doi: 10.1161/CIRCULATIONAHA.105.166478
| ||||||||||||||||||||||||||||||||||||||||||||||||||
(Circulation. 2005;112:III-100 – III-108.)
© 2005 American Heart Association, Inc.
Section 1 |
Part 8: Interdisciplinary Topics
From the 2005 International Consensus Conference on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations, hosted by the American Heart Association in Dallas, Texas, January 23–30, 2005.
 |
Introduction |
|---|
 Top Introduction Educational MethodsEducational EvaluationEthicsOutcomes and Cost-EffectivenessReferences |
|---|
The Interdisciplinary Task Force discussed topics that applied to several task forces and in particular focused on questions about educational methods, ethics, and outcomes. Some of these topics are discussed in other sections of this document (eg, the topic of medical emergency teams is discussed in Part 4: "Advanced Life Support").
To maintain consistency with the science statements in other sections, studies using manikins were recorded as LOE 6, irrespective of the study design.
|
Educational Methods |
|---|
|
TopIntroductionEducational MethodsEducational EvaluationEthicsOutcomes and Cost-EffectivenessReferences |
|---|
Acquisition and retention of skills are poor after conventional CPR training.1 Evidence for and against several resuscitation training methods was reviewed, highlighting the need for further research.
Devices
CPR Prompt DevicesW190A,W190B
Consensus on Science
Twenty-seven randomized studies using models from the motor skills literature (LOE 6)2–28 and one randomized study using manikins (LOE 6)29 showed that the use of audio or visual prompts during motor skills acquisition training improved student skills performance during or immediately after training. These studies and supporting theory from 2 studies (LOE 7)30,31 indicate that the overuse of guiding prompts during training reduced skills retention in the long term.
Treatment Recommendation
Audio and visual prompts and other forms of directive or corrective feedback that guide action sequences and timing of chest compressions and ventilations may help early learning of CPR skills. Training must include ample practice time without prompting devices to optimize skills retention for situations in which prompting devices are not available.
Instructional Methods
Effective AED Instructional MethodsW191A,W191B
Consensus on Science
Seven studies (LOE 432–35; LOE 536,37; LOE 738 showed improved rates of survival from out-of-hospital cardiac arrest when CPR plus automated external defibrillation training (traditional 4-hour course) was made widely available to lay first responders. The prospective randomized trial of lay rescuer automated external defibrillation programs did not specifically evaluate the training provided, but sites where rescuers were trained and equipped to provide CPR or CPR plus automated external defibrillator (AED) use showed higher survival rates compared with national reports (LOE 7).38
Twenty studies (LOE 539; LOE 640–58) document consistent improvement in simulated AED use and skills retention using diverse training methods and durations. Three studies (LOE 6)59–61 show that within a simulated arrest scenario the correct and appropriate use of an AED depends on the AED user interface.
Treatment Recommendation
Community lay responder AED training is recommended. There is insufficient evidence to recommend a specific instructional method for AED training. AED manufacturers should increase the ease of AED user interface to improve efficacy.
Effective BLS Instructional MethodsW185A,W185B,W192
Consensus on Science
Nineteen randomized manikin studies (LOE 6)48,62–79 and one extrapolated study (LOE 7)80 showed considerable variability in BLS skills acquisition and retention with the use of different instructional formats (video instruction, computer-assisted instruction, and traditional instruction). Four randomized studies using manikins (LOE 6)66–69 indicated that one video instruction program (a self-instructional synchronous "watch-while-you-practice" program) achieved better skills acquisition and retention than other educational formats. One randomized study of adult learners using manikins showed that a brief video self-instruction program produced CPR skills performance equivalent to or better than traditional training (LOE 6).81
Treatment Recommendation
Instruction methods should not be limited to traditional techniques; newer training methods (eg, "watch-while-you-practice" video programs) may be more effective. Training programs should be evaluated to verify that they enable effective skills acquisition and retention.
Instructional Methods for Hand Position in Chest CompressionsW189
Consensus on Science
Six randomized controlled trials (RCTs) using manikins (LOE 6)67,69,82–85 evaluated hand positioning in detail. One trial82 compared a simplified message ("place hands in the center of the chest") versus the standard method (anatomical landmarks) for teaching correct hand placement. Three of the 6 trials83–85 compared a staged teaching approach with standard teaching. Two of the trials67,69 compared the results of video self-instruction with standard teaching on CPR performance. The likelihood of achieving an acceptable hand position was no different between those who had received detailed instruction on anatomical landmarks and those who were instructed to simply compress the center of the chest.
In 4 manikin RCTs (LOE 6)82–85 the use of anatomical landmarks to determine hand placement delayed delivery of the first chest compression after a ventilation; thus, fewer compressions were delivered per minute. Incorrect rescuer hand placement can injure the victim (LOE 6).86,87
Treatment Recommendation
Teaching hand placement for chest compression should be simplified with less attention to anatomical landmarks and emphasis on the importance of minimizing interruption to chest compressions and performing an adequate number of chest compressions per minute.
Retraining Intervals
Retraining Intervals in Advanced and Basic Life SupportW186A,W86
Consensus on Science
One prospective cohort study (LOE 3),88 1 survey (LOE 5),89 and 10 manikin studies (LOE 6),90–99 documented decay in healthcare provider ALS skills and knowledge after ALS training and retraining from as little as 6 weeks to 2 years. Refresher courses based only on knowledge did not prevent the decay in psychomotor skills.
A single randomized manikin study (LOE 6)100 concluded that retraining at either 3- or 6-month intervals resulted in similar BLS performance at 12 months and providers who were retrained performed significantly better than controls with no retraining.
Treatment Recommendation
Frequent retraining (theory and practice) is required to maintain both BLS and ALS skills. The optimal interval for retraining has not been established.
Media Campaigns
Media Campaigns Targeting Chest PainW193A,W193B
Consensus on Science
One large RCT (LOE 1),101 a Cochrane systematic review (LOE 1),102 and 4 additional studies (LOE 3103,104; LOE 4105,106) evaluating the impact of mass media campaigns indicate that they do not reduce the delay to presentation at the hospital following onset of chest pain. Conversely 7 studies (LOE 3)107–113 did report reduced delay in the patient’s response to chest pain.
The evidence that mass media campaigns reduce patient delay from the onset of symptoms to presentation at hospital is equivocal and suggests that the impact of such campaigns, particularly on prehospital delay times, may be greater for populations in which the baseline delay time is long.
There is evidence that mass media campaigns can increase the use of ambulance transport (LOE 1)101 in patients with symptoms that suggest myocardial ischemia. In several studies (LOE 1102; LOE 3107,110,114; LOE 4105) the number of patients presenting to the emergency department increased in the early stages of the media campaign but soon returned to baseline.
The impact of mass media campaigns on rates of mortality from ischemic heart disease remains inconclusive (LOE 3)109; however, the inference is that by reducing prehospital delay time, the mortality rate should decrease.
Treatment Recommendation
Given that the data is inconsistent, mass media campaigns should not be considered the only option for reducing patient delay but rather part of an overall system approach to reduce the interval from onset of symptoms of chest pain to hospital presentation.
|
Educational Evaluation |
|---|
|
TopIntroductionEducational MethodsEducational EvaluationEthicsOutcomes and Cost-EffectivenessReferences |
|---|
Although there is considerable literature on the evaluation of educational processes in general, there are few studies of resuscitation education.
Attitude Toward Performing CPR
Barriers to Performing CPRW184A,W184B
Consensus on Science
One RCT (LOE 2),115 1 prospective controlled cohort study (LOE 3),116 2 cohort and case studies (LOE 4),117,118 supported by 27 cohort and case studies (LOE 5119–138; LOE 7139–145) indicate hesitancy or unwillingness to perform CPR, particularly mouth-to-mouth ventilation, on adult patients in and out of hospital, even after CPR training.
Reasons for the hesitancy or unwillingness to perform CPR include, but are not limited to, fear of contracting a disease while performing mouth-to-mouth ventilations, fear of performing the skills incorrectly, and fear of hurting the patient.
Treatment Recommendation
CPR training programs should include discussion of the minimal risk of contracting infectious diseases while performing mouth-to-mouth ventilation. "Chest compression only" resuscitation may be considered when there is a reluctance to perform mouth-to-mouth ventilation (see Part 2: "Adult Basic Life Support").
Written Test Scores and Skills CompetenceW188A,W188B
Consensus on Science
Do written test scores correlate with competence in CPR skills? None of the studies reviewed was designed specifically to answer this question. In 14 of 17 studies test scores correlated with CPR proficiency. Of the 7 studies with good written test scores (LOE 6 manikin studies), 4 studies were associated with good CPR skills146–149 and 3 studies with poor CPR skills.150–152 In 2 manikin studies (LOE 6)68,153 mediocre written test scores correlated with mediocre or borderline CPR performance. In 6 manikin studies (LOE 6),72,147,153–156 poor written test performance was associated with poor CPR capability. In 5 manikin studies (LOE 6),150–152,157,158 written test scores did not correlate with CPR proficiency.
