Is current training in basic and advanced cardiac life support (BLS & ACLS) effective? A study of BLS & ACLS knowledge amongst healthcare professionals of North-Kerala

doi:10.5847/wjem.j.1920-8642.2016.04.004

Abstract

Abstract:

BACKGROUND: Healthcare professionals are expected to have knowledge of current basic and advanced cardiac life support (BLS/ACLS) guidelines to revive unresponsive patients.
METHODS: A cross-sectional study was conducted to evaluate the current practices and knowledge of BLS/ACLS principles among healthcare professionals of North-Kerala using pretested self-administered structured questionnaire. Answers were validated in accordance with American Heart Association's BLS/ACLS teaching manual and the results were analysed.
RESULTS: Among 461 healthcare professionals, 141 (30.6%) were practicing physicians, 268 (58.1%) were nurses and 52 (11.3%) supporting staff. The maximum achievable score was 20 (BLS 15/ ACLS 5). The mean score amongst all healthcare professionals was 8.9±4.7. The mean score among physicians, nurses and support staff were 8.6±3.4, 9±3.6 and 9±3.3 respectively. The majority of healthcare professionals scored ≤50% (237, 51.4%); 204 (44.3%) scored 51%-80% and 20 (4.34%) scored >80%. Mean scores decreased with age, male sex and across occupation. Nurses who underwent BLS/ACLS training previously had significantly higher mean scores (10.2±3.4) than untrained (8.2±3.6, P=0.001). Physicians with <5 years experience (P=0.002) and nurses in the private sector (P=0.003) had significantly higher scores. One hundred and sixty three (35.3%) healthcare professionals knew the correct airway opening manoeuvres like head tilt, chin lift and jaw thrust. Only 54 (11.7%) respondents were aware that atropine is not used in ACLS for cardiac arrest resuscitation and 79 (17.1%) correctly opted ventricular fibrillation and pulseless ventricular tachycardia as shockable rhythms. The majority of healthcare professionals (356, 77.2%) suggested that BLS/ACLS be included in academic curriculum.
CONCLUSION: Inadequate knowledge of BLS/ACLS principles amongst healthcare professionals, especially physicians, illuminate lacunae in existing training systems and merit urgent redressal.

Key words: Basic life support, Advanced cardiac life support, Healthcare professionals, Awareness, Cardiopulmonary resuscitation

Madavan Nambiar, Nisanth Menon Nedungalaparambil, Ottapura Prabhakaran Aslesh. Is current training in basic and advanced cardiac life support (BLS & ACLS) effective? A study of BLS & ACLS knowledge amongst healthcare professionals of North-Kerala[J]. World Journal of Emergency Medicine, 2016, 7(4): 263-269.

