论文研究-在沙特阿拉伯麦加进行心肺复苏培训后保留和不进行总结报告三个月的技能：一项随机对照试验资源-CSDN文库

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Open Journal of Preventive Medicine, 2019, 9, 141-154

https://www.scirp.org/journal/ojpm

ISSN Online: 2162-2485

ISSN Print: 2162-2477

DOI:

10.4236/ojpm.2019.911013 Nov. 27, 2019 141 Open Journal of Preventive Medicine

Retention of Skills with and without Debriefing

Three-Months after Cardiopulmonary

Resuscitation Training in Makkah, Saudi

Arabia: A Randomized Controlled Trial

Rehab Mohammed Gaafar

, Soha Aly Elmorsy

, Abdulmajeed Soliman Khan

Mohammad Kamel Al-harazi

, Shaimaa Kamel Al-harazi

, Nouf Kamel Al-harazi

Saudi Heart Association, Riyadh, KSA

Research Center, King Abdullah Medical City, Makkah, KSA

Internal Medicine Department, Hera General Hospital Makkah, Ministry of Health (MoH), Makkah, KSA

Community Medicine Department, MoH, Hera General Hospital, Makkah, KSA

King Saud University for Health Sciences, Riyadh, KSA

Umm Al-Qura University, Makkah, KSA

Abstract

Background

Evidence of cardiopulmonary resuscitation (CPR) performance

has driven interest in procedures, e.g., debriefing to improve CPR quality.

Aim

To investigate retention of skills with and without debriefing 3-

months

after CPR training on high-fidelity manikins (HFM) among participants in-

volved in the “Heart Safe City Initiative” event (HSCI) in Makkah

, Saudi

Arabia.

Methodology

A randomized controlled design was used during Oc-

tober 2017-January 2018. Participants were divided into two groups: an in-

tervention group to receive debriefing after CPR (debriefing group or “sub-

jects”), and a non-intervention group (“controls”). Participants were tested re-

peatedly: before training (pre-training test), immediately after and 3-

months

after training (retention or late test); and scores for each test were

recorded.

Results

The study’s subjects and controls did not vary by age, sex, nationali-

ty, and profession’s criteria (

> 0.05, all analyses). The mean retention post-

tests scores significantly varied between subjects and controls [

(df = 200) =

27.7,

< 0.0001)]; however, the two groups did not vary in their immediate

score levels (mean ranks: 106.77 v. 95.68,

= 0.18). Further, the immediate

posttest scores were significantly higher than the pretests’ within the study

population as a whole group [mean difference 38.05% ± 27.59%,

(df = 201) =

13.5,

< 0.001]; within subjects [mean difference 40.68% ± 29.26%,

(105) =

14.31,

< 0.0001]; and within controls [mean difference 35.06% ± 25.44%,

How to cite this paper:

Gaafar, R.M.,

Elmorsy, S

.A., Khan, A.S., Al-harazi, M.K.,

-harazi, S.K. and Al-harazi, N.K. (2019

)

Retention of Skills with and without

De-

briefing Three

-Months after Cardiopul-

monary Resuscitation Training in Makkah,

Saudi Arabia: A Randomized Controlled

Trial

Open Journal of Preventive Med

cine

, 141-154.

https://doi.org/10.4236/ojpm.2019.911013

Received:

September 8, 2019

Accepted:

November 24, 2019

Published:

November 27, 2019

9 by author(s) and

Scientific

Research Publishing Inc.

This work is licensed under the Creative

Commons Attribution International

License (CC BY

4.0).

http://creativecommons.org/licenses/by/4.0/

Open Access

R. M. Gaafar et al.

DOI:

10.4236/ojpm.2019.911013 142 Open Journal of Preventive Medicine

(df = 95) = 13.50,

< 0.0001]. The retention scores also behaved likewise

[mean difference 40.35% ± 27.5%,

(df = 201) = 20.85,

< 0.0001; mean dif-

ference 52.57% ± 25.22%,

(df = 105) = 21.46,

< 0.0001; mean difference

26.86% ± 23.39%,

(df = 95) = 22.12,

< 0.0001, respectively]. Subjects re-

ported a significantly higher retention scores than the immediate scores

[mean difference 11.88% ± 25.67%,

(df = 200),4.76,

< 0.

0001]; compared

with controls who performed otherwise (mean difference −

8.19% ± 27.20%,

(df = 97) = −2.95,

< 0.0001).

Conclusions

Debriefing using HFM training

achieves the target of improving the public’s skills of CPR. Considering the

urgent need to recruit every society member to be a heartsaver; debriefing af-

ter CPR training helps improve the quality and retention of basic CPR skills.