Treatment Recommendation
A written test score does not always reflect BLS skills competence. Therefore, a written test or questionnaire should not be used as the sole determinant of a person’s acquisition of the skills needed to perform CPR.
|
Ethics |
|---|
|
TopIntroductionEducational MethodsEducational EvaluationEthicsOutcomes and Cost-EffectivenessReferences |
|---|
The ethical issues surrounding resuscitation are dependent on local culture and law. Consideration of the patient’s wishes, the family’s desires, cultural issues, and local laws makes specific recommendations about ethical decisions generally inappropriate.
Impact of DNAR on ResuscitationW179A,W179B,W179C
Consensus on Science
The emergency medical services (EMS) system is activated for many patients in cardiac arrest who are chronically ill, have a terminal illness, or have do-not-attempt-resuscitation (DNAR) orders (LOE 4).159–161 Studies from the United States and Australia indicate that Caucasians and better-educated persons are more likely to have advance directives (LOE 4162–165; LOE 7166–168). There is evidence that out-of-hospital healthcare providers can interpret and use DNAR orders and other documents to limit treatment (LOE 3169,170; LOE 4171; LOE 7172).
The most studied DNAR form is the Physician Orders for Life-Sustaining Treatment (POLST) form.170,171,173–175
Treatment Recommendation
We recommend the use of standardized out-of-hospital physician orders for patients who are chronically ill or have a terminal illness. These must be easily understood by EMS personnel. Additional instructions should indicate whether EMS personnel are to initiate or continue life-sustaining interventions for patients in cardiac arrest and those in near-arrest. Because laws governing the use of DNAR forms and advance directives vary by jurisdiction, providers should be aware of local laws and regulations.176
Family Member Presence During CPRW180A,W180B
Consensus on Science
No studies evaluated the effect of the presence of parents during resuscitation of children. Studies on parents’ opinions indicate their preference to be at the side of the child who is dying (LOE 5),177 during CPR (LOE 5),177 or during procedures (LOE 7).177–184 However, 5 studies (LOE 3)185–189 found that staff members were reluctant to allow parents to be present during resuscitation.
Most relatives of adult patients requiring CPR state that they would like to be offered the option of being present in the resuscitation room (LOE 5).190–194 A survey of adult patients indicated that many, but not all, would prefer to have certain family members present (LOE 5).195 Family presence during resuscitation did not impact on self-reported stress among staff (LOE 3),196 nor was it disruptive for staff (LOE 5).191,194 Family members considered their presence to be beneficial (LOE 5)191,193,194,197 and their adjustment to the death of the patient made easier by their presence during the resuscitation attempt (LOE 2198; LOE 5191,197).
There are no data to support or refute the importance of having a dedicated staff member available to support family members during resuscitation for either adults or children, but this practice is well described (LOE 2198; LOE 5191).
Treatment Recommendation
There is no data indicating that the presence of relatives in the resuscitation room is harmful. Therefore, it is reasonable to give select family members the opportunity to be present during resuscitation unless the adult patient has raised a prior objection.
|
Outcomes and Cost-Effectiveness |
|---|
|
TopIntroductionEducational MethodsEducational EvaluationEthicsOutcomes and Cost-EffectivenessReferences |
|---|
Research about the "quality of life" for survivors of cardiac arrest is plagued by the lack of a consistent definition of quality of life and how best to measure it. Nonetheless, the increasing demand for limited healthcare resources makes it important to measure the effectiveness of CPR in terms of quality of survival and not just the number of survivors.
Outcomes
Quality of Life Outcomes After CPRW182A,W182B
Consensus on Science
In 6 nonrandomized prospective cohort studies (LOE 3)144,199–203 and 20 additional studies (LOE 4204–210; LOE 5211–223) of long-term survivors of in- and out-of-hospital cardiac arrest, the quality of life among the majority of adult survivors is similar to that of the general population. Cognitive deficits in survivors, such as memory loss and depression, are common. In 2 studies (LOE 4)224,225 neurologic outcomes were poor after cardiac arrest in children. Two studies indicate that the quality of life may not be as good in some cohorts, such as long-term care patients (LOE 5).226,227
Treatment Recommendation
The quality of life for most adult survivors of cardiac arrest and CPR is good. There are few reports about longer-term quality of life in children. For more information about prognosis in adults, children, and neonates, see Part 2: "Adult Basic Life Support," Part 6: "Pediatric Basic and Advanced Life Support," and Part 7: "Neonatal Resuscitation."
Cost-Effectiveness
Cost-Effectiveness in CPR Training ProgramsW183
Consensus on Science
In the single study (LOE 3)148 that considers the cost-effectiveness of CPR training programs, traditional CPR training in an unselected population of laypeople is expensive compared with accepted cost-effectiveness thresholds. Conversely, selective training of laypeople at high risk of witnessing a cardiac arrest (ie, persons living in households with a recent survivor of myocardial infarction) is much more cost-effective.
Treatment Recommendation
It is reasonable for CPR programs to emphasize the enrollment of laypeople with the highest probability of encountering a victim of cardiac arrest. Other potentially more cost-effective methods of training should be considered (see previous sections).
|
Footnotes |
|---|
This article has been copublished in Resuscitation.
© 2005 American Heart Association, the International Liaison Committee on Resuscitation, and the European Resuscitation Council.
|
References |
|---|
|
TopIntroductionEducational MethodsEducational EvaluationEthicsOutcomes and Cost-EffectivenessReferences |
|---|
1. Chamberlain DA, Hazinski MF. Education in resuscitation: an ILCOR symposium: Utstein Abbey: Stavanger, Norway: June 22–24, 2001. Circulation. 2003; 108: 2575–2594.
2. Goodwin AP. Cardiopulmonary resuscitation training revisited. J R Soc Med. 1992; 85: 452–453.[Abstract]
3. Guadagnoli MA, Kohl RM. Knowledge of results for motor learning: relationship between error estimation and knowledge of results frequency. J Mot Behav. 2001; 33: 217–224.[Medline] [Order article via Infotrieve]
4. Pringle RK. Guidance hypothesis with verbal feedback in learning a palpation skill. J Manipulative Physiol Ther. 2004; 27: 36–42.[CrossRef][Medline] [Order article via Infotrieve]
5. Schmidt RA, Young DE, Swinnen S, Shapiro DC. Summary knowledge of results for skill acquisition: support for the guidance hypothesis. J Exp Psychol. 1989; 15: 352–359.
6. Swinnen S. Interpolated activities during the knowledge-of-results delay and post-knowledge-of-results interval: effects on performance and learning. J Exp Psychol. 1990; 16: 692–705.
7. Winstein CJ, Schmidt RA. Reduced frequency of knowledge of results enhances motor skill learning. J Exp Psychol. 1990; 16: 677–691.
8. Wrisberg CA, Wulf G. Diminishing the effects of reduced frequency of knowledge of results on generalized motor program learning. J Mot Behav. 1997; 29: 17–26.
9. Wulf G, Lee TD, Schmidt RA. Reducing knowledge of results about relative versus absolute timing: differential effects on learning. J Mot Behav. 1994; 26: 362–369.[Medline] [Order article via Infotrieve]
10. Wulf G, Schmidt RA. The learning of generalized motor programs: reducing the relative frequency of knowledge of results enhances memory. J Exp Psychol. 1989; 15: 748–757.
11. Anderson DI, Magill RA, Sekiya H. A reconsideration of the trials-delay of knowledge of results paradigm in motor skill learning. Res Q Exerc Sport. 1994; 65: 286–290.[Medline] [Order article via Infotrieve]
12. Anderson DI, Magill RA, Sekiya H. Motor learning as a function of KR schedule and characteristics of task-intrinsic feedback. J Mot Behav. 2001; 33: 59–66.[Medline] [Order article via Infotrieve]
13. Butki BD, Hoffman SJ. Effects of reducing frequency of intrinsic knowledge of results on the learning of a motor skill. Percept Mot Skills. 2003; 97: 569–580.[CrossRef][Medline] [Order article via Infotrieve]
14. Croce R, Horvat M, Roswal G. Augmented feedback for enhanced skill acquisition in individuals with traumatic brain injury. Percept Mot Skills. 1996; 82: 507–514.[Medline] [Order article via Infotrieve]
15. Gable CD, Shea CH, Wright DL. Summary knowledge of results. Res Q Exerc Sport. 1991; 62: 285–292.[Medline] [Order article via Infotrieve]
16. Gillespie M. Summary versus every-trial knowledge of results for individuals with intellectual disabilities. Adapted Physical Activity Quarterly. 2003; 20: 46–56.
