Skip to main content
SpringerLink
Log in

Starting at school

An approach to improve resuscitation outcomes?

Reanimations-Training: Beginn in der Schule

Ein Ansatz zur Verbesserung des Outcome?

  • Leitthema
  • Published:
Notfall + Rettungsmedizin Aims and scope Submit manuscript

Abstract

Background

Outcome from out-of-hospital cardiac arrest (OOHCA) is typically limited. Favorable outcome is associated with the incidence and quality of bystander cardiopulmonary resuscitation (CPR) before arrival of emergency medical services (EMS). The whole society will have to undertake substantial educational efforts to improve outcome from OOHCA. School education appears to be especially suitable for this purpose, since children are much more susceptible to the topic than young adults, and CPR could be anchored as a cultural skill at an early stage of lifelong learning.

This article summarizes experience from published projects and extracts principles for implementation.

Methods

On the background of existing literature, considerations are made concerning learning objectives, potential time points for instruction, educational formats, and implementation strategies.

Results

As the most important learning objectives, especially for short learning formats, we identified detection of cardiac arrest, call for help and phone for professional EMS, and thoracic compressions. Ventilation and recovery position should be of minor importance and should not be included in short courses for means of clarity.

A special problem is the availability of qualified instructors. Therefore, differential approaches have to be evaluated according to regional structures.

Zusammenfassung

Hintergrund

Die Prognose nach Herz-Kreislauf-Stillstand außerhalb eines Krankenhauses („out-of-hospital cardiac arrest“, OOHCA) ist in der Regel schlecht. Ein günstiges Outcome ist assoziiert mit der Durchführung und der Qualität von Laienreanimation („bystander cardiopulmonary resuscitation“) vor dem Eintreffen des Rettungsdienstes („emergency medical services“, EMS). Um das Outcome nach OOHCA zu verbessern, müssen massive Ausbildungs-Anstrengungen in allen Gesellschaftsbereichen unternommen werden. Dafür scheint die Schulzeit besonders geeignet, da Kinder für das Thema ungleich viel aufgeschlossener sind als junge Erwachsene. So könnte die kardiopulmonale Reanimation in einem frühen Stadium lebenslangen Lernens als Alltagskompetenz verankert werden.

Der Beitrag soll die publizierten Erfahrungen veröffentlichter Projekte zusammenfassen, um Prinzipien für die Implementierung abzuleiten.

Methoden

Auf dem Hintergrund der verfügbaren Literatur werden Überlegungen dargelegt zu den Problemfeldern Lernziele, mögliche Zeitpunkte und Formate für die Ausbildung sowie Strategien für die Umsetzung.

Ergebnisse

Als wichtigste Lernziele, vor allem für kurze Ausbildungsformate, wurden identifiziert: Erkennen des Herz-Kreislauf-Stillstandes, Notruf und Alarmieren des Rettungsdienstes sowie Thoraxkompressionen. Auf Beatmung und stabile Seitenlage sollte weniger fokussiert werden, und in kurzen Ausbildungsformaten sollten sie aus Gründen der Übersichtlichkeit gar nicht vorkommen.

Ein besonderes Problem ist die Verfügbarkeit qualifizierter Trainer. Daher müssen unterschiedliche Ansätze evaluiert werden, welche die jeweiligen regionalen Strukturen berücksichtigen.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Andresen D, Arntz HR, Gräfling W (2008) Public access resuscitation program including defibrillator trainig for lay persons: a randomized trial to evaluate the impact of training course duration. Resuscitation 76:419–424

    Article  PubMed  Google Scholar 

  2. Axelsson A, Herlitz J, Ekström L, Homberg S (1996) Bystander-initiated cardiopulmonary resuscitation out-of-hospital. A first description of the bystanders and their experiences. Resuscitation 33:3–11

