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Research Confirms That High-Quality Resuscitation Challenges Many in Healthcare

By Marnie Kelly, Vice President, Resuscitation Solutions, HealthStream

High-quality CPR is difficult to master and retain. Why?

  • Most CPR training programs are infrequent, which results in quick deterioration of skills that are taught (Meaney et al., 2013).
  • Instructor-led CPR training may not be effective for learning basic CPR skills or retention of these skills (Kardong-Edgren et al., 2010).
  • Students often fail to develop adequate skills during CPR training—especially in the areas of compression rate, compression depth, and ventilation rate. (Kardong-Edgren et al., 2012)
  • Providers are unable to retain CPR skills without practice (Oermann, Kardong-Edgren, and Odom-Maryon, 2011)

Some Solutions to the Problem

A study by Kardong-Edgren et al. (2010), addressed several recommendations that were made in an American Heart Association expert panel. The purpose of their study was to compare a computer-based CPR course that included VAM (voice assisted manikin) feedback (HeartCode® BLS) with an instructor-led course (IL) in terms of compression rate and depth, correct hand placement, ventilation frequency and volume on 604 nursing students across 10 nursing schools. While they found no difference between the two methodologies on compression rate, “students who had the HeartCode course and practiced CPR on VAMs had significantly more compressions with adequate depth (p < 0.0001) and ventilations with adequate volume (p < 0.0001) than did students trained by instructors (p. 1023).”

A few other studies found similar results.

  • Niles, Sutton, Donoghue, and Kalsi (2009) found that refresher training with a portable manikin/ defibrillator system resulted in significantly shorter times for proficiency in CPR.
  • Mpotosa, De Weverb, and Cleymanse (2013) found that short self-learning CPR sessions with a training video and computerized voice feedback manikin training was very successful in learning effective CPR.
  • Diez, Rodriguez-Diez, and Nagore (2013) in a study of 2nd year medical students found that VAM participants (as opposed to IL) performed more accurately in terms of hand position and produced better compression rates. Cost reduction and time saving for instructors was also mentioned.

In conclusion, the research is clearly indicating that more frequent and more automated training can improve resuscitation skills.

This blog post excerpts an article from our recent eBook, High-Quality CPR: Breathing New Life Into Your Training Program, available for download here.


Diez, N., Rodriguez-Diez, M., & Nagore, D. (2013). Randomized trial of cardiopulmonary resuscitation training for medical students: Voice advisory mannequin compared to guidance provided by an instructor. Simulation in Healthcare, 234-241.

Griffin, Russell, LP, FP-C, (2013). Improving Outcomes with High Quality CPR. American Heart Association. Conference Presentation.

Kardong-Edgren, S. E., Oermann, M. H., Odom-Maryon, T., & Ha, Y. (2010). Comparison of two instructional modalities for nursing student CPR skill acquisition. Resuscitation, 81, 1019-1024.

Kardong-Edgren, S.E., Oermann, M. H., & Odom-Maryon, T. (2012). Findings from a nursing student CPR study. Journal for Nurses in Staff Development, 28, 9-15.

Meaney, P., Bobrow, B. J., Mancini, M. E., Christenson, J., de Caen, A. R., Bhanji, F., . . . Leary, M. (2013). Cardiopulmonary resuscitation quality: Improving cardiac resuscitation outcomes both inside and outside the hospital. Circulation, 128, 417-435.

Mpotosa, N., De Weverb, B., & Cleymanse, N. (2013). Efficiency of short individualized CPR self-learning sessions with automated assessment and feedback. Resuscitation, 84, 1267-1273.

Niles, D., Sutton, R. M., Donoghue, A., & Kalsi, M. S. (2009). Rolling refreshers: A novel approach to maintain CPR psychomotor skill competence. Resuscitation, 80, 909-912.

O’Connor, Robert E. (2011). High-quality CPR & the roadmap to improved survival from cardiac arrest. Journal of Emergency Medical Services.

Oermann, M. H., Kardong-Edgren, S. E., & Odom-Maryon, T. (2011). Effects of monthly practice on nursing students' CPR psychomotor skill performance. Resuscitation, 82, 447-453.

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