17. Goodwin JE, Eckerson JM, Voll CA Jr. Testing specificity and guidance hypotheses by manipulating relative frequency of KR scheduling in motor skill acquisition. Percept Mot Skills. 2001; 93: 819–824.[CrossRef][Medline] [Order article via Infotrieve]
18. Guadagnoli MA, Leis B, Van Gemmert AW, Stelmach GE. The relationship between knowledge of results and motor learning in Parkinsonian patients. Parkinsonism Relat Disord. 2002; 9: 89–95.[CrossRef][Medline] [Order article via Infotrieve]
19. Guay M, Salmoni A, Lajoie Y. Summary knowledge of results and task processing load. Res Q Exerc Sport. 1997; 68: 167–171.[Medline] [Order article via Infotrieve]
20. Kohl RM, Guadagnoli MA. The scheduling of knowledge of results. J Mot Behav. 1996; 28: 233–240.[Medline] [Order article via Infotrieve]
21. Lee TD, White MA, Carnahan H. On the role of knowledge of results in motor learning: exploring the guidance hypothesis. J Mot Behav. 1990; 22: 191–208.[Medline] [Order article via Infotrieve]
22. Liu J, Wrisberg CA. The effect of knowledge of results delay and the subjective estimation of movement form on the acquisition and retention of a motor skill. Res Q Exerc Sport. 1997; 68: 145–151.[Medline] [Order article via Infotrieve]
23. Park JH, Shea CH, Wright DL. Reduced-frequency concurrent and terminal feedback: a test of the guidance hypothesis. J Mot Behav. 2000; 32: 287–296.[Medline] [Order article via Infotrieve]
24. Schmidt RA, Wulf G. Continuous concurrent feedback degrades skill learning: implications for training and simulation. Hum Factors. 1997; 39: 509–525.[CrossRef][Medline] [Order article via Infotrieve]
25. Weeks DL, Kordus RN. Relative frequency of knowledge of performance and motor skill learning. Res Q Exerc Sport. 1998; 69: 224–230.[Medline] [Order article via Infotrieve]
26. Wulf G, Schmidt RA, Deubel H. Reduced feedback frequency enhances generalized motor program learning but not parameterization learning. J Exp Psychol. 1993; 19: 1134–1150.
27. Yao WX. Average-KR schedule benefits generalized motor program learning. Percept Mot Skills. 2003; 97: 185–191.[CrossRef][Medline] [Order article via Infotrieve]
28. Shewokis PA, Kennedy CZ, Marsh JL. Effects of bandwidth knowledge of results on the performance and learning of a shoulder internal rotation isokinetic strength task. Isokinet Exerc Sci. 2000; 8: 129–139.
29. Wik L, Thowsen J, Steen PA. An automated voice advisory manikin system for training in basic life support without an instructor: a novel approach to CPR training. Resuscitation. 2001; 50: 167–172.[CrossRef][Medline] [Order article via Infotrieve]
30. Salmoni AW, Schmidt RA, Walter CB. Knowledge of results and motor learning: a review and critical reappraisal. Psychol Bull. 1984; 95: 355–386.[CrossRef][Medline] [Order article via Infotrieve]
31. Winstein CJ. Knowledge of results and motor learning—implications for physical therapy. Phys Ther. 1991; 71: 140–149.
32. Lerner EB, Hinchey PR, Billittier IV AJ. A survey of first-responder firefighters’ attitudes, opinions, and concerns about their automated external defibrillator program. Prehosp Emerg Care. 2003; 7: 120–124.[Medline] [Order article via Infotrieve]
33. Bertrand C, Rodriguez Redington P, Lecarpentier E, Bellaiche G, Michel D, Teiger E, Morris W, Le Bourgeois JP, Barthout M. Preliminary report on AED deployment on the entire Air France commercial fleet: a joint venture with Paris XII University Training Programme. Resuscitation. 2004; 63: 175–181.[CrossRef][Medline] [Order article via Infotrieve]
34. Chadda KD, Kammerer R. Early experiences with the portable automatic external defibrillator in the home and public places. Am J Cardiol. 1987; 60: 732–733.[CrossRef][Medline] [Order article via Infotrieve]
35. Mosesso VN, Jr, Davis EA, Auble TE, Paris PM, Yealy DM. Use of automated external defibrillators by police officers for treatment of out-of-hospital cardiac arrest. Ann Emerg Med. 1998; 32: 200–207.[CrossRef][Medline] [Order article via Infotrieve]
36. Valenzuela TD, Roe DJ, Nichol G, Clark LL, Spaite DW, Hardman RG. Outcomes of rapid defibrillation by security officers after cardiac arrest in casinos. N Engl J Med. 2000; 343: 1206–1209.
37. Destro A, Marzaloni M, Sermasi S, Rossi F. Automatic external defibrillators in the hospital as well? Resuscitation. 1996; 31: 39–43.[CrossRef][Medline] [Order article via Infotrieve]
38. The Public Access Defibrillation Trial Investigators. Public-access defibrillation and survival after out-of-hospital cardiac arrest. N Engl J Med. 2004; 351: 637–646.
39. Walters G, D’Auria D, Glucksman E. Automated external defibrillators: implications for training qualified ambulance staff. Ann Emerg Med. 1992; 21: 692–697.[CrossRef][Medline] [Order article via Infotrieve]
40. Cummins RO, Schubach JA, Litwin PE, Hearne TR. Training lay persons to use automatic external defibrillators: success of initial training and one-year retention of skills. Am J Emerg Med. 1989; 7: 143–149.[CrossRef][Medline] [Order article via Infotrieve]
41. Gundry JW, Comess KA, DeRook FA, Jorgenson D, Bardy GH. Comparison of naive sixth-grade children with trained professionals in the use of an automated external defibrillator. Circulation. 1999; 100: 1703–1707.
42. Kaye W, Mancini ME, Giuliano KK, Richards N, Nagid DM, Marler CA, Sawyer-Silva S. Strengthening the in-hospital chain of survival with rapid defibrillation by first responders using automated external defibrillators: training and retention issues. Ann Emerg Med. 1995; 25: 163–168.[CrossRef][Medline] [Order article via Infotrieve]
43. Kooij FO, van Alem AP, Koster RW, de Vos R. Training of police officers as first responders with an automated external defibrillator. Resuscitation. 2004; 63: 33–41.[CrossRef][Medline] [Order article via Infotrieve]
44. Lawson L, March J. Automated external defibrillation by very young, untrained children. Prehosp Emerg Care. 2002; 6: 295–298.[Medline] [Order article via Infotrieve]
45. Mattei LC, McKay U, Lepper MW, Soar J. Do nurses and physiotherapists require training to use an automated external defibrillator? Resuscitation. 2002; 53: 277–280.[CrossRef][Medline] [Order article via Infotrieve]
46. McDaniel CM, Berry VA, Haines DE, DiMarco JP. Automatic external defibrillation of patients after myocardial infarction by family members: practical aspects and psychological impact of training. Pacing Clin Electrophysiol. 1988; 11: 2029–2034.[CrossRef][Medline] [Order article via Infotrieve]
47. McKee DR, Wynne G, Evans TR. Student nurses can defibrillate within 90 seconds: an evaluation of a training programme for third year student nurses in the use of an automatic external defibrillator. Resuscitation. 1994; 27: 35–37.[CrossRef][Medline] [Order article via Infotrieve]
48. Meischke HW, Rea T, Eisenberg MS, Schaeffer SM, Kudenchuk P. Training seniors in the operation of an automated external defibrillator: a randomized trial comparing two training methods. Ann Emerg Med. 2001; 38: 216–222.[CrossRef][Medline] [Order article via Infotrieve]
49. Moore JE, Eisenberg MS, Cummins RO, Hallstrom A, Litwin P, Carter W. Lay person use of automatic external defibrillation. Ann Emerg Med. 1987; 16: 669–672.[CrossRef][Medline] [Order article via Infotrieve]
50. Roccia WD, Modic PE, Cuddy MA. Automated external defibrillator use among the general population. J Dent Educ. 2003; 67: 1355–1361.[Abstract]
51. Sandroni C, Fenici P, Franchi ML, Cavallaro F, Menchinelli C, Antonelli M. Automated external defibrillation by untrained deaf lay rescuers. Resuscitation. 2004; 63: 43–48.[CrossRef][Medline] [Order article via Infotrieve]
52. Ten Eyck RP. Automated external defibrillator training and skills maintenance in Air Force emergency medical services systems. Mil Med. 1993; 158: 579–581.[Medline] [Order article via Infotrieve]
53. Usatch BR, Cone DC. Automated external defibrillator training and skill retention at a ski patrol. Prehosp Emerg Care. 2002; 6: 325–329.[Medline] [Order article via Infotrieve]
54. Warwick JP, Mackie K, Spencer I. Towards early defibrillation—a nurse training programme in the use of automated external defibrillators. Resuscitation. 1995; 30: 231–235.[CrossRef][Medline] [Order article via Infotrieve]
55. Wik L, Dorph E, Auestad B, Steen PA. Evaluation of a defibrillator-basic cardiopulmonary resuscitation programme for non medical personnel. Resuscitation. 2003; 56: 167–172.[CrossRef][Medline] [Order article via Infotrieve]
56. Woollard M, Whitfeild R, Smith A, Colquhoun M, Newcombe RG, Vetteer N, Chamberlain D. Skill acquisition and retention in automated external defibrillator (AED) use and CPR by lay responders: a prospective study. Resuscitation. 2004; 60: 17–28.[CrossRef][Medline] [Order article via Infotrieve]
57. Zeitz CJ, Zeitz KM, Ward G, Inglis A. The acquisition and maintenance of defibrillation skills by lay first responders. Resuscitation. 2003; 56: 77–82.[CrossRef][Medline] [Order article via Infotrieve]
