Methods
hands-only, CCM, UC
HEART, EMERGENCY
This was a prospective randomized controlled trial to compare the effectiveness of fit-CPR (intervention) against the conventional classroom method (CCM) in teaching hands-only CPR (control). This study was carried out in Banda Aceh, Indonesia, from August to November 2018. It involved Syiah Kuala University, Aceh, Indonesia students. We received approval from the Universiti Kebangsaan Malaysia (UKM), Medical Research and Ethics Committees and carried out this study following the Helsinki Declaration. This study includes pre-test, post-test, and 6-month retention tests. The Ethical approval was obtained from the Research Ethics Committee of the Faculty of Medicine, Universiti Kebangsaan Malaysia (UKM FF-2018-345).The study was carried out using convenience sampling during the orientation week for new university students. An announcement on the study was carried out, and those who were interested voluntarily join the study. Those who had CPR training within the previous 2 years, not physically healthy or refused to participate were excluded. Those who did not finish the study protocol were excluded. They received details regarding the study’s process and were given a consent form. Name, age, gender, comorbidities, contact information, experience learning or doing CPR, and degree of physical activity were all recorded as necessary.The intervention was divided into 3 phases: i) 25 minutes (mins) of hands-only CPR teaching accompanied by music, ii) 20 mins of moderate-intensity physical activity, and iii) 2 mins of hands-only CPR on a manikin (- Flow diagram of the intervention group versus the control group. CPR: cardiopulmonary resuscitation, min: minutesThe first phase started with the main instructor introducing the fit-CPR protocol. Following that, 3 rounds of mass CPR practice were conducted with music and interspersed with a mini-briefing. Each round involved CPR practice and mini-briefings (first round: 30 seconds CPR practice and 5-minute mini-briefing; second round: 1-minute CPR practice and 7-minute mini-briefing, and the third round: 2-minute CPR practice and 10-minute mini-briefing plus a question and answer ([Q&A] session). The longer mini-briefing session allowed for recovery and more participant inquiries. The briefings were kept short to avoid boredom while focusing on performing CPR’s critical knowledge and foundations. Attendees learned on the 5-T CPR principles, indications, contraindications, and CPR termination during this mini-briefing and Q&A session. The participant-to-manikin ratio was kept at 1:1. The instructors’ role was to circulate among the participants, connect with them, answer questions, and teach hands-only CPR to the beat of the music. Demonstrators were positioned in front of the attendees on an elevated platform to facilitate the practice while-watching method. The facilitators moved among the participants, assisting them in performing CPR using only their hands (hands-only CPR).The second phase involved physical activity, which included running for at least 20 mins on a designated pathway, followed by a 5- to 10-mins rest interval. Participants were expected to increase their basal heart rate by at least 60% during this activity. The third phase required participants to execute hands-only CPR within 2 mins without the assistance of instructors, facilitators, demonstrators, or any music.Participants in the control group were required to complete the following 2 phases: i) a 45-minute lecture on cardiopulmonary resuscitation (delivered by a certified American Heart Association basic life support instructor). The lecture discussed the science and concepts of cardiopulmonary resuscitation, its indications and contraindications, and the 5 CPR steps of Danger, Response, Airway, Breathing, and Circulation (DRABC); ii) 30-mins face-to-face classroom teaching hands-only CPR with a ratio of 1:1:6 instructor-to-manikin-to-student.As a means of measurement, a validated questionnaire and Objective Structured Clinical Examination (OSCE) checklist were used to assess participants’ basic CPR knowledge and performance, which had been obtained from the author of a previously published study.The outcomes measured for CPR knowledge were as follows: CPR indication, correct steps of hands-only CPR, the emergency number, hand placement, compression rate, compression depth, and CPR termination. The performance of CPR was evaluated using the OSCE checklist, which included questions about the victim’s response, calling for help, the steps of CPR, hand placement, and performing high-quality CPR. High-quality CPR involved a push-fast (100 to 120 chest compressions per minute), push-hard (at least 2-inch depth or a click sound on the mannequin), and adequate chest recoil with minimal interruption of chest compression.The sample size was calculated using OpenEpi (JavaScript, MIT), which is an online open-source application.The participants were divided into intervention and control groups using Research Randomizer (Urbaniak, G. C., & Plous, S. [2013)]). The researcher randomly assigned participants to both groups via concealment of allocation. Each participant was assigned a unique code (UC) number to avoid bias. Throughout the trial, they could not change their UC number. The UC was 3 digits. An intervention participant’s code was 1XX, while a control participant’s code was 2XX. The first digit corresponded to the intervention/control group, while the second and third were the participant numbers. For example, UC ‘201’ was the first participant in the control group, and UC ‘108’ was the eighth person in the intervention group.Emergency physicians, senior paramedics, medical officers, and medical educators volunteered as assessors. To limit inter-rater discrepancies, a video calibration workshop and a debriefing session were organized. Assessors watched 5 videos of various CPR performances and scored them using the checklist during the video calibration session. Recalibration was performed until the assessors’ scores for a particular performance diverged by not more than one. The assessors were debriefed in order to improve the study’s comprehension and scoring process. The assessors were blinded to the intervention and control groups during the CPR sessions.