Relationship between knowledge of cardiopulmonary resuscitation guidelines and performance.
OBJECTIVE
Despite widespread training with CPR guidelines, CPR is often poorly performed. We explore relationships between knowledge of CPR guidelines and performance (compression rate, compression depth, compression to ventilation ratio, and ventilation volume).


METHODS
Sixty professional EMTs were sampled at 26 randomly ordered EMS response stations from an urban system of 31 stations. A recording manikin and video model were used to assess performance in a standardized scenario, and a survey was used to assess guideline knowledge. Survey and performance outcomes were categorized prospectively as correct or incorrect based on the International CPR Guidelines from 2000. Relationships were modeled with logistic regression. Covariates included years of work experience, frequency of CPR performance, and ALS versus BLS EMT level.


RESULTS
Compression rate was between 80 and 120 min(-1) in 56% (33/59) of trials. Compression depth was 1.5-2 in. in 39% (23/59), compression to ventilation ratio approximated to 15:2 in 42% (25/59), and ventilation volume was 800-1,200 cm(3) in 13% (8/60). Accurate knowledge of the CPR guidelines was associated with better performance of chest compression rate and compression to ventilation ratio. Adjusted OR (95% CI) were 4.6 (1.2-18.1) for compression rate, 1.7 (0.4-6.5) for compression depth, 4.5 (1.1-18.5) for compression to ventilation ratio, and 9.0 (0.2-351) for ventilation volume.


CONCLUSIONS
Although accurate knowledge of guidelines is associated with increased odds of correct performance of some aspects of CPR, overall performance remains poor.
Department of Emergency Medicine, University of Alabama, Birmingham, USA. toddbrown@uabmc.edu
Todd B
TB
Brown
Johnny A
JA
Dias
Devashish
D
Saini
Reesha C
RC
Shah
Stacey S
SS
Cofield
Thomas E
TE
Terndrup
Richard A
RA
Kaslow
John W
JW
Waterbor
D000328:Adult; D016887:Cardiopulmonary Resuscitation / Q000379:methods / Q000592:standards*; D002983:Clinical Competence; D003430:Cross-Sectional Studies; D004634:Emergency Medical Technicians / Q000592:standards*; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D016015:Logistic Models; D008297:Male; D017410:Practice Guidelines as Topic; D011795:Surveys and Questionnaires