Relationship between level of CPR training, self-reported skills, and actual manikin test performance—an observational study

Background - Quality of bystander cardiopulmonary resuscitation (CPR) skills may influence out of hospital cardiac arrest (OHCA) outcomes. We analyzed how the level of CPR training related to indicators of good CPR quality and also the relationship between self-reported skills and actual CPR performance. Methods - Two hundred thirty-seven persons trained in standardized BLS curricula were divided into three groups according to the level of training: group I (40 h basic first aid training), group II, and group III (96 h advanced first aid, group III had also some limited additional life support training courses). We recorded the participants’ real-life CPR experience and self-reported CPR skills, and then assessed selected CPR quality indicators on a manikin. The data were analyzed with multivariate logistic regression. Differences between groups were analyzed with ANOVA/MANOVA. Results - Out of 237 participants, 125 had basic training (group I), 84 reported advanced training (group II), and 28 advanced training plus additional courses (group III). Group II and III had shorter start-up time, better compression depth and hand positioning, higher fraction of effective rescue ventilations, shorter hands-off time, and thus a higher chest compression fraction. Chest compression rate did not differ between groups. The participants in group I assessed their own skills and preparedness significantly lower than groups II and III both before and after the test. In addition, group III reported higher confidence in examining the critically ill patient and preparedness in doing CPR before the manikin test than both groups I and II. However, the observed differences between groups II and III in self-reported skills and preparedness were not statistically significant after the test. Conclusion - As expected, higher levels of BLS training correlated with better CPR quality. However, this study showed that ventilations and hands-on time were the components of CPR that were most affected by the level of training. Self-assessments of CPR ability correlated well to actual test performance and may have a role in probing CPR skills in students. The results may be important for BLS instructors and program developers