Randomised controlled trials of staged teaching for basic life support 2. Comparison of CPR performance and skill retention using either staged instruction or conventional training

Teaching CPR in stages is a strategy designed to improve skill acquisition and retention. This method has been compared with conventional teaching in a randomised trial involving 495(-)volunteers. The first ('bronze') stage w as simplified by omitting ventilation and giving compressions in sets of 50 with pauses to open the victim's airway; in the second ('silver') stage ve ntilation was introduced in a ratio of 50 compressions to five breaths, and in the third ('gold') stage, the volunteers were converted to conventional CPR. 51% of those taught by this method reattended for the second ('silver ') stage compared with 25% who were taught conventional CPR and advised to return for a revision session. 38% of the staged group reattended for the t hird ('gold') compared with 8% for the conventional group. Modest improveme nt in skill acquisition has earlier been reported for the 'bronze' stage te aching, and this has been followed by better performance in some of the com ponents tested after the subsequent stages. Comparisons after the 'gold' st age were limited by the small numbers who reattended for a third session of conventional training, but no special difficulties were noted in changing the ratio of compressions to ventilation that was necessary to convert the staged training volunteers to conventional CPR. The increased number of com pressions that can be achieved by teaching 'bronze' stage CPR with no venti lation was retained, to a lesser degree, when the 'silver' ratio of 50 comp ressions to five breaths was compared with the conventional 15:2 ratio. Our observations suggest that during the first critical 8 min of a resuscitati on attempt, 58% more compressions might be delivered by using the 50:5 rati o - an increase that is likely to result in a significant augmentation of b lood flow with important clinical implications. More comparative informatio n will become available when the results of unannounced home testing are an alysed. (C) 2001 Elsevier Science Ireland Ltd. All rights reserved.