    Article  PubMed  CAS  Google Scholar 

  3. Bång A, Herlitz J, Martinell S (2003) Interaction between emergency medical dispatcher and caller in suspected out-of-hospital cardiac arrest calls with focus on agonal breathing. A review of 100 tape recordings of true cardiac arrest cases. Resuscitation 56:25–34

    Article  PubMed  Google Scholar 

  4. Breckwoldt J, Beetz D, Schnitzer L et al (2007) Medical students teaching basic life support to school children as a required element of medical education: A randomised controlled study comparing three different approaches to fifth year medical training in emergency medicine. Resuscitation 74:158–165

    Article  PubMed  Google Scholar 

  5. Breckwoldt J, Schloesser SM (2008) Actions of bystanders of out-of-hospital cardiac arrest (OOHCA). Resuscitation 77S:S7 [Abstr]

    Article  Google Scholar 

  6. Breckwoldt J, Schloesser SM, Arntz HR (2009) Perceptions of collapse and assessment of cardiac arrest by bystanders of out-of hospital cardiac arrest (OOHCA). Resuscitation doi:10.1016/j.resuscitation.2009.06.028

    Google Scholar 

  7. Burghofer K, Schlechtriemen T (2005) Konsequenzen aus der Altruismusforschung für die Ausbildung in Erster Hilfe [German]. Notfall Rettungsmed 8:408–411

    Article  Google Scholar 

  8. Chamberlain DA, Hazinski MF (2003) Education in Resuscitation – ILCOR advisory statement. Resuscitation 59:11–43

    Article  PubMed  Google Scholar 

  9. Choa M, Park I, Chung HS et al (2008) The effectiveness of cardiopulmonary resuscitation instruction: animation versus dispatcher through a cellular phone. Resuscitation 77:87–94

    PubMed  Google Scholar 

  10. Corne L, Rydant L, Lauwaert D, Bruynseels P (1984) Teaching cardiopulmonary resuscitation basic life support to school-children. Acta Anaesthesiol Belg 35:107–113

    PubMed  Google Scholar 

  11. Eisenberg MS (2006) Incidence and significance of gasping or agonal breathing in cardiac arrest patients. Curr Opin Crit Care 12:204–206

    Article  PubMed  Google Scholar 

  12. Eisenburger P, Safar P (1999) Life supporting first aid training of the public – review and recommendations. Resuscitation 41:3–18

    Article  PubMed  CAS  Google Scholar 

  13. Fabry G (2008) Medizindidaktik [in German]. Bern (Huber)

  14. Gundry JW, Comess KA, DeRook FA et al (1999) Comparison of naive sixth-grade children with trained professionals in the use of an automated external defibrillator. Circulation 100(16):1703–1707

    PubMed  CAS  Google Scholar 

  15. Hallstrom AP, Ornato JP, Weisfeldt M et al (2004) Public access defibrillation trial investigators. Public-access defibrillation and survival after out-of-hospital cardiac arrest. N Engl J Med 351(7):637–646

    Article  PubMed  CAS  Google Scholar 

  16. Handley AJ (1993) Recovery position. Resuscitation 26(1):93–95

    Article  PubMed  CAS  Google Scholar 

  17. Hauff SR, Rea TD, Culley LL et al (2003) Factors impeding dispatcher-assisted telephone cardiopulmonary resuscitation. Ann Emerg Med 42:731–737

    Article  PubMed  Google Scholar 

  18. Herlitz J, Ekstrom L, Wennerblom B et al (1994) Effect of bystander initiated cardiopulmonary resuscitation on ventricular fibrillation and survival after witnessed cardiac arrest outside hospital. Br Heart J 72:408–412

    Article  PubMed  CAS  Google Scholar 

  19. Herlitz J, Engdahl J, Svensson L et al (2005) Factors associated with an increased chance of survival among patients suffering from an out-of-hospital cardiac arrest in a national perspective in Sweden. Am Heart J 149:61–66