Figures/Tables 7

Table 1

BLS/ACLS questionnaire

Basic life support
1) BLS is advocated by? (1)
a. American Thoracic Society
b. World Health Organization
c. Academic Emergency Medicine
d. American Heart Association
e. Don't know
2) Full form of AED is? (1)
a. Automatic electric defibrillator
b. Autonomous electric defibrillator
c. Automated external defibrillator
d. Automated electric defibrillator
e. Don't know
3) What is the first step to do when you see a person lying unconscious in a safe place? (1)
a. Call for help
b. Check for response
c. Give rescue breaths
d. Check pulse
e. Don't know
4) What will you do next after you find the patient has no pulse in the above scenario? (1)
a. Call for help/ get AED
b. Check for response
c. Give rescue breaths
d. Start CPR
e. Don't know
5) In child CPR with 2 persons, the ratio of compression: ventilation is (1)
a. 15:1
b. 3:1
c. 30:2
d. 15:2
e. Don't know
6) Rate of compression: ventilation for adult CPR is (1)
a. 30:2
b. 8:1
c. 15:1
d. 15:2
e. Don't know
7) When are you supposed to check for pulse in BLS during CPR? (1)
a. Every 2 minutes
b. 3 minutes
c. 5 minutes
d. 1 minute
e. Don't know
8) What are the maneuvers to open the airway in an unresponsive patient? (3)
a. Head tilt
b. Chin lift
c. Neck flexion
d. Jaw thrust
e. Don't know
9) What is the next step to do for a collapsed patient if there is no pulse between CPR? (1)
a. Ventilate only
b. Continue CPR
c. Give chest compressions only
d. Check pupil
e. Don't know
10) In Basic Life Support guidelines, the order of steps for initially starting CPR is? (3)
a. Circulation, Airway, Breathing (C-A-B)
b. Airway, Circulation, Breathing (A-C-B)
c. Airway, Breathing, Circulation (A-B-C)
d. Breathing, Circulation, Airway (B-C-A)
e. Don't know
11) In BLS, pulse check can take how much time? (1)
a. 1-5 seconds
b. 5-10 seconds
c. 10-20 seconds
d. 30-60 seconds
e. Don't know
Advanced cardiac life support
12) The drug which is appropriately given in pulseless electrical activity is? (1)
a. Inj. Atropine 0.5 mg
b. Inj. Atropine 1 mg
c. Inj. Adrenaline 1 mg 1/10 000
d. Inj. Adrenaline 1 mg 1/1 000
e. Don't know
13) What is the ideal route of administration of Adrenaline during cardiac arrest? (1)
a. IV
b. IM
c. Intracardiac
d. SC
e. Don't know
14) The shockable ECG rhythms in cardiac arrest are? (2)
a. PEA
b. VF
c. Pulseless VT
d. Asystole
e. Don't know
15) Which drug is not used in ACLS to revive a cardiac arrest? (1)
a. Atropine
b. Adrenaline
c. Amiodarone
d. Vasopressin
e. Don't know

Table 1

Table 2

Table 3

Table 4

Table 5

Table 6

Table 7

References 15

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Basic life support
1. D	2. C	3. B	4. A
5. D	6. A	7. A	8. A, B, D
9. B	10. A	11. B
Advanced cardiac life support
12. C	13. A	14. B, C	15. A

Characteristics	Number	Percent
Age group
20-39 years	348	75.5
40-59 years	90	19.5
60 years and above	23	5.0
Gender
Female	333	72.2
Male	128	27.8
Occupation
Doctor	141	30.6
Nurse	268	58.1
Paramedic/support staff	52	11.3
Qualification
Class XII or below	45	9.8
Degree holders	117	25.4
Post graduates	97	21.0
Other diploma holders	202	43.8
Experience (in years)
< 5	224	48.6
6-10	90	19.5
11-20	83	18.0
> 20	64	13.9
Total	461	100.0

Category	Number	Mean score	SD	P value
Sector
Private	99	8.9	3.4	0.1
Government	42	7.8	3.3	0.1
Qualification
MBBS/Degree	48	9.0	3.9	0.32
Specialist	86	8.2	3.0
Superspecialist	7	9.6	3.9
Experience (in years)
<5	44	10.1	3.5	0.002
6-10	14	7.6	3.8
11-20	30	7.4	3.0
>20	53	8.2	3.0
BLS/ACLS training
Trained	66	8.5	3.2	0.82
Not-trained	75	8.6	3.6	0.82
Total	141	8.6	3.4

Category	Number	Mean score	SD	P value
Sector
Private	242	9.2	3.4	0.003
Government	26	7.4	3.3	0.003
Qualification
Midwife	26	8.8	3.9	0.8
B. Sc nursing	53	9.4	3.2
M. Sc nursing	5	9.6	2.9
General nursing	184	9.0	3.7
Experience (in years)
<5	145	8.6	3.5	0.2
6-10	67	9.6	3.5
11-20	46	9.6	3.8
>20	10	8.8	4.4
BLS/ACLS training
Trained	109	10.2	3.4	0.001
Not-trained	159	8.2	3.6	0.001
Total	268	9.0	3.6

Category	Number	Mean score	SD	P value
Sector
Private	49	9.0	3.4	0.8
Government	3	9.3	1.5	0.8
Qualification
Class X/below	19	9.4	4.0	0.2
X-XII	16	7.9	3.0
Degree	17	9.5	2.6
Experience (in years)
<5	35	8.6	3.2	0.1
6-10	9	8.3	3.5
11-20	7	11.1	3.0
>20	1	14.0	-
BLS/ACLS training
Trained	3	6.3	3.1	0.1
Not-trained	49	9.1	3.3	0.1
Total	52	9.0	3.3