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Certified Basic Life Support Instructors Identify Improper Cardiopulmonary Resuscitation Skills Poorly

Instructor Assessments Versus Resuscitation Manikin Data

Hansen, Camilla MD; Bang, Camilla MD; Stærk, Mathilde MD; Krogh, Kristian MD, PhD; Løfgren, Bo MD, PhD

doi: 10.1097/SIH.0000000000000386
Empirical Investigations

Introduction During basic life support (BLS) training, instructors assess learners' cardiopulmonary resuscitation (CPR) skills and correct errors to ensure high-quality performance. This study aimed to investigate certified BLS instructors' assessments of CPR skills.

Methods Data were collected at BLS courses for medical students at Aarhus University, Aarhus, Denmark. Two certified BLS instructors evaluated each learner with a cardiac arrest test scenario, where learners demonstrated CPR on a resuscitation manikin for 3.5 minutes. Instructors' assessments were compared with manikin data as reference for correct performance. The first 3 CPR cycles were analyzed. Correct chest compressions were defined as 2 or more of 3 CPR cycles with 30 ± 2 chest compressions, 50 to 60 mm depth, and 100 to 120 min−1 rate. Correct rescue breaths were defined as 50% or more efficient breaths with visible, but not excessive manikin chest inflation (for instructors) or 500 to 600mL air (manikin data).

Results Overall, 90 CPR assessments were performed by 16 instructor pairs. Instructors passed 81 (90%) learners, whereas manikin pass rate was 2%. Instructors identified correct chest compressions with a sensitivity of 0.96 [95% confidence interval (CI) = 0.79–1) and a specificity of 0.05 (95% CI = 0.01–0.14), as well as correct rescue breaths with a sensitivity of 1 (95% CI = 0.40–1) and a specificity of 0.07 (95% CI = 0.03–0.15). Instructors mistakenly failed 1 learner with adequate chest compression depth, while passing 53 (59%) learners with improper depth. Moreover, 80 (89%) improper rescue breath performances were not identified.

Conclusions Certified BLS instructors assess CPR skills poorly. Particularly, improper chest compression depth and rescue breaths are not identified.

From the Research Center for Emergency Medicine, Aarhus University Hospital, Aarhus (C.H., C.B., M.S., B.L.); Department of Internal Medicine, Randers Regional Hospital, Randers (C.H., C.B., M.S., B.L.), and Clinical Research Unit, Randers Regional Hospital, Randers (C.H., C.B., M.S.); Department of Anesthesia and Intensive Care, Aarhus University Hospital (K.K.); Centre for Health Sciences Education, Aarhus University, Aarhus, (K.K.), Department of Clinical Medicine, Aarhus University, Aarhus (B.L.), and Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark (B.L.).

Reprints: Bo Løfgren, MD, PhD, Department of Internal Medicine, Randers Regional Hospital, 8930 Randers NE, Denmark (e-mail:

The authors declare no conflicts of interest.

Salary support for the lead author of the study was provided by Aarhus University, Denmark. Office supplies were provided by Research Center for Emergency Medicine, Aarhus University Hospital, Denmark. The funding bodies were not involved in designing the study, data analysis, interpretation, or writing the article.

This study is attributed to Research Center for Emergency Medicine, Aarhus University Hospital, Aarhus, Denmark.

Online date: September 6, 2019

© 2019 Society for Simulation in Healthcare