Trials of teaching methods in basic life support (4): comparison of simulated CPR performance at unannounced home testing after conventional or staged training.

This study compares the retention of basic life support (BLS) skills after 6 and 12 months by lay persons trained either in a conventional manner, or using a staged approach. Three classes, each of 2h, were offered to volunteers over a period of 4 months. For the conventional group, the second and third classes consisted of review of skills. Those in the staged group were first taught chest compression alone; chest compression with ventilation in a ratio of 50:5 was introduced at the second class; full standard CPR was taught at the third class. A total of 495 volunteers entered the study, 262 being randomly allocated to conventional training, and 233 to staged training. More of those who received staged training attended a second (78 volunteers) and third class (41 volunteers), compared with those who received conventional training (36 and 17, respectively). The objective of this study, however, was to compare the strategies of the different training methods. A total of 291 volunteers (167 conventional and 124 staged training) were available for unannounced home testing of full conventional CPR 6 months after initial training, and 260 volunteers (135 conventional and 125 staged training) were tested at 12 months. At 6 months, those taught by the staged method were significantly better at time to first compression (P < 0.0001), compression rate (P = 0.024), and hand position (P = 0.0001). At 12 months, those taught by the staged method were significantly better at shouting for help (P = 0.005), time to first compression (P < 0.0001), and compression depth (P = 0.003). Those taught conventionally were significantly better at checking for a carotid pulse at both 6 and 12 months (P < 0.0001). These results suggest that training lay persons in basic life support skills using a staged approach leads to overall better skill retention at 6 and 12 months, and has other advantages including a greater willingness to re-attend follow-up classes.