title: Effects of a mandatory basic life support training programme on the no-flow fraction during in-hospital cardiac resuscitation: an observational study.
abstract: OBJECTIVE
  Many hospitals have basic life support (BLS) training programmes, but the effects on the quality of chest compressions are unclear. This study aimed to evaluate the no-flow fraction (NFF) during BLS provided by standard care nursing teams over a five-year observation period during which annual participation in the BLS training was mandatory.
  
  
  METHODS
  All healthcare professionals working at Dresden University Hospital were instructed in BLS and automated external defibrillator (AED) use according to the current European Resuscitation Council guidelines on an annual basis. After each cardiac arrest occurring on a standard care ward, AED data were analyzed. The time without chest compressions during the period without spontaneous circulation (i.e., the no-flow fraction) was calculated using thoracic impedance data.
  
  
  RESULTS
  For each year of the study period (2008-2012), a total of 1454, 1466, 1487, 1432, and 1388 health care professionals, respectively, participated in the training. The median no-flow fraction decreased significantly from 0.55 [0.42; 0.57] (median [25‰; 75‰]) in 2008 to 0.3 [0.28; 0.35] in 2012. Following revision of the BLS curriculum after publication of the 2010 guidelines, cardiac arrest was associated with a higher proportion of patients achieving ROSC (72% vs. 48%, P=0.025) but not a higher survival rate to hospital discharge (35% vs. 19%, P=0.073).
  
  
  CONCLUSIONS
  The NFF during in-hospital cardiac resuscitation decreased after establishment of a mandatory annual BLS training for healthcare professionals. Following publication of the 2010 guidelines, more patients achieved ROSC after in-hospital cardiac arrest.
authors.affiliation: ResQer (Resuscitation - Quality in Education and Research), Department of Anesthesiology and Intensive Care Medicine, University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany; Interdisciplinary Medical Simulation Centre (ISIMED), University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany. Electronic address: mpmueller.web@gmail.com.
authors.forename: Michael P
authors.initials: MP
authors.lastname: Müller
authors.affiliation: ResQer (Resuscitation - Quality in Education and Research), Department of Anesthesiology and Intensive Care Medicine, University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany; Interdisciplinary Medical Simulation Centre (ISIMED), University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany.
authors.forename: Torsten
authors.initials: T
authors.lastname: Richter
authors.affiliation: ResQer (Resuscitation - Quality in Education and Research), Department of Anesthesiology and Intensive Care Medicine, University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany; Interdisciplinary Medical Simulation Centre (ISIMED), University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany.
authors.forename: Norbert
authors.initials: N
authors.lastname: Papkalla
authors.affiliation: ResQer (Resuscitation - Quality in Education and Research), Department of Anesthesiology and Intensive Care Medicine, University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany; Interdisciplinary Medical Simulation Centre (ISIMED), University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany.
authors.forename: Cynthia
authors.initials: C
authors.lastname: Poenicke
authors.affiliation: ResQer (Resuscitation - Quality in Education and Research), Department of Anesthesiology and Intensive Care Medicine, University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany.
authors.forename: Carsten
authors.initials: C
authors.lastname: Herkner
authors.affiliation: ResQer (Resuscitation - Quality in Education and Research), Department of Anesthesiology and Intensive Care Medicine, University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany; Interdisciplinary Medical Simulation Centre (ISIMED), University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany.
authors.forename: Anne
authors.initials: A
authors.lastname: Osmers
authors.affiliation: ResQer (Resuscitation - Quality in Education and Research), Department of Anesthesiology and Intensive Care Medicine, University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany; Interdisciplinary Medical Simulation Centre (ISIMED), University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany.
authors.forename: Sigrid
authors.initials: S
authors.lastname: Brenner
authors.affiliation: ResQer (Resuscitation - Quality in Education and Research), Department of Anesthesiology and Intensive Care Medicine, University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany.
authors.forename: Thea
authors.initials: T
authors.lastname: Koch
authors.affiliation: Coordination Centre for Clinical Trials, University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany.
authors.forename: Uta
authors.initials: U
authors.lastname: Schwanebeck
authors.affiliation: ResQer (Resuscitation - Quality in Education and Research), Department of Anesthesiology and Intensive Care Medicine, University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany.
authors.forename: Axel R
authors.initials: AR
authors.lastname: Heller
mesh_terms: D000368:Aged; D016887:Cardiopulmonary Resuscitation / Q000193:education* / Q000706:statistics & numerical data; D047548:Defibrillators; D004632:Emergency Medical Services / Q000706:statistics & numerical data; D005260:Female; D006282:Health Personnel / Q000193:education*; D006323:Heart Arrest / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D008297:Male; D037141:Mandatory Programs; D015996:Survival Rate
keywords: Basic life support; Chest compression fraction; Hands-off time; In-hospital cardiac arrest; No-flow fraction