Keywords

Cardiopulmonary Resuscitation, Debriefing, Retention, Skills, Saudi Arabia

1. Introduction

Cardiac arrest refers to the sudden cessation of cardiac activity with hemody-

namic collapse takes place, typically due to sustained ventricular tachycar-

dia/ventricular fibrillation (VF) [1] [2]. Cardiac arrest strikes suddenly, hence

the name “sudden cardiac arrest” (SCA), leaving less than 5% chance to survive

the attack [3]. In addition to the number of lives lost, cardiac arrest has a consi-

derable economic impact; measured in terms of productive years of life lost due

to premature death or avoidable neurologic disability, it constitutes a societal

burden equal to or greater than that of other leading causes of death in the

community [4]. This is why only prevention and the need to develop strategies

for management of sudden cardiac death are warranted. Several factors influence

the development of risk factors for SCA, including the presence of underlying

cardiovascular disease (CVD), including coronary heart disease (CHD), atheros-

clerosis, hypertension, heart failure, as well as inherited disorders affecting car-

diac rhythm, such as long QT interval syndrome [1]. The setting where SCA

takes place is an important determinant for the survivability outcome of an SCA

incident. Around 347,000 out-of-hospital cardiac arrest (OHCA) and 209,000

in-hospital cardiac arrests (IHCAs) occur in adults each year in the US; millions

more occurring across the rest of North America, Europe, and Asia [5]. Cardiac

arrest becomes more common with age; and males are more often affected [1].

Sudden cardiac death (SCD) may often follow, unless a successful intervention,

e.g., defibrillation or spontaneous reversion restores circulation, has been

achieved; in which case the event is referred to as aborted SCD. However, a

bradyarrhythmia is responsible for some cases of SCD [2] [6]. Absence of pulse

is the prominent sign of cardiac arrest [1], however the exact mechanism of the

collapse may be impossible to establish. For the vast majority of patients who

die suddenly, cardiac activity is not being monitored at the time of their col-

R. M. Gaafar et al.

DOI:

10.4236/ojpm.2019.911013 143 Open Journal of Preventive Medicine

lapse. As a result, the mechanism can only be inferred, based upon information

obtained after the process has been initiated. On the other hand, there have

been many cases in which the initiating event has been witnessed or recorded

[6] [7].

Management

and

prevention

through

public

awareness

and

preparedness

The prevention of OHCAs is the most important factor for increasing the sur-

vival rate. In many cases, time from recognition of cardiac arrest to the arrival of

emergency medical service (EMS) is long, leaving bystanders in a critical posi-

tion to potentially influence patient prognosis. Prior training in CPR and use of

AED may influence bystander interventions. The European Resuscitation Coun-

cil has published that there will be a European cardiac arrest awareness day each

year (Oct. 16) [8]. More than 70 percent SCA incidents occur in the home,

which is why home AEDs have the potential to save the lives of countless loved

ones struck by cardiac arrest.

The sequence of actions whereas joining the victim of SCA with survival is

called “chain of survival (COS)” [9]. System-based improvements to the COS

had yielded increases in survival from OHCA. However, in order for the patient

to have the best chance of surviving an OHCA, early recognition, early CPR and

defibrillation must be provided within the first 4 minutes of the cardiac arrest.

Geri

et al.

[10] define CPR as a therapeutic intervention performed for patients

with cardiac and respiratory arrest. Bystander CPR is a key life-saving factor in

the COS. Further, adequate post-resuscitation care of OHCA victims should be

considered for transportation to a specialized cardiac arrest center as part of a

broader regional system of care [9]. The Saudi Heart Association (SHA) set CPR

guidelines practically suite SCA and chocking incidents in the Saudi populations

[9]. The SHA recommends starting CPR with the sequence of circula-

tion-airway-breathing (CAB) in the pre-hospital situations, while the sequence

of ABC is still effective within the healthcare facilities. Thereby, delivering prop-

er starting chest compressions as soon as possible before trying to open the air-

way and give rescue breathing is vital to high-quality CPR and optimizes the

chance of return of spontaneous circulation and surviving the attack [11]. Un-

fortunately, the lack of interest in learning CPR and the fear of doing something

wrong or of legal liability are obstacles limiting bystander to learn and perform

CPR. Further, the retention of skills after CPR training has been demonstrated to

be poor in several domains after only a few months [12].

Debriefing

and

retention

resuscitation

performance

: Debriefing involves

a guided reflection in the cycle of experiential learning [13]. Especially in medi-

cal emergency, debriefing is a powerful tool to assure retention of resuscitation

practice knowledge and skills, and hence positively influence patient outcome

[14]. A variety of debriefing approaches are available to help refresh and main-

tain previously acquired CPR skills [15] [16].

Pre-training evaluation and feed-

back have been shown to improve CPR skills immediately following training.

The need for efficient retraining is obvious, but the optimal format for refresher

training is still one of the knowledge gaps to be addressed [14]. The research

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论文研究 - 在沙特阿拉伯麦加进行心肺复苏培训后保留和不进行总结报告三个月的技能：一项随机对照试验

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论文研究 - 在沙特阿拉伯麦加进行心肺复苏培训后保留和不进行总结报告三个月的技能：一项随机对照试验

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