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Timing for BLS retraining

Question Type:
Full Question:
Among students who are taking BLS courses (P), does any specific interval for update or retraining (I), compared with standard practice (ie. 12 or 24 monthly) (C), change improve patient outcomes, skill performance in actual resuscitations, skill performance at 1 year, skill performance at course conclusion, cognitive knowledge (O)?
Consensus on Science:
For critical outcomes of patient outcome and skill performance during actual resuscitation, we found no published evidence. For the important outcome of skill performance 3 to 12 months after initial training, we identified very-low-quality evidence (downgraded for risk of bias, inconsistency, and indirectness) from 3 RCTs(Woollard 2006, 237; Frkovic 2008, 24; Oermann 2011, 447) and 2 non-RCTs(Chamberlain 2002, 179; Ahn 2011, 1543) evaluating the effects of additional updates or retraining compared with standard practice (12–24 monthly). The heterogeneous nature of the studies prevented pooling of data. Two studies (1 RCT and 1 non-RCT) evaluated the effect of high-frequency, low-dose training (6 minutes monthly practice and every-2-weeks video reminder) after standard BLS courses and demonstrated benefit on CPR performance (compression depth, 40.3±6.6 versus 36.5±7.7 mm)(Oermann 2011, 447) and on time to shock delivery (time [mean±SD], 60.0±12.9 versus 73.6±22 s).(Oermann 2011, 447) Two other RCTs and 1 non-RCT conducting a variety of retraining and evaluating 5 to 6 months after the retraining showed no benefit on chest compression quality or time to shock delivery.(Chamberlain 2002, 179; Woollard 2006, 237; Frkovic 2008, 24) For the important outcome of cognitive knowledge, we identified very-low-quality evidence (downgraded for risk of bias, inconsistency, and indirectness) from 1 RCT(Woollard 2006, 237) demonstrating improved self-reported confidence score (96 versus 92; P=0.038) after additional traditional BLS retraining and 1 non-RCT(Ahn 2011, 1543) demonstrating increased willingness to perform CPR (RR, 0.62; 95% CI, 0.40–0.96) after high-frequency, low-dose training (every-2-weeks video reminder).(Ahn 2011, 1543) Studies evaluating BLS skill retention demonstrated rapid decay in BLS skills (eg, chest compression quality and time to defibrillation) within 3 to 12 months after initial training.(Mancini 2010, S539; Soar 2010, e288)
Treatment Recommendation:
There is insufficient evidence to recommend the optimum interval or method for BLS retraining for laypeople.Because there is evidence of skills decay within 3 to 12 months after BLS training and evidence that frequent training improves CPR skills, responder confidence, and willingness to perform CPR, we suggest that individuals likely to encounter cardiac arrest consider more frequent retraining (weak recommendation, very-low-quality evidence).Values, Preferences, and Task Force Insights In making this recommendation, we place emphasis on the need for individuals and organizations to determine the importance of BLS skill maintenance, based on their local context and the feasibility of more frequent training.The search strategy for this PICO question focused on lay providers, but the results were considered to be generalizable. The EIT Task Force debated at length whether to recommend a specific interval for retraining, but opted to leave this to the discretion of the organizations involved because the only evidence is that CPR skills decay before the currently recommended 12- to 24-month retraining intervals.
CoSTR Attachments:
EIT 628 GRADE evidence table_n.docx    
EIT 628 GRADE recommendation table_n.docx    
Summary of Bias Assessments EIT628_will full descriptions_n.xlsx    

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