosage of adrenaline in asystole was known to 89% of respondents; in our study, only to 46% of those specializing in anaesthesiology.

In our survey, the residents in anaesthesiology and intensive therapy came from various centres of Poland. The group was not numerous; however, deficits of knowledge of resuscitation found before the training were spectacular. It is worth stressing that questionnaires completed at the end of courses showed markedly better knowledge in this field, confirming that refresher courses should be mandatory.

CONCLUSIONS

1. The knowledge of resuscitation guidelines among both the interns and physicians specializing in anaesthesiology and intensive therapy is not satisfactory.

2. Physicians specializing in anaesthesiology and intensive therapy should update their knowledge of resuscitation guidelines for adults and children during mandatory refresher courses.   

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REFERENCES

1.    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.

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

3.    Iirola T, Lund VE, Katila AJ, Mattila-Vuori A, Palve H: Teaching hospital physicians’ skills and knowledge of resuscitation algorithms are deficient. Acta Anaesthesiol Scand 2002; 46: 1150-1154.

4.    Noordergraaf GJ, Be WK, Sabbe M, Diets RF, Noordergraaf A, Van Hemelrijck J: Training needs and qualification of anaesthesiologists not exposed to ALS. Resuscitation 1999; 40: 147-160.

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

6.    Kaye W, Mancini ME, Rallis SF: Advanced cardiac life support refresher course using standardized objective-based Mega Code testing. Crit Care Med 1987; 15: 55-60.

7.    Stross JK: Maintaining competency in advanced cardiac life support skills. JAMA 1983; 249: 3339-3341.

8.    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.

9.    Su E, Schmidt TA, Mann NC, Zechnich AD: A randomized controlled trial to assess decay in acquired knowledge among paramedics completing a pediatric resuscitation course. Acad Emerg Med 2000; 7: 779-786.

10.    Heitmiller ES, Nelson KL, Hunt EA, Schwartz JM, Yaster M, Shaffner DH: A survey of anesthesiologists’ knowledge of American Heart Association Pediatric Advanced Life Support Resuscitation Guidelines. Resuscitation 2008; 79: 499-505.

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address:

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

received: 27.04.2010
accepted: 19.07.2010