58. Walters G, Glucksman E, Evans TR. Training St John Ambulance volunteers to use an automated external defibrillator. Resuscitation. 1994; 27: 39–45.[CrossRef][Medline] [Order article via Infotrieve]
59. Andre AD, Jorgenson DB, Froman JA, Snyder DE, Poole JE. Automated external defibrillator use by untrained bystanders:can the public-use model work? Prehosp Emerg Care. 2004; 8: 284–291.[CrossRef][Medline] [Order article via Infotrieve]
60. Eames P, Larsen PD, Galletly DC. Comparison of ease of use of three automated external defibrillators by untrained lay people. Resuscitation. 2003; 58: 25–30.[CrossRef][Medline] [Order article via Infotrieve]
61. Fleischhackl R, Losert H, Haugk M, Eisenburger P, Sterz F, Laggner AN, Herkner H. Differing operational outcomes with six commercially available automated external defibrillators. Resuscitation. 2004; 62: 167–174.[CrossRef][Medline] [Order article via Infotrieve]
62. Dracup K, Moser DK, Doering LV, Guzy PM. Comparison of cardiopulmonary resuscitation training methods for parents of infants at high risk for cardiopulmonary arrest. Ann Emerg Med. 1998; 32: 170–177.[CrossRef][Medline] [Order article via Infotrieve]
63. Fabius DB, Grissom EL, Fuentes A. Recertification in cardiopulmonary resuscitation: a comparison of two teaching methods. J Nurs Staff Dev. 1994; 10: 262–268.[Medline] [Order article via Infotrieve]
64. Messmer P, Meehan R, Gilliam N, White S, Donaldson P. Teaching infant CPR to mothers of cocaine-positive infants. J Contin Educ Nurs. 1993; 24: 217–220.[Medline] [Order article via Infotrieve]
65. Plank CH, Steinke KR. Effect of two teaching methods on CPR retention. J Nurs Staff Dev. 1989; 5: 145–147.[Medline] [Order article via Infotrieve]
66. Braslow A, Brennan RT, Newman MM, Bircher NG, Batcheller AM, Kaye W. CPR training without an instructor: development and evaluation of a video self-instructional system for effective performance of cardiopulmonary resuscitation. Resuscitation. 1997; 34: 207–220.[CrossRef][Medline] [Order article via Infotrieve]
67. Todd KH, Braslow A, Brennan RT, Lowery DW, Cox RJ, Lipscomb LE, Kellermann AL. Randomized, controlled trial of video self-instruction versus traditional CPR training. Ann Emerg Med. 1998; 31: 364–369.[CrossRef][Medline] [Order article via Infotrieve]
68. Todd KH, Heron SL, Thompson M, Dennis R, O’Connor J, Kellermann AL. Simple CPR: a randomized, controlled trial of video self-instructional cardiopulmonary resuscitation training in an African American church congregation. Ann Emerg Med. 1999; 34: 730–737.[CrossRef][Medline] [Order article via Infotrieve]
69. Batcheller AM, Brennan RT, Braslow A, Urrutia A, Kaye W. Cardiopulmonary resuscitation performance of subjects over forty is better following half-hour video self-instruction compared to traditional four-hour classroom training. Resuscitation. 2000; 43: 101–110.[CrossRef][Medline] [Order article via Infotrieve]
70. Edwards MJ, Hannah KJ. An examination of the use of interactive videodisc cardiopulmonary resuscitation instruction for the lay community. Comput Nurs. 1985; 3: 250–252.[Medline] [Order article via Infotrieve]
71. Nelson M, Brown CG. CPR instruction: modular versus lecture course. Ann Emerg Med. 1984; 13: 118–121.[CrossRef][Medline] [Order article via Infotrieve]
72. Kaczorowski J, Levitt C, Hammond M, Outerbridge E, Grad R, Rothman A, Graves L. Retention of neonatal resuscitation skills and knowledge: a randomized controlled trial. Fam Med. 1998; 30: 705–711.[Medline] [Order article via Infotrieve]
73. Liberman M, Golberg N, Mulder D, Sampalis J. Teaching cardiopulmonary resuscitation to CEGEP students in Quebec—a pilot project. Resuscitation. 2000; 47: 249–257.[CrossRef][Medline] [Order article via Infotrieve]
74. Friesen L, Stotts NA. Retention of Basic Cardiac Life Support content: the effect of two teaching methods. J Nurs Educ. 1984; 23: 184–191.[Medline] [Order article via Infotrieve]
75. Jerin JM, Ansell BA, Larsen MP, Cummins RO. Automated external defibrillators: skill maintenance using computer-assisted learning. Acad Emerg Med. 1998; 5: 709–717.[Medline] [Order article via Infotrieve]
76. Long CA. Teaching parents infant CPR—lecture or audiovisual tape? MCN Am J Matern Child Nurs. 1992; 17: 30–32.[CrossRef][Medline] [Order article via Infotrieve]
77. Clark LJ, Watson J, Cobbe SM, Reeve W, Swann IJ, Macfarlane PW. CPR ’98: a practical multimedia computer-based guide to cardiopulmonary resuscitation for medical students. Resuscitation. 2000; 44: 109–117.[CrossRef][Medline] [Order article via Infotrieve]
78. Done ML, Parr M. Teaching basic life support skills using self-directed learning, a self-instructional video, access to practice manikins and learning in pairs. Resuscitation. 2002; 52: 287–291.[CrossRef][Medline] [Order article via Infotrieve]
79. Umlauf MG. How to provide around-the-clock CPR certification without losing any sleep. J Contin Educ Nurs. 1990; 21: 248–251.[Medline] [Order article via Infotrieve]
80. Dracup K, Moser DK, Doering LV, Guzy PM, Juarbe T. A controlled trial of cardiopulmonary resuscitation training for ethnically diverse parents of infants at high risk for cardiopulmonary arrest. Crit Care Med. 2000; 28: 3289–3295.[CrossRef][Medline] [Order article via Infotrieve]
81. Lynch B, Einspruch E, Nichol G, Becker L, Aufderheide T, Idris A. Effectiveness of a 30-min CPR self-instruction program for lay responders: a controlled randomized study. Resuscitation. 2005; 67: 31–43.[CrossRef][Medline] [Order article via Infotrieve]
82. Handley AJ. Teaching hand placement for chest compression—a simpler technique. Resuscitation. 2002; 53: 29–36.[CrossRef][Medline] [Order article via Infotrieve]
83. Assar D, Chamberlain D, Colquhoun M, Donnelly P, Handley AJ, Leaves S, Kern KB. Randomised controlled trials of staged teaching for basic life support, 1: skill acquisition at bronze stage. Resuscitation. 2000; 45: 7–15.[CrossRef][Medline] [Order article via Infotrieve]
84. Chamberlain D, Smith A, Colquhoun M, Handley AJ, Kern KB, Woollard M. Randomised controlled trials of staged teaching for basic life support, 2: comparison of CPR performance and skill retention using either staged instruction or conventional training. Resuscitation. 2001; 50: 27–37.[CrossRef][Medline] [Order article via Infotrieve]
85. Smith A, Colquhoun M, Woollard M, Handley AJ, Kern KB, Chamberlain D. Trials of teaching methods in basic life support (4): comparison of simulated CPR performance at unannounced home testing after conventional or staged training. Resuscitation. 2004; 61: 41–47.[CrossRef][Medline] [Order article via Infotrieve]
86. Clements F, McGowan J. Finger position for chest compressions in cardiac arrest in infants. Resuscitation. 2000; 44: 43–46.[CrossRef][Medline] [Order article via Infotrieve]
87. Reynolds PE, Turner MM. Relative merits of ARC guidelines for ECC. Resuscitation. 2003; 57: 187–191.[CrossRef][Medline] [Order article via Infotrieve]
88. Makker R, Gray-Siracusa K, Evers M. Evaluation of advanced cardiac life support in a community teaching hospital by use of actual cardiac arrests. Heart Lung. 1995; 24: 116–120.[CrossRef][Medline] [Order article via Infotrieve]
89. Anthonypillai F. Retention of advanced cardiopulmonary resuscitation knowledge by intensive care trained nurses. Intensive Crit Care Nurs. 1992; 8: 180–184.[CrossRef][Medline] [Order article via Infotrieve]
90. Azcona LA, Gutierrez GE, Fernandez CJ, Natera OM, Ruiz-Speare O, Ali J. Attrition of advanced trauma life support (ATLS) skills among ATLS instructors and providers in Mexico. J Am Coll Surg. 2002; 195: 372–377.[CrossRef][Medline] [Order article via Infotrieve]
91. Birnbaum ML, Robinson NE, Kuska BM, Stone HL, Fryback DG, Rose JH. Effect of advanced cardiac life-support training in rural, community hospitals. Crit Care Med. 1994; 22: 741–749.[Medline] [Order article via Infotrieve]
92. Hammond F, Saba M, Simes T, Cross R. Advanced life support: retention of registered nurses’ knowledge 18 months after initial training. Aust Crit Care. 2000; 13: 99–104.[Medline] [Order article via Infotrieve]
93. Kaye W, Mancini ME, Rallis SF. Advanced cardiac life support refresher course using standardized objective-based Mega Code testing. Crit Care Med. 1987; 15: 55–60.[Medline] [Order article via Infotrieve]
94. Kaye W, Wynne G, Marteau T, Dubin HG, Rallis SF, Simons RS, Evans TR. An advanced resuscitation training course for preregistration house officers. J R Coll Physicians Lond. 1990; 24: 51–54.[Medline] [Order article via Infotrieve]
95. O’Steen DS, Kee CC, Minick MP. The retention of advanced cardiac life support knowledge among registered nurses. J Nurs Staff Dev. 1996; 12: 66–72.[Medline] [Order article via Infotrieve]
96. Schwid HA, O’Donnell D. Anesthesiologists’ management of simulated critical incidents. Anesthesiology. 1992; 76: 495–501.[Medline] [Order article via Infotrieve]
97. Young R, King L. An evaluation of knowledge and skill retention following an in-house advanced life support course. Nurs Crit Care. 2000; 5: 7–14.[Medline] [Order article via Infotrieve]
