Will changing the emphasis from 'pulseless' to 'no signs of circulation' improve the recall scores for effective life support skills in children?
Frederick K., Bixby E., Orzel M-N., Stewart-Brown S., Willett K.
This study analyses, retrospectively, an established data set to measure the effect of the circulation change in European Resuscitation Council Guidelines. This prospective matched control study examined the extent to which Year 6 (10-11 years) children retained and were able to demonstrate the sequencing and assessment skills of Basic Life Support (BLS) techniques 5 months after BLS training through the Injury Minimization Programme for Schools (I.M.P.S.). A total of 1292 children were enrolled at the beginning of the study: 657 in the intervention group received BLS through I.M.P.S., 635 children in the control group received no planned intervention. Children in both groups were tested 5 months after intervention using small portable manikins. Chi-square analysis of individual variables indicated that the intervention group was better (P<0.0005) than controls in almost all areas of basic life support (BLS). 'Adequate' BLS skills, the minimum skills considered to be effective, were also demonstrated in both groups, intervention 4.1%, controls 0.5%. Recalculation of these variables removing the check on the carotid pulse resulted in an increase to 24% of adequate BLS skills in the intervention group. Conversely, only 2.1% of controls performed to this standard. With strict adherence to Resuscitation Council guidelines, 'optimal' life saving procedures (all primary BLS steps performed optimally), were initiated by very few, marginally better in the intervention than the control group, intervention 6 (1.1%) controls 0 (0%). Some children in both groups performed the cardio-pulmonary resuscitation (CPR) element of BLS in an ineffective manner. Changing the circulation assessment would seem appropriate and allow recognition of life support attempts that are beneficial if not optimal.