title: Can a flowchart improve the quality of bystander cardiopulmonary resuscitation?
abstract: BACKGROUND
  Since the introduction of basic life support in the 1950s, on-going efforts have been made to improve the quality of bystander cardiopulmonary resuscitation (CPR). Even though bystander-CPR can increase the chance of survival almost fourfold, the rates of bystander initiated CPR have remained low and rarely exceed 20%. Lack of confidence and fear of committing mistakes are reasons why helpers refrain from initiating CPR. The authors tested the hypothesis that quality and confidence of bystander-CPR can be increased by supplying lay helpers with a basic life support flowchart when commencing CPR, in a simulated resuscitation model.
  
  
  METHODS
  After giving written informed consent, 83 medically untrained laypersons were randomised to perform basic life support for 300s with or without a supportive flowchart. The primary outcome parameter was hands-off time (HOT). Furthermore, the participants' confidence in their actions on a 10-point Likert-like scale and time-to-chest compressions were assessed.
  
  
  RESULTS
  Overall HOT was 147±30 s (flowchart) vs. 169±55 s (non-flowchart), p=0.024. Time to chest compressions was significantly longer in the flowchart group (60±24 s vs. 23±18 s, p<0.0001). Participants in the flowchart group were significantly more confident when performing BLS than the non-flowchart counterparts (7±2 vs. 5±2, p=0.0009).
  
  
  CONCLUSIONS
  A chart provided at the beginning of resuscitation attempts improves quality of CPR significantly by decreasing HOT and increasing the participants' confidence when performing CPR. As reducing HOT is associated with improved outcome and positively impacting the helpers' confidence is one of the main obstacles to initiate CPR for lay helpers, charts could be utilised as simple measure to improve outcome in cardiopulmonary arrest.
authors.affiliation: Medical Simulation and Emergency Management Research Group, Department of Anaesthesia, General Intensive Care and Pain Management, Medical University of Vienna, Austria. bernhard.roessler@meduniwien.ac.at
authors.forename: B
authors.initials: B
authors.lastname: Rössler
authors.forename: M
authors.initials: M
authors.lastname: Ziegler
authors.forename: M
authors.initials: M
authors.lastname: Hüpfl
authors.forename: R
authors.initials: R
authors.lastname: Fleischhackl
authors.forename: K A
authors.initials: KA
authors.lastname: Krychtiuk
authors.forename: K
authors.initials: K
authors.lastname: Schebesta
mesh_terms: D000328:Adult; D016887:Cardiopulmonary Resuscitation / Q000193:education*; D005260:Female; D006801:Humans; D008297:Male; D058687:Out-of-Hospital Cardiac Arrest / Q000628:therapy*; D011446:Prospective Studies; D058996:Quality Improvement; D013664:Teaching Materials