98. Stross JK. Maintaining competency in advanced cardiac life support skills. JAMA. 1983; 249: 3339–3341.
99. Su E, Schmidt TA, Mann NC, Zechnich AD. A randomized controlled trial to assess decay in acquired knowledge among paramedics completing a pediatric resuscitation course. Acad Emerg Med. 2000; 7: 779–786.[Medline] [Order article via Infotrieve]
100. Berden HJ, Willems FF, Hendrick JM, Pijls NH, Knape JT. How frequently should basic cardiopulmonary resuscitation training be repeated to maintain adequate skills? BMJ. 1993; 306: 1576–1577.
101. Luepker RV, Raczynski JM, Osganian S, Goldberg RJ, Finnegan JR Jr, Hedges JR, Goff DC Jr, Eisenberg MS, Zapka JG, Feldman HA, Labarthe DR, McGovern PG, Cornell CE, Proschan MA, Simons-Morton DG. Effect of a community intervention on patient delay and emergency medical service use in acute coronary heart disease: the Rapid Early Action for Coronary Treatment (REACT) Trial. JAMA. 2000; 284: 60–67.
102. Grilli R, Ramsay C, Minozzi S. Mass media interventions: effects on health services utilisation. Cochrane Database Syst Rev. 2001: CD000389.
103. Ho MT, Eisenberg MS, Litwin PE, Schaeffer SM, Damon SK. Delay between onset of chest pain and seeking medical care: the effect of public education. Ann Emerg Med. 1989; 18: 727–731.[CrossRef][Medline] [Order article via Infotrieve]
104. Bett N, Aroney G, Thompson P. Impact of a national educational campaign to reduce patient delay in possible heart attack. Aust N Z J Med. 1993; 23: 157–161.[Medline] [Order article via Infotrieve]
105. Wright RS, Kopecky SL, Timm M, Pflaum DD, Carr C, Evers K, Bell J. Impact of community-based education on health care evaluation in patients with acute chest pain syndromes: the Wabasha Heart Attack Team (WHAT) project. Fam Pract. 2001; 18: 537–539.
106. Moses HW, Engelking N, Taylor GJ, Prabhakar C, Vallala M, Colliver JA, Silberman H, Schneider JA. Effect of a two-year public education campaign on reducing response time of patients with symptoms of acute myocardial infarction. Am J Cardiol. 1991; 68: 249–251.[CrossRef][Medline] [Order article via Infotrieve]
107. Herlitz J, Hartford M, Karlson BV, Risenfors M, Blohm M, Luepker RV, Wennerblom B, Holmberg S. Effect of a media campaign to reduce delay times for acute myocardial infarction on the burden of chest pain patients in the emergency department. Cardiology. 1991; 79: 127–134.[Medline] [Order article via Infotrieve]
108. Herlitz J, Blohm M, Hartford M, Karlson BW, Luepker R, Holmberg S, Risenfors M, Wennerblom B. Follow-up of a 1-year media campaign on delay times and ambulance use in suspected acute myocardial infarction. Eur Heart J. 1992; 13: 171–177.
109. Blohm M, Hartford M, Karlson BW, Karlsson T, Herlitz J. A media campaign aiming at reducing delay times and increasing the use of ambulance in AMI. Am J Emerg Med. 1994; 12: 315–318.[CrossRef][Medline] [Order article via Infotrieve]
110. Gaspoz JM, Unger PF, Urban P, Chevrolet JC, Rutishauser W, Lovis C, Goldman L, Heliot C, Sechaud L, Mischler S, Waldvogel FA. Impact of a public campaign on pre-hospital delay in patients reporting chest pain. Heart. 1996; 76: 150–155.
111. Breuer HW, Eckert K. The Gorlitz myocardial infarction project: An information campaign to reduce the prehospital time of acute myocardial infarctions in Eastern Saxonia. [German]. Herz Kreislauf. 1999; 31: 443–447.
112. Maeso-Madronero JL, Bergbauer M, Mensing M, Murza G, Athanasiou K, Lange S. HEUH ‘Recognition of myocardial infarction and correct acting’—a project aiming at reducing the prehospital delay time in acute myocardial infarction. [German]. Herz Kreislauf. 2000; 32: 257–262.
113. Mitic WR, Perkins J. The effect of a media campaign on heart attack delay and decision times. Can J Public Health. 1984; 75: 414–418.[Medline] [Order article via Infotrieve]
114. Eppler E, Eisenberg MS, Schaeffer S, Meischke H, Larson MP. 911 and emergency department use for chest pain: results of a media campaign. Ann Emerg Med. 1994; 24: 202–208.[Medline] [Order article via Infotrieve]
115. Moser DK, Dracup K, Doering LV. Effect of cardiopulmonary resuscitation training for parents of high-risk neonates on perceived anxiety, control, and burden. Heart Lung. 1999; 28: 326–333.[CrossRef][Medline] [Order article via Infotrieve]
116. Kandakai T, King K. Perceived self-efficacy in performing lifesaving skills: an assessment of the American Red Cross’s Responding to Emergencies course. J Health Educ. 1999; 30: 235–241.
117. Lester CA, Donnelly PD, Assar D. Lay CPR trainees: retraining, confidence and willingness to attempt resuscitation 4 years after training. Resuscitation. 2000; 45: 77–82.[CrossRef][Medline] [Order article via Infotrieve]
118. Pane GA, Salness KA. A survey of participants in a mass CPR training course. Ann Emerg Med. 1987; 16: 1112–1116.[CrossRef][Medline] [Order article via Infotrieve]
119. Axelsson A, Herlitz J, Fridlund B. How bystanders perceive their cardiopulmonary resuscitation intervention: a qualitative study. Resuscitation. 2000; 47: 71–81.[CrossRef][Medline] [Order article via Infotrieve]
120. Axelsson A, Thoren A, Holmberg S, Herlitz J. Attitudes of trained Swedish lay rescuers toward CPR performance in an emergency: a survey of 1012 recently trained CPR rescuers. Resuscitation. 2000; 44: 27–36.[CrossRef][Medline] [Order article via Infotrieve]
121. Brenner BE, Van DC, Cheng D, Lazar EJ. Determinants of reluctance to perform CPR among residents and applicants: the impact of experience on helping behavior. Resuscitation. 1997; 35: 203–211.[CrossRef][Medline] [Order article via Infotrieve]
122. Chu K, May C, Clark MJ, Breeze K. CPR training in households of patients with chest pain. Prehosp Emerg Care. 2003; 7: 219–224.[Medline] [Order article via Infotrieve]
123. Elif AA, Zeynep K. Knowledge of basic life support: a pilot study of the Turkish population by Baskent University in Ankara. Resuscitation. 2003; 58: 187–192.[CrossRef][Medline] [Order article via Infotrieve]
124. Gross CP, Reisman AB, Schwartz MD. The physician as ambivalent Samaritan:will internists resuscitate victims of out-of-hospital emergencies? J Gen Intern Med. 1998; 13: 491–494.[CrossRef][Medline] [Order article via Infotrieve]
125. Holmberg M, Holmberg S, Herlitz J. Effect of bystander cardiopulmonary resuscitation in out-of-hospital cardiac arrest patients in Sweden. Resuscitation. 2000; 47: 59–70.[CrossRef][Medline] [Order article via Infotrieve]
126. Hubble MW, Bachman M, Price R, Martin N, Huie D. Willingness of high school students to perform cardiopulmonary resuscitation and automated external defibrillation. Prehosp Emerg Care. 2003; 7: 219–224.
