Background
Methods
Setting
The performance was terminated 120 s after the first external chest compression (ECC). If the participant did not perform CPR, the scenario was stopped after 90 s. No further instructions were provided during the performance.The participant was asked to enter a room in which a BLS manikin was lying on the floor with a zippered jacket covering the torso. No information about the scenario was provided in advance. The standardized text was read by the course instructor: “Imagine you are witnessing a person collapsing right in front of you. The manikin represents this person. There is no one else nearby. Please take all measures you would take if the manikin was a real person. Keep going until you receive a signal to stop.”
Measurement and data acquisition
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≥ 60% correct compression depth
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Average compression rate of 100–120 min− 1
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≥ 60% compressions with complete release
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Green: all three criteria were met
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Yellow: two of the three criteria were met
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Red: one of the criteria were met
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Black: none of the criteria we met
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Undressed torso
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Adequate minimum no-flow time (no longer than 2 s for two rescue breaths)
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Correct hand position
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Correct compression depth
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Correct compression rate
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Complete release between compressions
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Arms kept straight
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Vertical direction of compressions
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No delay to start CPR
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Compression-ventilation ratio of 30:2
Statistical methods
Results
Study population
Observed endpoints
Performance data
Average compression rate(min−1) | Compressions with complete release(%) | Correct compression depth(%) | |||
---|---|---|---|---|---|
Average compression rate of 100–120 min−1 and > 60% correct compression depth and > 60% compressions with complete release | N | 11 | 11 | 11 | |
Mean | 112.8 | 94.7 | 94.0 | ||
SD | 5.47 | 12.5 | 9.7 | ||
Mini. | 101 | 60.1 | 66.7 | ||
Max. | 120 | 100.0 | 100.0 | ||
Average compression rate of 100–120 min−1 and > 60% compressions with complete release | N | 28 | 28 | 28 | |
Mean | 109.6 | 98.3 | 6.7 | ||
SD | 6.37 | 6.7 | 10.7 | ||
Min. | 100 | 64.7 | 0.0 | ||
Max. | 120 | 100.0 | 43.2 | ||
> 60% compressions with complete release and > 60% correct compression depth | N | 24 | 24 | 24 | |
Mean | 102.8 | 98.0 | 85.4 | ||
SD | 33.5 | 8.0 | 13.5 | ||
Min. | 39 | 60.4 | 61.8 | ||
Max. | 153 | 100.0 | 100.0 | ||
> 60% compressions with complete release | N | 77 | 77 | 77 | |
Mean | 94.8 | 99.3 | 10.7 | ||
SD | 31.1 | 02.5 | 16.1 | ||
Min. | 33 | 84.5 | 0.0 | ||
Max. | 187 | 100.0 | 57.7 | ||
> 60% correct compression depth | N | 2 | 2 | 2 | |
Mean | 139.0 | 41.6 | 88.7 | ||
SD | 14.1 | 20.2 | 9.3 | ||
Min. | 129 | 27.3 | 82.1 | ||
Max. | 149 | 55.9 | 95.2 | ||
Insufficient CPR performance in all categories | N | 9 | 9 | 9 | |
Mean | 61.4 | 12.9 | 19.4 | ||
SD | 73.6 | 19.4 | 33.1 | ||
Min. | 0 | 0.0 | 00.0 | ||
Max. | 160 | 54.6 | 95.2 | ||
Total | N | 151 | 151 | 151 | |
Mean | 98.7 | 92.7 | 29.5 | ||
SD | 33.4 | 22.5 | 37.2 | ||
Min. | 0 | 0.0 | 0.0 | ||
Max. | 187 | 100.0 | 100.0 |
Interrater reliability
Mean joint probability of agreement (%) | Mean Light’s Kappa | |
---|---|---|
Undressed torso | 94.9 (±1.8) | 0.87 (±0.11) |
Compression-ventilation ratio of 30:2 | 85.3 (±2.7) | 0.63 (±0.05) |
No delay in starting CPR | 76.8 (±4.6) | 0.45 (±0.11) |
Correct compression rate | 76.6 (±5.4) | 0.49 (±0.07) |
Arms kept straight | 76.3 (±7.1) | 0.46 (±0.11) |
Correct compression depth | 75.3 (±3.4) | 0.49 (±0.04) |
Vertical direction of compressions | 74.2 (±4.6) | 0.44 (±0.09) |
Minimum no-flow time | 73.6 (±9.8) | 0.42 (±0.16) |
Correct hand position | 72.2 (±2.7) | 0.47 (±0.08) |
Complete release between compressions | 67.2 (±4.5) | 0.30 (±0.06) |
Matching rater evaluations and performance data
Mean joint probability of agreement (%) | Mean Light’s Kappa | Sensitivity | Specificity | |||||
---|---|---|---|---|---|---|---|---|
n
| Range(%) | Mean(%) |
n
| Range(%) | Mean(%) | |||
Correct compression rate | 72.6 (±7.3) | 0.41 (±0.14) | 39 | 48.7–94.9 | 77.5 | 111 | 55.0–91.0 | 71.0 |
Correct compression depth | 70.1 (±6.4) | 0.35 (±0.14) | 37 | 50.0–94.3 | 74.3 | 113 | 50.9–78.9 | 68.8 |
Complete release between compressions | 67.7 (±12.7) | 0.15 (±0.11) | 140 | 44.8–83.0 | 67.6 | 10 | 50.0–88.9 | 68.5 |
Traffic light category by performance data | Traffic light categoryby checklist-based evaluation | Total | ||||
---|---|---|---|---|---|---|
n
| 9 | 1 | 1 | 0 | 11 | |
Number of performances within category (%) | 81.8 | 9.1 | 9.1 | 0.0 | 100.0 | |
n
| 17 | 19 | 11 | 5 | 52 | |
Number of performances within category (%) | 32.7 | 36.5 | 21.2 | 9.6 | 100.0 | |
n
| 9 | 24 | 23 | 23 | 79 | |
Number of performances within category (%) | 11.4 | 30.4 | 29.1 | 29.1 | 100.0 | |
n
| 1 | 0 | 1 | 6 | 8 | |
Number of performances within category (%) | 12.5 | 0.0 | 12.5 | 75.0 | 100.0 |