title: Training hospital providers in basic CPR skills in Botswana: acquisition, retention and impact of novel training techniques.
abstract: OBJECTIVE
  Globally, one third of deaths each year are from cardiovascular diseases, yet no strong evidence supports any specific method of CPR instruction in a resource-limited setting. We hypothesized that both existing and novel CPR training programs significantly impact skills of hospital-based healthcare providers (HCP) in Botswana.
  
  
  METHODS
  HCP were prospectively randomized to 3 training groups: instructor led, limited instructor with manikin feedback, or self-directed learning. Data was collected prior to training, immediately after and at 3 and 6 months. Excellent CPR was prospectively defined as having at least 4 of 5 characteristics: depth, rate, release, no flow fraction, and no excessive ventilation. GEE was performed to account for within subject correlation.
  
  
  RESULTS
  Of 214 HCP trained, 40% resuscitate ≥ 1/month, 28% had previous formal CPR training, and 65% required additional skills remediation to pass using AHA criteria. Excellent CPR skill acquisition was significant (infant: 32% vs. 71%, p<0.01; adult 28% vs. 48%, p<0.01). Infant CPR skill retention was significant at 3 (39% vs. 70%, p<0.01) and 6 months (38% vs. 67%, p<0.01), and adult CPR skills were retained to 3 months (34% vs. 51%, p=0.02). On multivariable analysis, low cognitive score and need for skill remediation, but not instruction method, impacted CPR skill performance.
  
  
  CONCLUSIONS
  HCP in resource-limited settings resuscitate frequently, with little CPR training. Using existing training, HCP acquire and retain skills, yet often require remediation. Novel techniques with increased student: instructor ratio and feedback manikins were not different compared to traditional instruction.
authors.affiliation: Department of Anesthesia and Critical Care, Children's Hospital of Philadelphia, Philadelphia, PA, United States. meaney@email.chop.edu
authors.forename: Peter A
authors.initials: PA
authors.lastname: Meaney
authors.forename: Robert M
authors.initials: RM
authors.lastname: Sutton
authors.forename: Billy
authors.initials: B
authors.lastname: Tsima
authors.forename: Andrew P
authors.initials: AP
authors.lastname: Steenhoff
authors.forename: Nicole
authors.initials: N
authors.lastname: Shilkofski
authors.forename: John R
authors.initials: JR
authors.lastname: Boulet
authors.forename: Amanda
authors.initials: A
authors.lastname: Davis
authors.forename: Andrew M
authors.initials: AM
authors.lastname: Kestler
authors.forename: Kasey K
authors.initials: KK
authors.lastname: Church
authors.forename: Dana E
authors.initials: DE
authors.lastname: Niles
authors.forename: Sharon Y
authors.initials: SY
authors.lastname: Irving
authors.forename: Loeto
authors.initials: L
authors.lastname: Mazhani
authors.forename: Vinay M
authors.initials: VM
authors.lastname: Nadkarni
mesh_terms: D000328:Adult; D001902:Botswana; D016887:Cardiopulmonary Resuscitation / Q000193:education*; D005260:Female; D006801:Humans; D008297:Male; D010564:Personnel, Hospital / Q000193:education*; D011446:Prospective Studies; D016037:Single-Blind Method