Learning aspects of out-of-hospital cardiac arrest and learning activities in basic life support - a study among laypersons at workplaces in Sweden

Abstract

Abstract Background: Out-of-hospital cardiac arrest (OHCA) is one of the leading causes of death worldwide. Despite healthcare improvements, prevention for cardiovascular health, training in adult basic life support (BLS) with cardiopulmonary resuscitation (CPR) and automated external defibrillation (AED), together with increased public awareness of cardiovascular disease, survival from OHCA still remains poor. Aim: To 1) explore the effectiveness and the intended learning outcome after training in BLS calculated as a total score of practical skills, theoretical knowledge, confidence and willingness to act by comparing different learning activities among laypersons at workplaces and 2) describe characteristics and 30-day survival of OHCAs occurring at workplaces in comparison to OHCAs at other places and factors associated with survival after OHCA at workplaces in Sweden. Methods: Studies I-III were conducted as cluster randomised, controlled trials with parallel analyses. The outcome was the total score on the Cardiff Test for the intended learning outcome of theoretical knowledge and practical skills in BLS, primarily six months after training and secondarily directly after training. Study IV was performed as a register-based, observational study and the outcome was survival to 30 days for cases of OHCA reported by the emergency medical service and factors associated with the outcome after OHCA at workplaces. Results: Study I was unable statistically to demonstrate a difference in learning outcome in BLS between self-learning and instructor-led learning. Studies II and III showed that a preparatory, web-based, interactive education on stroke, acute myocardial infarction, OHCA, CPR, AED and healthy lifestyle factors, in addition to instructor-led and film-based (Study III) practical training in BLS, improved the learning outcome for practical skills in CPR and AED. Study IV showed that the incidence of OHCAs at workplaces in Sweden was low and survival was relatively high when compared with other places outside hospital. Being found in a shockable cardiac rhythm was a strong independent predictor of survival after OHCAs at workplaces. OHCAs at workplaces were defibrillated more frequently and with a shorter delay to shock when compared with other places outside hospital. Conclusion: Instructor-led and film-based training in BLS, with the addition of a preparatory, web-based, interactive education, benefits the learning outcome for practical skills in BLS for laypersons at workplaces. Although the incidence of OHCAs at workplaces is low, the survival rate is relatively high and the probability of survival was lower at all other places outside hospital, apart from crowded public places, than at workplaces. Through existing legislation, workplaces have the opportunity regularly to offer training in BLS to employees and the clinical implications could be that more trained laypersons are able to start effective resuscitation both inside and outside the workplace environment, thereby increasing OHCA survival even more.