Can a novel infant CPR retraining strategy result in longer skill retention?

Abstract

The overall aim of this thesis was to create a novel, tailored, competence-based strategy to infant cardiopulmonary resuscitation (iCPR) retraining, with the ultimate goal of maximising retention of iCPR skills and potentially, improve survival rates after cardiac arrest. To interpret real changes in iCPR performance, consistency and variability of simulated iCPR skills were investigated through a within-day and between-day reliability study. Intraclass Correlation Coefficient, Standard Error of Measurement and Minimal Detectable Change were used. The results demonstrated that iCPR skills are highly repeatable and consistent, indicating that changes in performance after training can be considered real skill decay or improvement, and not variability in human performance. However, when the metrics are transformed in quality indices, large changes are required to be confident of real change. Differences in performance between dominant hand (DH) and non-dominant hand (NH) during simulated iCPR, and how perception of fatigue may affect performance, were also investigated. A randomised study was conducted, and the results indicated no significant differences in performance with DH versus NH for any iCPR metric. However, perception of fatigue is higher in NH and is related to compression rate and residual leaning, but with no effect on quality of performance. Based on the results, individuals performing iCPR can offer similar quality of infant chest compressions, regardless of the hand used. To investigate iCPR skill acquisition and retention, a prospective, longitudinal, interventional study with 118 participants was conducted. The results indicate that, despite individuals requiring different amounts of input and time (four to 28 minutes after initial training) to achieve iCPR competence, the retention of those skills was as high as 96% at follow-up. This suggests that the optimal reinforcement schedule is highly likely to vary depending on the individual achieving iCPR competence. It may be argued that this tailored, competence-based retraining model, can potentially reduce training costs overall, enhance iCPR performance, and in consequence, may improve the chances of survival after infant cardiac arrest.