127. Jelinek GA, Gennat H, Celenza T, O’Brien D, Jacobs I, Lynch D. Community attitudes towards performing cardiopulmonary resuscitation in Western Australia. Resuscitation. 2001; 51: 239–246.[CrossRef][Medline] [Order article via Infotrieve]
128. Johnston TC, Clark MJ, Dingle GA, FitzGerald G. Factors influencing Queenslanders’ willingness to perform bystander cardiopulmonary resuscitation. Resuscitation. 2003; 56: 67–75.[CrossRef][Medline] [Order article via Infotrieve]
129. Kliegel A, Scheinecker W, Sterz F, Eisenburger P, Holzer M, Laggner AN. The attitudes of cardiac arrest survivors and their family members towards CPR courses. Resuscitation. 2000; 47: 147–154.[CrossRef][Medline] [Order article via Infotrieve]
130. Lester C, Donnelly P, Assar D. Community life support training:does it attract the right people? Public Health. 1997; 111: 293–296.[CrossRef][Medline] [Order article via Infotrieve]
131. Locke CJ, Berg RA, Sanders AB, Davis MF, Milander MM, Kern KB, Ewy GA. Bystander cardiopulmonary resuscitation: concerns about mouth-to-mouth contact. Arch Intern Med. 1995; 155: 938–943.
132. McCormack AP, Damon SK, Eisenberg MS. Disagreeable physical characteristics affecting bystander CPR. Ann Emerg Med. 1989; 18: 283–285.[CrossRef][Medline] [Order article via Infotrieve]
133. Nolan RP, Wilson E, Shuster M, Rowe BH, Stewart D, Zambon S. Readiness to perform cardiopulmonary resuscitation: an emerging strategy against sudden cardiac death. Psychosom Med. 1999; 61: 546–551.
134. Platz E, Scheatzle MD, Pepe PE, Dearwater SR. Attitudes towards CPR training and performance in family members of patients with heart disease. Resuscitation. 2000; 47: 273–280.[CrossRef][Medline] [Order article via Infotrieve]
135. Ross CA, Winter MK, Mossesso VN Jr. Bystander CPR in two predominantly African American communities. Top Emerg Med. 2000; 22: 63–68.
136. Rowe BH, Shuster M, Zambon S, Wilson E, Stewart D, Nolan RP, Webster K. Preparation, attitudes and behaviour in nonhospital cardiac emergencies: evaluating a community’s readiness to act. Can J Cardiol. 1998; 14: 371–377.[Medline] [Order article via Infotrieve]
137. Shibata K, Taniguchi T, Yoshida M, Yamamoto K. Obstacles to bystander cardiopulmonary resuscitation in Japan. Resuscitation. 2000; 44: 187–193.[CrossRef][Medline] [Order article via Infotrieve]
138. Waalewijn RA, Tijssen JG, Koster RW. Bystander initiated actions in out-of-hospital cardiopulmonary resuscitation: results from the Amsterdam Resuscitation Study (ARRESUST). Resuscitation. 2001; 50: 273–279.[CrossRef][Medline] [Order article via Infotrieve]
139. Axelsson A. Bystander cardiopulmonary resuscitation:would they do it again? J Cardiovasc Nurs. 2001; 16: 15–20.[Medline] [Order article via Infotrieve]
140. Brenner B, Stark B, Kauffman J. The reluctance of house staff to perform mouth-to-mouth resuscitation in the inpatient setting:what are the considerations? Resuscitation. 1994; 28: 185–193.[CrossRef][Medline] [Order article via Infotrieve]
141. Hauff SR, Rea TD, Culley LL, Kerry F, Becker L, Eisenberg MS. Factors impeding dispatcher-assisted telephone cardiopulmonary resuscitation. Ann Emerg Med. 2003; 42: 731–737.[CrossRef][Medline] [Order article via Infotrieve]
142. Hew P, Brenner B, Kaufman J. Reluctance of paramedics and emergency medical technicians to perform mouth-to-mouth resuscitation. J Emerg Med. 1997; 15: 279–284.[CrossRef][Medline] [Order article via Infotrieve]
143. Horowitz BZ, Matheny L. Health care professionals’ willingness to do mouth-to-mouth resuscitation. West J Med. 1997; 167: 392–397.[Medline] [Order article via Infotrieve]
144. Stiell I, Nichol G, Wells G, De Maio V, Nesbitt L, Blackburn J, Spaite D; OPALS Study Group. Health-related quality of life is better for cardiac arrest survivors who received citizen CPR. Circulation. 2003; 108: 1939–1944.
145. Swor RA, Jackson RE, Compton S, Domeier R, Zalenski R, Honeycutt L, Kuhn GJ, Frederiksen S, Pascual RG. Cardiac arrest in private locations: different strategies are needed to improve outcome. Resuscitation. 2003; 58: 171–176.[CrossRef][Medline] [Order article via Infotrieve]
146. Brennan RT. Student, instructor, and course factors predicting achievement in CPR training classes. Am J Emerg Med. 1991; 9: 220–224.[CrossRef][Medline] [Order article via Infotrieve]
147. Broomfield R. A quasi-experimental research to investigate the retention of basic cardiopulmonary resuscitation skills and knowledge by qualified nurses following a course in professional development. J Adv Nurs. 1996; 23: 1016–1023.[Medline] [Order article via Infotrieve]
148. Groeneveld PW, Owens DK. Cost-effectiveness of training unselected laypersons in cardiopulmonary resuscitation and defibrillation. Am J Med. 2005; 118: 58–67.[Medline] [Order article via Infotrieve]
149. Tweed WA, Wilson E, Isfeld B. Retention of cardiopulmonary resuscitation skills after initial overtraining. Crit Care Med. 1980; 8: 651–653.[Medline] [Order article via Infotrieve]
150. Carrillo Alvarez A, Lopez-Herce Cid J, Moral Torrero R, Sancho Perez L, Vigil Escribano D. [Evaluation of basic and advanced pediatric resuscitation courses]. An Esp Pediatr. 2000; 53: 125–134.[Medline] [Order article via Infotrieve]
151. Tanigawa K, Tanaka K. Demographic differences in the resuscitation knowledge and skills of the Standard First Aid Class ambulance crews in Japan. Eur J Emerg Med. 1998; 5: 41–46.[Medline] [Order article via Infotrieve]
152. Lewis FH, Kee CC, Minick MP. Revisiting CPR knowledge and skills among registered nurses. J Contin Educ Nurs. 1993; 24: 174–179.[Medline] [Order article via Infotrieve]
153. Celenza T, Gennat HC, O’Brien D, Jacobs IG, Lynch DM, Jelinek GA. Community competence in cardiopulmonary resuscitation. Resuscitation. 2002; 55: 157–165.[CrossRef][Medline] [Order article via Infotrieve]
154. Fossel M, Kiskaddon RT, Sternbach GL. Retention of cardiopulmonary resuscitation skills by medical students. J Med Educ. 1983; 58: 568–575.[Medline] [Order article via Infotrieve]
155. Wenzel V, Lehmkuhl P, Kubilis PS, Idris AH, Pichlmayr I. Poor correlation of mouth-to-mouth ventilation skills after basic life support training and 6 months later. Resuscitation. 1997; 35: 129–134.[CrossRef][Medline] [Order article via Infotrieve]
156. West H. Basic infant life support: retention of knowledge and skill. Paediatr Nurs. 2000; 12: 34–37.[Medline] [Order article via Infotrieve]
157. Nagashima K, Suzuki A, Takahata O, Sengoku K, Fujimoto K, Yokohama H, Iwasaki H. [A survey on cardio-pulmonary resuscitation knowledge of the nursing staff in the Asahikawa Medical College Hospital]. Masui. 2002; 51: 68–70.[Medline] [Order article via Infotrieve]
158. Vanderschmidt H, Burnap TK, Thwaites JK. Evaluation of a cardiopulmonary resuscitation course for secondary schools. Med Care. 1975; 13: 763–774.[CrossRef][Medline] [Order article via Infotrieve]
159. Becker LJ, Yeargin K, Rea TD, Owens M, Eisenberg MS. Resuscitation of residents with do not resuscitate orders in long-term care facilities. Prehosp Emerg Care. 2003; 7: 303–306.[Medline] [Order article via Infotrieve]
160. Dull SM, Graves JR, Larsen MP, Cummins RO. Expected death and unwanted resuscitation in the prehospital setting. Ann Emerg Med. 1994; 23: 997–1002.[Medline] [Order article via Infotrieve]
161. Guru V, Verbeek P, Morrison L. Response of paramedics to terminally ill patients with cardiac arrest: an ethical dilemma. CMAJ. 1999; 161: 1251–1254.
162. Braun K, Onaka A, Horiuchi B. Advance directive completion rates and end-of-life preferences in Hawaii. J Am Geriatr Soc. 2002; 49: 1708–1713.
163. Hanson LC, Rodgman E. The use of living wills at the end of life: a national study. Arch Intern Med. 1996; 156: 1018–1022.
164. Kiely D, Mitchell S, Marlow A, Murphy K, Morris J. Racial and state differences in the designation of advance directives in nursing home residents. J Am Geriatr Soc. 2001; 49: 1346–1352.[CrossRef][Medline] [Order article via Infotrieve]
165. Suri D, Egleston B, Brody J, Rudberg M. Nursing home resident use of care directives. J Gerontol A Biol Sci Med Sci. 1999; 54: 225–229.
