A survey of basic resuscitation knowledge among medical personnel of a paediatric hospital

Over the last decade, the resuscitation principles have changed repeatedly. The recent guidelines were presented in 2005 [1]. Thus, the resuscitation-related knowledge among medical staff should be verified and undated. Numerous studies show that in many cases the retention of knowledge amongst physicians and nurses is inadequate [2, 3].
The objective of the present study was to evaluate the knowledge among medical personnel of a paediatric hospital concerning principles of basic life support.
Methods
The study group consisted of hospital employees, physicians and nurses, who voluntarily consented to the test. Anaesthesiologists were excluded.  
The research tool was a written test with open questions assessing the knowledge of basic life support (BLS) and a questionnaire concerning the knowledge of latest guidelines and participation in courses. The test questions checked the knowledge of issues regarding adults, children and infants, in particular, the principles of chest compressions (method, place and frequency), artificial lung ventilation (number of rescue breath) in victims with the circulation preserved, manoeuvres to provide patent airways, compression:ventilation ratio in the presence of one or two rescuers and the respiratory volumes recommended in the guidelines.
The results were statistically analysed using the Pearson’s ?2 test. P<0.005 was considered significant.
Results
The study population included 118 employees of a paediatric hospital (64 physicians and 54 nurses) constituting about 25% of the personnel working in that hospital. The population was gender-diverse (92 women and 26 men). The biggest group consisted of the 31-40-year-old individuals (n=44). The results were divided according to specializations or profiles of employment: N – nurses, SN – surgical nurses (including scrub and anaesthesiological nurses), P – physicians and S – surgeons.
Over half of respondents did not know the definition of an adult. The highest number of wrong answers concerned the place and frequency of chest compressions (significant differences were observed between nurses and physicians). The rules of resuscitation strategies in the presence of two rescuers were unknown (higher deficits among nurses compared to physicians). Only few nurses knew the tidal volumes currently recommended (Table 1).
Moreover, the definition of a child was poorly known. Amongst surgical nurses, the knowledge of paediatric resuscitation was two- or threefold higher than among the remaining nurses. In the group of physicians, such differences were not observed and over 50% of them gave correct answers (Table 2).
The definition of an infant was best known, which, however, had no effect on the knowledge resuscitation procedures in this age group. As for chest compressions, all elements of the procedure were unknown for the majority of nurses of both groups, except for the technique of their administration (Table 3).
Interestingly, only every fifth nurse completed first aid courses, in the group of physicians – every second. The knowledge concerning the year of revision of guidelines was unsatisfactory and the sources – scarce (Table 4).
Discussion
The knowledge of cardio-pulmonary resuscitation among the hospital medical personnel was selective. The majority of respondents (physicians and nurses) did not properly define the age ranges of an adult and a child. Due to lack of this knowledge, a victim was qualified to the wrong age group and the resuscitation  provided using inappropriate algorithms. It should be mentioned that the European Resuscitation Council changed the adult-child age limit in 2005. The answers of respondents confirm their lack of knowledge of the latest guidelines.
The knowledge of techniques of chest compressions was fragmentary, and varied responses were found in the group of physicians and nurses. The principles to carry out this procedure have also been recently modified: ”the centre of the chest” was assumed the place of compression; in children and infants the depth of compressions was increased – 1/3 of the anterior-posterior chest dimension; pressures with both hands were  allowed in children [1].
