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AED training methods

Question Type:
Intervention
Full Question:
Among students who are taking AED courses in an educational setting (P), does any specific training intervention (I), compared with traditional lecture/practice sessions (C), change clinical outcome, skill performance in actual resuscitations, skill performance at 1 year, skill performance at course conclusion, cognitive knowledge, use of AEDs (O)?
Consensus on Science:
No study addressed the critical outcomes of skill performance in an actual resuscitation or patient outcome. All studies for this PICO question were manikin based, and all participants were adults.(Meischke 2001, 216; Reder 2006, 443; Roppolo 2007, 276; de Vries 2008, 76; de Vries 2010, 1004; Miotto 2010, 328; Roppolo 2011, 319) The included studies used manikin-based scenarios as the standard method for assessment, and end points did not extend beyond skill retention after 6 months. Substantial heterogeneity was found for interventions and controls, and for time points of assessment. Except for 2 studies(Meischke 2001, 216; de Vries 2010, 1004) none investigated AED training in isolation. All other studies address the whole sequence of BLS together with AED related outcomes. To account for the nature of training, 4 subquestions were specified. For both groups of lay providers and healthcare providers, the question was subdivided into (a) self-instruction without (or with minimal) instructor involvement versus a traditional instructor-led course, and (b) self-instruction combined with instructor-led versus a traditional course. For Lay Providers For the subquestion of self-instruction without (or with minimal) instructor involvement versus a traditional instructor-led course, we identified low-quality evidence (downgraded for indirectness) addressing the important outcome of skill retention after 2 to 6 months.(Meischke 2001, 216; Reder 2006, 443; Roppolo 2007, 276; de Vries 2010, 1004) For 2 of the investigated DVD-based teaching methods, the RR to pass the overall test directly after the course was only 0.36 (95% CI, 0.25–0.53), and 0.35 (95% CI, 0.24–0.51) if compared with instructor-led training.(de Vries 2010, 1004) No significant difference was found 2 months after training when comparing a computer-learning-only course to instructor-led training.(Reder 2006, 443) No significant difference was reported for AED performance (time to first shock and AED placement) for a video self-learning intervention of 30 minutes in comparison with instructor-led training of 3 to 4 hours.(Roppolo 2007, 276) Training for senior citizens (video self-training of 11 minutes plus 45 minutes of manikin training plus minimal instructor) was not significantly different compared with the control group. This study also suggests a saving of resources by the alternative training method.(Meischke 2001, 216) For the subquestion of self-instruction combined with instructor-led versus traditional courses, we identified low-quality evidence (downgraded for indirectness) addressing the important outcomes of skill retention after 2 months for the following 2 studies: • Interactive computer session of 45 minutes plus 45 minutes of instructor-based practice led to results comparable with those from a traditional course of the same duration.(Reder 2006, 443) AED skills remained rather stable over 2 months, while CPR skills deteriorated significantly. • A 9-minute DVD plus manikin training plus scenario training was inferior to traditional training, with an RR to pass the overall test of 0.55, which increased to 0.84 after 2 months.(de Vries 2010, 1004) This may indicate a potential learning effect of the short postcourse test. For Healthcare Providers For the subquestion of self-instruction without (or with minimal) instructor involvement versus traditional instructor-led course, we identified very-low-quality evidence (downgraded for indirectness and imprecision) addressing the important outcome of skill performance at end of course, or 2 weeks after completion. Isolated self-instructed training was as efficient as traditional training, but testing was limited to the end of the course.(Roppolo 2011, 319) No differences were found between groups, but significant time (and financial) savings were reported.(de Vries 2008, 76) However, the sample size was very low. Another study showed worse results for theory-only training, but this study was flawed because the control group was inadequate.(Miotto 2010, 328) For the subquestion of self-instruction combined with instructor-led versus traditional courses, we identified low-quality evidence (downgraded for indirectness) for the important outcomes of skill performance at end of course, or 2 weeks after completion. Training time was reduced while performance was only slightly reduced. A 40-minute skills lab training plus instructor was associated with a higher rate of mistakes in AED operations.(Roppolo 2011, 319) In another study, no differences were found between groups, but significant time (and financial) savings were reported in the self-instruction combined with instructor-training group(de Vries 2008, 76); however, the sample size was very low.
Treatment Recommendation:
For lay providers learning AED skills, we suggest that self-instruction combined with short instructor-led training may replace longer traditional courses (weak recommendation, low-quality evidence). For healthcare providers learning AED skills, we suggest that self-directed training (as short as 40 minutes) may be used in place of traditional training (weak recommendation, low-quality evidence). Values, Preferences, and Task Force Insights In making this recommendation, we place value on pragmatic considerations such that if instructor-led training is not available, then self-directed training (or no training at all [“just do it”]) is an acceptable pragmatic option to use AED as stated in the 2010 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations (CoSTR).(Mancini 2010, S539; Soar 2010, e288) Very little research was conducted on AED teaching outside of the context of a (standard) BLS course (only 2 studies(Meischke 2001, 216; de Vries 2010, 1004) reported on that setting). All data were extracted from studies in the context of BLS teaching. The ILCOR 2010 CoSTR stated that laypeople and healthcare providers could use an AED without training(Gundry 1999, 1703; Mattei 2002, 277; Reder 2006, 443) and that untrained individuals could deliver a shock with an AED.(Beckers 2005, R110; Beckers 2007, 444; Mitchell 2008, 301) The current systematic review investigated whether a specific training intervention in an educational setting changed clinical or learning outcomes. The original intent was to produce a single consensus on science with treatment recommendations based on a single PICO question. As the literature was reviewed, it became clear that there was marked heterogeneity in populations studied and the types of interventions, so multiple subsections were developed with multiple treatment recommendations.
CoSTR Attachments:
651_AED_training_final_proposal_pre_TR.doc    
EIT 651 self-instruction_combined_hc_prof.pdf    
EIT 651 self-instruction_combined_lays.pdf    
EIT 651 self-instruction_without_hc_profs.pdf    
EIT 651 self-instruction_without_lays.pdf    
EIT 651 self-instruction_without_lays_recomm.pdf    
ILCOR_C2015_PICO_651-final-2.ppt    

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