166. Lahn M, Friedman B, Bijur P, Haughey M, Gallagher EJ. Advance directives in skilled nursing facility residents transferred to emergency departments. Acad Emerg Med. 2001; 8: 1158–1162.[Medline] [Order article via Infotrieve]
167. McAuley WJ, Travis SS. Advance care planning among residents in long-term care. Am J Hosp Palliat Care. 2003; 20: 353–359.
168. Waddell C, McNamara B. The stereotypical fallacy: a comparison of Anglo and Chinese Australians’ thoughts about facing death. Mortality. 1997; 2: 149–161.[CrossRef]
169. Naess A, Steen E, Steen P. Ethics in treatment decisions during out-of-hospital resuscitation. Resuscitation. 1997; 35: 245–256.
170. Schmidt TA, Hickman SE, Tolle SW, Brooks HS. The Physician Orders for Life-Sustaining Treatment program: Oregon emergency medical technicians’ practical experiences and attitudes. J Am Geriatr Soc. 2004; 52: 1430–1434.[CrossRef][Medline] [Order article via Infotrieve]
171. Dunn P, Schmidt T, Carley M, Donius M, Weinstein M, Dull V. A method to communicate patient preferences about medically indicated life-sustaining treatment in the out-of-hospital setting. J Am Geriatr Soc. 1996; 44: 785–791.[Medline] [Order article via Infotrieve]
172. Marco C, Schears R. Prehospital resuscitation practices: a survey of prehospital providers. J Emerg Med. 2003; 24: 101–106.[CrossRef][Medline] [Order article via Infotrieve]
173. Hickman SE, Tolle SW, Brummel-Smith K, Carley MM. Use of the Physician Orders for Life-Sustaining Treatment program in Oregon nursing facilities: beyond resuscitation status. J Am Geriatr Soc. 2004; 52: 1424–1429.[CrossRef][Medline] [Order article via Infotrieve]
174. Lee MA, Brummel-Smith K, Meyer J, Drew N, London MR. Physician orders for life-sustaining treatment (POLST): outcomes in a PACE program. Program of All-Inclusive Care for the Elderly. J Am Geriatr Soc. 2000; 48: 1343–1344.[Medline] [Order article via Infotrieve]
175. Tolle SW, Tilden VP, Nelson CA, Dunn PM. A prospective study of the efficacy of the physician order form for life-sustaining treatment. J Am Geriatr Soc. 1998; 46: 1097–1102.[Medline] [Order article via Infotrieve]
176. Sabatino CP. Survey of state EMS-DNR laws and protocols. J Law Med Ethics. 1999; 27: 297–315.[Medline] [Order article via Infotrieve]
177. Boie ET, Moore GP, Brummett C, Nelson DR. Do parents want to be present during invasive procedures performed on their children in the emergency department? A survey of 400 parents. Ann Emerg Med. 1999; 34: 70–74.[CrossRef][Medline] [Order article via Infotrieve]
178. Haimi-Cohen Y, Amir J, Harel L, Straussberg R, Varsano Y. Parental presence during lumbar puncture: anxiety and attitude toward the procedure. Clin Pediatr (Phila). 1996; 35: 2–4.
179. Bauchner H, Vinci R, Waring C. Pediatric procedures:do parents want to watch? Pediatrics. 1989; 84: 907–909.
180. Bauchner H, Waring C, Vinci R. Parental presence during procedures in an emergency room: results from 50 observations. Pediatrics. 1991; 87: 544–548.
181. Bauchner H, Vinci R, Bak S, Pearson C, Corwin MJ. Parents and procedures: a randomized controlled trial. Pediatrics. 1996; 98: 861–867.
182. Merritt KA, Sargent JR, Osborn LM. Attitudes regarding parental presence during medical procedures. Am J Dis Child. 1990; 144: 270–271.
183. Sacchetti A, Lichenstein R, Carraccio CA, Harris RH. Family member presence during pediatric emergency department procedures. Pediatr Emerg Care. 1996; 12: 268–271.[Medline] [Order article via Infotrieve]
184. Taylor N, Bonilla L, Silver P, Sagy M. Pediatric procedure:do parents want to be present? Crit Care Med. 1996; 24: A131.
185. Beckman AW, Sloan BK, Moore GP, Cordell WH, Brizendine EJ, Boie ET, Knoop KJ, Goldman MJ, Geninatti MR. Should parents be present during emergency department procedures on children, and who should make that decision? A survey of emergency physician and nurse attitudes. Acad Emerg Med. 2002; 9: 154–158.[CrossRef][Medline] [Order article via Infotrieve]
186. Helmer SD, Smith RS, Dort JM, Shapiro WM, Katan BS. Family presence during trauma resuscitation: a survey of AAST and ENA members. American Association for the Surgery of Trauma. Emergency Nurses Association. J Trauma. 2000; 48: 1015–1022;discussion 1023–1024.
187. McClenathan BM, Torrington KG, Uyehara CF. Family member presence during cardiopulmonary resuscitation: a survey of US and international critical care professionals. Chest. 2002; 122: 2204–2211.
188. O’Brien MM, Creamer KM, Hill EE, Welham J. Tolerance of family presence during pediatric cardiopulmonary resuscitation: a snapshot of military and civilian pediatricians, nurses, and residents. Pediatr Emerg Care. 2002; 18: 409–413.[CrossRef][Medline] [Order article via Infotrieve]
189. Waseem M, Ryan M. Parental presence during invasive procedures in children:what is the physician’s perspective? South Med J. 2003; 96: 884–887.[Medline] [Order article via Infotrieve]
190. Barratt F, Wallis DN. Relatives in the resuscitation room: their point of view. J Accid Emerg Med. 1998; 15: 109–111.
191. Doyle CJ, Post H, Burney RE, Maino J, Keefe M, Rhee KJ. Family participation during resuscitation: an option. Ann Emerg Med. 1987; 16: 673–675.[CrossRef][Medline] [Order article via Infotrieve]
192. Grice AS, Picton P, Deakin CD. Study examining attitudes of staff, patients and relatives to witnessed resuscitation in adult intensive care units. Br J Anaesth. 2003; 91: 820–824.
193. Meyers TA, Eichhorn DJ, Guzzetta CE. Do families want to be present during CPR? A retrospective survey. J Emerg Nurs. 1998; 24: 400–405.[CrossRef][Medline] [Order article via Infotrieve]
194. Meyers TA, Eichhorn DJ, Guzzetta CE, Clark AP, Klein JD, Taliaferro E, Calvin A. Family presence during invasive procedures and resuscitation. Am J Nurs. 2000; 100: 32–42;quiz 43.
195. Benjamin M, Holger J, Carr M. Personal preferences regarding family member presence during resuscitation. Acad Emerg Med. 2004; 11: 750–753.[CrossRef][Medline] [Order article via Infotrieve]
196. Boyd R, White S. Does witnessed cardiopulmonary resuscitation alter perceived stress in accident and emergency staff? Eur J Emerg Med. 2000; 7: 51–53.[Medline] [Order article via Infotrieve]
197. Hanson C, Strawser D. Family presence during cardiopulmonary resuscitation: Foote Hospital emergency department’s nine-year perspective. J Emerg Nurs. 1992; 18: 104–106.[Medline] [Order article via Infotrieve]
198. Robinson SM, Mackenzie-Ross S, Campbell Hewson GL, Egleston CV, Prevost AT. Psychological effect of witnessed resuscitation on bereaved relatives. Lancet. 1998; 352: 614–617.[CrossRef][Medline] [Order article via Infotrieve]
199. Nichol G, Stiell IG, Hebert P, Wells GA, Vandemheen K, Laupacis A. What is the quality of life for survivors of cardiac arrest? A prospective study. Acad Emerg Med. 1999; 6: 95–102.[Medline] [Order article via Infotrieve]
200. van Alem AP, Waalewijn RA, Koster RW, de Vos R. Assessment of quality of life and cognitive function after out-of-hospital cardiac arrest with successful resuscitation. Am J Cardiol. 2004; 93: 131–135.[CrossRef][Medline] [Order article via Infotrieve]
201. Granja C, Cabral G, Pinto AT, Costa-Pereira A. Quality of life 6-months after cardiac arrest. Resuscitation. 2002; 55: 37–44.[CrossRef][Medline] [Order article via Infotrieve]
202. Dimopoulou I, Anthi A, Michalis A, Tzelepis GE. Functional status and quality of life in long-term survivors of cardiac arrest after cardiac surgery. Crit Care Med. 2001; 29: 1408–1411.[CrossRef][Medline] [Order article via Infotrieve]
203. Martin-Castro C, Bravo M, Navarro-Perez P, Mellado Vergel FJ. [Survival and the quality of life in extrahospital cardiorespiratory arrest]. Medicina Clinica. 1999; 113: 121–123.[Medline] [Order article via Infotrieve]
204. Bunch TJ, White RD, Gersh BJ, Meverden RA, Hodge DO, Ballman KV, Hammill SC, Shen WK, Packer DL. Long-term outcomes of out-of-hospital cardiac arrest after successful early defibrillation. N Engl J Med. 2003; 348: 2626–2633.
205. de Vos R, de Haes HC, Koster RW, de Haan RJ. Quality of survival after cardiopulmonary resuscitation. Arch Intern Med. 1999; 159: 249–254.