    Article  PubMed  Google Scholar 

  20. Hill K, Mohan C, Stevenson M, McCluskey D (2009) Objective assessment of CPR skills of 10–11-year-old schoolchildren using two different external compression to ventilation ratios. Resuscitation 80:96–99

    Article  PubMed  CAS  Google Scholar 

  21. Hollenberg J, Herlitz J, Lindqvist J et al (2008) Improved survival after out-of-hospital cardiac arrest is associated with an increase in proportion of emergency crew-witnessed cases and bystander cardiopulmonary resuscitation. Circulation 118:389–396

    Article  PubMed  Google Scholar 

  22. Isbye DL, Meyhoff CS, Lipert FK, Rasmussen LS (2007) Skill retention in adults and in children 3 months after BLS training using a simple personal resuscitation manikin. Resuscitation 74:396–402

    Article  Google Scholar 

  23. Isbye DL, Rasmussen LS, Ringsted C, Lippert FK (2007) Disseminating cardiopulmonary resuscitation training by distributing 35,000 personal manikins among school children. Circulation 116:1380–1385

    Article  PubMed  Google Scholar 

  24. Isbye DL, Meyhoff CS, Lippert FK, Rasmussen LS (2007) Skill retention in adults and in children 3 months after basic life support training using a simple personal resuscitation manikin. Resuscitation 74:296–302

    Article  PubMed  Google Scholar 

  25. Jones I, Whitfield R, Colquhoun M et al (2007) At what age can school children provide effective chest compressions? An observational study from the Heartstart UK schools training programme. BMJ 334:1201–1203

    Article  PubMed  Google Scholar 

  26. Kaye W, Rallis SF, Mancini ME et al (1991) The problem of poor retention of CPR skills may lie with the instructor, not the learner or the curriculum. Resuscitation 21:67–87

    Article  PubMed  CAS  Google Scholar 

  27. Kellum MJ (2007) Compression-only CPR for bystanders and first responders. Curr Opin Crit Care 13:268–272

    Article  PubMed  Google Scholar 

  28. Lackner CK, Kanz KG, Rothenberger S, Ruppert M (2001) AED-Anwenderperformanz von Laien- und Ersthelfern [German]. Notfall Rettungsmed 4:572–584

    Article  Google Scholar 

  29. Lafferty C, Larsen PD, Galletly D (2003) Resuscitation training in New Zealand schools. N Z Med J 116(1181):U582

    PubMed  Google Scholar 

  30. Lester CA, Weston CF, Donnelly PD et al (1994) The need of wider dissemination of CPR: are the schools the answer? Resuscitation 28:233–237

    Article  PubMed  CAS  Google Scholar 

  31. Lester CA, Donnelly P, Weston CF, Morgan M (1996) Teaching school children CPR. Resuscitation 31:33–38

    Article  PubMed  CAS  Google Scholar 

  32. Lewis RM, Fulstow R, Smith GB (1997) The teaching of cardiopulmonary resuscitation in schools in Hampshire. Resuscitation 35:27–31

    Article  PubMed  CAS  Google Scholar 

  33. Lind B (1961) Teaching mouth-to-mouth resuscitation in primary schools. Acta Anaesthesiol Scand 9:63–69

    Google Scholar 

  34. McCormack AP, Damon SK, Eisenberg MS (1989) Disagreeable physical characteristics affecting bystander CPR. Ann Emerg Med 18:283–285

    Article  PubMed  CAS  Google Scholar 

  35. Miró O, Jiménez-Fábrega X, Espigol G et al (2006) Teaching bls to 12–16 year olds in Barcelona schools: view of head teachers. Resuscitation 70:107–116

    Article  PubMed  Google Scholar 

  36. Nolan JP, Baskett P (2005) European resuscitation council guidelines for resuscitation 2005. Resuscitation 67(2–3):1–314

    Google Scholar 

  37. Osche S (2004) Defibrillation durch Ersthelfer [in German]. Notfall Rettungsmed 7:32–33

    Article  Google Scholar 

  38. Phillips PS, Nolan JP (2001) Training in basic and advanced life support in UK medical schools: a questionnaire survey. BMJ 323(7303):22–23

