Bringing order from chaos: The challenge of training lay responders to use automated external defibrillators and provide cardiopulmonary resuscitation

Abstract

Each minute's delay to treatment for out-of-hospital cardiac arrest (OHCA) with ventricular fibrillation (VF) reduces the likelihood of survival by ten per cent. Automated external defibrillators (AEDs) were developed to make rapid definitive treatment more widely available.AEDs use a computer algorithm to diagnose the collapsed patient's heart rhythm and determine the need for a defibrillatory electric shock. This requires no intellectual input from the operator, whose actions are directed by simple written and recorded vocal prompts. Increasing the number of members of the public with the ability to access and use AEDs and provide cardiopulmonary resuscitation (CPR) is a cost-effective strategy for reducing deaths from OHCA. However, conventional training often results in inadequate skill acquisition and fails to ensure skill retention beyond three to six months. Classes without instructors and which use computer-assisted learning or automated voice-advisory manikins have resulted in competence similar to that achieved with traditional training, and may be more cost-effective and convenient. Simplified staged CPR classes offer improved skill acquisition and have a moderate benefit for skill retention. Short self-instructional video training classes or frequently repeated brief practice sessions with feedback from a voice-advisory manikin (both in the absence of an instructor) offer the greatest benefit for CPR skill acquisition and retention, but have not been used for AED instruction. Further research is required to determine the optimal method for training lay members of the public to use AEDs. It seems, however, that the ideal teaching strategy is unlikely to utilise a conventional instructor-led model.