The majority of medical personnel did not know the frequency of artificial lung ventilation at the circulation preserved in an adult, child or infant as well as manoeuvres to provide patent airways in these age groups. According to the current ERC guidelines, hyperventilation, also during lung ventilation with the circulation preserved, should be avoided. Moreover, the physicians` and nurses` knowledge of resuscitation cycles (number of compressions:number of breaths) in the presence of one and two rescuers  was inadequate; this is a novel guideline introduced by ERC. In all victims, the ratio should be identical – 30 compressions:2 breaths. The proportion can be changed into 15:2 only in children and infants, provided that the resuscitation is administered by two rescuers [1]. The recommended tidal volume (6-7 mL kg-1), identical for all victims, is another relevant ERC guideline. Hyperventilation used in circulatory arrest worsens the prognosis and survival [1], yet the majority of physicians and nurses could not define proper tidal volumes.  
Insufficient resuscitation-related knowledge among the medical personnel has been widely documented, e.g. in the studies amongst resident paediatricians [2, 3], intensive therapy nurses[4] or even anaesthesiologists [5]. Our earlier studies demonstrated lack of resuscitation knowledge among graduates of medical universities [6].
The low numbers of nurses and physicians taking part in first aid courses is alarming. The European Resuscitation Council prepared unified curricula as a basis for courses  in non-instrumental and instrumental resuscitation in adults and children/infants [7, 8, 9]. Unfortunately, such courses are not obligatory in Poland, although continuity of education in this field broadens the knowledge and improves effectiveness of resuscitation. It is well known that the knowledge acquired during the courses is gradually forgotten; nevertheless, its level is high for some period [10, 11]. The Utstein guidelines recommend updating the knowledge every half a year [12].
Conclusions
1. Knowledge of cardio-pulmonary resuscitation among the medical personnel of a paediatric hospital was selective and their knowledge of guidelines inadequate.
2. First aid courses involve too low numbers of nurses and physicians.  
References
1.European Resuscitation Council Guidelines for Resuscitation 2005. Resuscitation 2005; 67 (Suppl.): 1-189.
2.Buss PW, McCabe M, Evans RJ, Davies A, Jenkins H: Aof basic resuscitation knowledge among resident paediatricians. Arch Dis Child 1993; 68: 75-78.
3.Nadel FM, Lavelle JM, Fein JA, Giardino AP, Deckert JM, Durbin DR: Assessing pediatric senior residents’ training in resuscitation: fund of knowledge, technical skills, and perception of confidence. Pediatr Emerg Care 2000; 16: 73-76.
4.Anthonypillai F: Retention of advanced cardiopulmonary resuscitation knowledge by intensive care trained nurses. Intensive Crit Care Nurs 1992; 8: 180-184.
5.Semeraro F, Signore L, Cerchiari EL: Retention of CPR performance in anaesthetists. Resuscitation 2006; 68: 101-108.
6.Grzeskowiak M: Are medical graduates well prepared to do CPR? Resuscitation 2004; 62: 350-351.
7.Handley AJ, Swain A: Advanced life support manual, Resuscitation Council (UK), London 1992.
8.Nolan J: Advanced life support training. Resuscitation 2001; 50: 9-11.
9.Phillips BM, Mackway-Jones K, Jewkes F: The European Resuscitation Council’s paediatric life support course “Advanced paediatric life support”. Resuscitation 2000; 47: 329-334.
10.Su E, Schmidt TA, Mann NC, Zechnich AD: Acontrolled trial to assess decay in acquired knowledge among paramedics completing apediatric resuscitation course. Acad Emerg Med 2000; 7: 779-786.
11.Gass DA, Curry L: Physicians’ and nurses’ retention of knowledge and skill after training in cardiopulmonary resuscitation. Can Med Assoc J 1983; 128: 550-551.
12.Chamberlain DA, Hazinski MF: Education in resuscitation: an ILCOR symposium: Utstein Abbey: Stavanger, Norway: June 22-24, 2001. Circulation 2003; 108: 2575-2594.

Table 1. Test results concerning resuscitation of adults (number of correct answers)

Abbreviations explained in the text
p – all correct answers vs all incorrect answers
Table 2. Test results concerning resuscitation in children (number of correct answers)

Abbreviations explained in the text
p – all correct answers vs all incorrect answers
Table 3. Results regarding resuscitation in infants (number of correct answers)

Abbreviations explained in the text
Table 4. Questionnaire results

e-mail: mgrzesko@ump.edu.pl