How can we optimize bystander basic life support in cardiac arrest?

Abstract

The aim of this thesis was to describe various aspects of cardiopulmonary resuscitation (CPR) and CPR training in order to find approaches for enhancing bystander interventions. Cardiac care patients (n=401) were interviewed with regard to their attitude toward CPR and CPR training (II). Among those who were co-habiting (n=268), possibilities for and obstacles in relation to training were investigated (III). An instrument for measuring quality of CPR performance was tested in a pilot study using a suitable selection of cardiac care nurses (I, n=10). Quality of performance was studied among laypersons after CPR training and three months later (IV, n=32). A qualitative method was used to describe spouses’ experiences during the cardiac arrest (CA) at home. Fifteen spouses were interviewed (V). Most of the cardiac care patients had a positive attitude towards CPR and many had trained or wished to undergo training in CPR (II). Two-thirds of patients who were co-habiting were unsure or doubted that their co-habitant had CPR training. More than half of these wanted their co-habitant to attend a course. Younger patients were more willing to participate in CPR training than those who were older. Major obstacles for CPR training were their own medical condition, and doubts concerning co-habitants physical ability or interest in participation (III). Measurements of the quality of CPR performance revealed several points of concern regarding CPR training and skill-retention; the difficulties in making the pauses for ventilations short enough, leading to low number of chest compressions per minute and poor performance regarding ventilations (I, IV). Immediately after training the laypersons performed relatively high proportions of chest compressions correctly, which after three months decreased significantly. ‘Too shallow’ chest compressions were common whilst the cardiac care nurses often made chest compressions ‘too deep’. Spouses’ experience of CA included two time domains and seven themes. Prior to the CA the themes deal with spouses’ perceptions and interpretations of early warning signs. When a CA developed spouses quickly perceived the seriousness of the situation. Some lacked the ability to intervene whilst others did everything in their power to influence the outcome. The Emergency call services played an important supportive role and guided spouses in performing CPR (V). Conclusion: CPR training for cardiac care patients and co-habitants is important and feasible. The outcome of training has to be enhanced. Simplification of the message and reduction in number of skills taught seems urgent. Symptoms and signs regarding myocardial infarction have to be communicated more clearly.