    Article  PubMed  CAS  Google Scholar 

  39. Rea TD (2005) Agonal respirations during cardiac arrest. Curr Opin Crit Care 11:188–91

    Article  PubMed  Google Scholar 

  40. Reder S, Quan L (2005) Cardiopulmonary resuscitation training in Washington state public high schools. Resuscitation 56:283–288

    Article  Google Scholar 

  41. Riegel B, Nafziger SD, McBurnie MA et al (2006) How well are cardiopulmonary resuscitation and automated external defibrillator skills retained over time? Results from the PAD trial. Acad Emerg Med 13:254–263

    Article  PubMed  Google Scholar 

  42. Ropollo LP, Pepe PE, Cimon N et al (2005) Modified cardiopulmonary resuscitation instruction protocols for emergency medical dispatchers: rationale and recommendations. Resuscitation 65:203–210

    Article  Google Scholar 

  43. Safar P, Brown TC, Holtey WJ, Wilder RJ (1961) Ventilation and circulation with closed chest cardiac massage in man. JAMA 176:574–576

    PubMed  CAS  Google Scholar 

  44. Schlechtriemen T, Wannemacher A, Kettel W, Altemeyer KH (2004) Erste-hilfe-ausbildung in der grundschule [in German]. Notfall Rettungsmed 7:174–180

    Google Scholar 

  45. SOS-KANTO study group (2007) Cardiopulmonary resuscitation by bystanders with chest compression only (SOS-KANTO): an observational study. Lancet 369:920–926

    Article  Google Scholar 

  46. Stiell I, Nichol G, Wells G et al (2003) Health-related quality of life is better for cardiac arrest survivors who received citizen cardiopulmonary resuscitation. Circulation 108:1939–1944

    Article  PubMed  Google Scholar 

  47. Sue E, Schmidt TA, Mann NC, Zechnich AD (2000) A randomised controlled trial to assess decay in acquired knowledge among paramedics completing a pediatric resuscitation course. Acad Emerg Med 7:779–786

    Article  Google Scholar 

  48. Swor S, Khan I, Domeier R et al (2006) CPR training and CPR performance: Do CPR-trained bystanders perform CPR? Acad Emerg Med 13:596–601

    Article  PubMed  Google Scholar 

  49. Toner P, Connolly M, Laverty L et al (2007) Teaching basic life support to school children using medical students and teachers in a “peer-training” model – results of the “ABC for life” programme. Resuscitation 75:169–175

    Article  PubMed  CAS  Google Scholar 

  50. Uray T, Lunzer A, Ochsenhofer A et al (2003) Feasibility of life-supporting first aid training as a mandatory subject in primary schools. Resuscitation 59(2):211–220

    Article  PubMed  Google Scholar 

  51. Van Kerschaver E, Delooz HH, Moens GF (1989) The effectiveness of repeated CPR training in a school population. Resuscitation 17:211–222

    Article  Google Scholar 

  52. Wik L, Steen PA, Bircher NG (1994) Quality of bystander cardiopulmonary resuscitation influences outcome after prehospital cardiac arrest. Resuscitation 27:195–203

    Article  Google Scholar 

Download references

Conflict of interest

The corresponding author states that there are no conflicts of interest.

Author information

Authors and Affiliations

  1. Klinik für Anästhesiologie und operative Intensivmedizin, Campus Benjamin Franklin, Charité – Universitätsmedizin Berlin, 12200, Berlin, Deutschland

    J. Breckwoldt

Authors
  1. J. Breckwoldt
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to J. Breckwoldt.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Breckwoldt, J. Starting at school. Notfall Rettungsmed 12 (Suppl 2), 39–44 (2009). https://doi.org/10.1007/s10049-009-1209-y

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10049-009-1209-y

Keywords

Schlüsselwörter

Search

Navigation