206. Hugo S, Borner Rodriguez E, Kummer-Bangerter A, Schuppel R, Von Planta M. Quality of life in long-term survivors of out-of-hospital cardiac arrest. Resuscitation. 2002; 53: 7–13.[CrossRef][Medline] [Order article via Infotrieve]
207. Saner H, Borner Rodriguez E, Kummer-Bangerter A, Schuppel R, von Planta M. Quality of life in long-term survivors of out-of-hospital cardiac arrest. Resuscitation. 2002; 53: 7–13.
208. Sauve MJ. Long-term physical functioning and psychosocial adjustment in survivors of sudden cardiac death. Heart Lung. 1995; 24: 133–144.[CrossRef][Medline] [Order article via Infotrieve]
209. Hsu JW, Madsen CD, Callaham ML. Quality-of-life and formal functional testing of survivors of out-of-hospital cardiac arrest correlates poorly with traditional neurologic outcome scales. Ann Emerg Med. 1996; 28: 597–605.[CrossRef][Medline] [Order article via Infotrieve]
210. Bertini G, Giglioli C, Giovannini F, Bartoletti A, Cricelli F, Margheri M, Russo L, Taddei T, Taiti A. Neuropsychological outcome of survivors of out-of-hospital cardiac arrest. J Emerg Med. 1990; 8: 407–412.[CrossRef][Medline] [Order article via Infotrieve]
211. Eisenburger P, List M, Schorkhuber W, Walker R, Sterz F, Laggner AN. Long-term cardiac arrest survivors of the Vienna emergency medical service. Resuscitation. 1998; 38: 137–143.[CrossRef][Medline] [Order article via Infotrieve]
212. Graves JR, Herlitz J, Bang A, Axelsson A, Ekstrom L, Holmberg M, Lindqvist J, Sunnerhagen K, Holmberg S. Survivors of out of hospital cardiac arrest: their prognosis, longevity and functional status. Resuscitation. 1997; 35: 117–121.[CrossRef][Medline] [Order article via Infotrieve]
213. Kuilman M, Bleeker JK, Hartman JA, Simoons ML. Long-term survival after out-of-hospital cardiac arrest: an 8-year follow-up. Resuscitation. 1999; 41: 25–31.[CrossRef][Medline] [Order article via Infotrieve]
214. Polo V, Ardeleani G, Pistone G, Baltrocchi M, Mongiat R, Porro A, Macchi C. [3-year-survival and quality of life after out-of-hospital heart arrest]. Ann Ital Med Int. 2000; 15: 255–262.[Medline] [Order article via Infotrieve]
215. Kamphuis HC, De Leeuw JR, Derksen R, Hauer R, Winnubst JA. A 12-month quality of life assessment of cardiac arrest survivors treated with or without an implantable cardioverter defibrillator. Europace. 2002; 4: 417–425.
216. Motzer SU, Stewart BJ. Sense of coherence as a predictor of quality of life in persons with coronary heart disease surviving cardiac arrest. Res Nurs Health. 1996; 19: 287–298.[CrossRef][Medline] [Order article via Infotrieve]
217. Nunes B, Pais J, Garcia R, Magalhaes Z, Granja C, Silva MC. Cardiac arrest: long-term cognitive and imaging analysis. Resuscitation. 2003; 57: 287–297.[CrossRef][Medline] [Order article via Infotrieve]
218. Paniagua D, Lopez-Jimenez F, Londono JC, Mangione CM, Fleischmann K, Lamas GA. Outcome and cost-effectiveness of cardiopulmonary resuscitation after in-hospital cardiac arrest in octogenarians. Cardiology. 2002; 97: 6–11.[CrossRef][Medline] [Order article via Infotrieve]
219. Roewer N, Kloss T, Puschel K. [Long-term result and quality of life following preclinical cardiopulmonary resuscitation]. Anasth Intensivther Notfallmed. 1985; 20: 244–250.[Medline] [Order article via Infotrieve]
220. Guerot E, Deye N, Diehl JL, Iftimovici E, Rezgui MN, Labrousse J. [Evaluation of outcome of patients hospitalized after pre-hospital cardiac arrest]. Arch Mal Coeur Vaiss. 2001; 94: 989–994.[Medline] [Order article via Infotrieve]
221. Beuret P, Feihl F, Vogt P, Perret A, Romand JA, Perret C. Cardiac arrest: prognostic factors and outcome at one year. Resuscitation. 1993; 25: 171–179.[CrossRef][Medline] [Order article via Infotrieve]
222. Earnest MP, Yarnell PR, Merrill SL, Knapp GL. Long-term survival and neurologic status after resuscitation from out-of-hospital cardiac arrest. Neurology. 1980; 30: 1298–1302.
223. Kliegel A, Scheinecker W, Eisenburger P, Sterz F, Malzer R, Kaff A, Redelsteiner C, Meixner G, Lillie P, Tikal M, Peschel H. Hurrah—We are still alive! A different dimension in post-resuscitative care: the annual gathering of cardiac arrest survivors at a typical Viennese wine tavern. Resuscitation. 2002; 52: 301–304.[CrossRef][Medline] [Order article via Infotrieve]
224. Schindler MB, Bohn D, Cox PN, McCrindle BW, Jarvis A, Edmonds J, Barker G. Outcome of out-of-hospital cardiac or respiratory arrest in children. N Engl J Med. 1996; 335: 1473–1479.
225. Ronco R, King W, Donley DK, Tilden SJ. Outcome and cost at a children’s hospital following resuscitation for out-of-hospital cardiopulmonary arrest. Arch Pediatr Adolesc Med. 1995; 149: 210–214.
226. Bilsky GS, Banja JD. Outcomes following cardiopulmonary resuscitation in an acute rehabilitation hospital: clinical and ethical implications. Am J Phys Med Rehabil. 1992; 71: 232–235.[CrossRef][Medline] [Order article via Infotrieve]
227. Mohr M, Bomelburg K, Bahr J. Attempted CPR in nursing homes—life-saving at the end of life? Anasthesiol Intensivmed Notfallmed Schmerzther. 2001; 36: 566–572.[CrossRef][Medline] [Order article via Infotrieve]
228. W86. http://circ.ahajournals.org/cgi/content/full/CIRCULATIONAHA.105.170522/DC151
229. W179A. http://circ.ahajournals.org/cgi/content/full/CIRCULATIONAHA.105.170522/DC304
230. W179B. http://circ.ahajournals.org/cgi/content/full/CIRCULATIONAHA.105.170522/DC305
231. W179C. http://circ.ahajournals.org/cgi/content/full/CIRCULATIONAHA.105.170522/DC306
232. W180A. http://circ.ahajournals.org/cgi/content/full/CIRCULATIONAHA.105.170522/DC307
233. W180B. http://circ.ahajournals.org/cgi/content/full/CIRCULATIONAHA.105.170522/DC308
234. W182A. http://circ.ahajournals.org/cgi/content/full/CIRCULATIONAHA.105.170522/DC310
235. W182B. http://circ.ahajournals.org/cgi/content/full/CIRCULATIONAHA.105.170522/DC311
236. W183. http://circ.ahajournals.org/cgi/content/full/CIRCULATIONAHA.105.170522/DC312
237. W184A. http://circ.ahajournals.org/cgi/content/full/CIRCULATIONAHA.105.170522/DC313
238. W184B. http://circ.ahajournals.org/cgi/content/full/CIRCULATIONAHA.105.170522/DC314
239. W185A. http://circ.ahajournals.org/cgi/content/full/CIRCULATIONAHA.105.170522/DC315
240. W185B. http://circ.ahajournals.org/cgi/content/full/CIRCULATIONAHA.105.170522/DC316
241. W186A. http://circ.ahajournals.org/cgi/content/full/CIRCULATIONAHA.105.170522/DC317
242. W188A. http://circ.ahajournals.org/cgi/content/full/CIRCULATIONAHA.105.170522/DC320
243. W188B. http://circ.ahajournals.org/cgi/content/full/CIRCULATIONAHA.105.170522/DC321
244. W189. http://circ.ahajournals.org/cgi/content/full/CIRCULATIONAHA.105.170522/DC322
245. W190A. http://circ.ahajournals.org/cgi/content/full/CIRCULATIONAHA.105.170522/DC323
246. W190B. http://circ.ahajournals.org/cgi/content/full/CIRCULATIONAHA.105.170522/DC324
247. W191A. http://circ.ahajournals.org/cgi/content/full/CIRCULATIONAHA.105.170522/DC325
248. W191B. http://circ.ahajournals.org/cgi/content/full/CIRCULATIONAHA.105.170522/DC326
249. W192. http://circ.ahajournals.org/cgi/content/full/CIRCULATIONAHA.105.170522/DC327
250. W193A. http://circ.ahajournals.org/cgi/content/full/CIRCULATIONAHA.105.170522/DC328
251. W193B. http://circ.ahajournals.org/cgi/content/full/CIRCULATIONAHA.105.170522/DC329
| ||||||||||||||||||||||||||||||||||||||||||||||||||