Dallas 2015
AED training methods
TFQO:
EVREVs:
Taskforce:
Robert Greif
Jan Breckwoldt, Henrik Fischer
Education Implementation and
Training (EIT)
COI Disclosure
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(specific to this systematic review)
Commercial/industry
None to declare
Potential intellectual conflicts
RG: # 344
HF:
# 84
JB:
# 30
2010
Consensus of Science
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1 study (LOE 2) demonstrated that training delivered by laypeople is as effective as training by
by HCPs.
1 study (LOE 1) reported that instruction by nurses, as compared with physicians, resulted in
better skill acquisition [for nurses].
4 studies (LOE 2; LOE 4) reported that the use of computer-based AED training improved skill
acquisition and retention, particularly when combined with manikin practice.
1 study (LOE 1) supported the use of video-self instruction when compared with instructor-led
training.
3 studies (LOE 1) showed that the use of video self instruction was less effective for some
elements when compared with instructor-led training.
1 study (LOE 1) supported the use of a training poster and manikin for learning AED skills.
3 studies (LOE 2; LOE 4) reported that laypeople and HCPs could use an AED without training.
3 studies (LOE 2) reported that untrained individuals could deliver a shock with an AED.
However, even minimal training (15-min lecture, 1-h lecture with manikin practice, or reading
instructions) improved performance (e.g., time to shock delivery, correct pad placement,
safety).
2010 Treatment
Recommendation
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AED use should not be restricted to trained personnel. Allowing
use of AEDs by individuals without prior formal training can be
beneficial and may be lifesaving. Since even brief training improves
performance (e.g., speed of use, correct pad placement), it is
recommended that training in the use of AEDs be provided.
Laypeople can be used as AED instructors. Short video/computer
self-instruction (with minimal or no instructor coaching) that
includes synchronous hands-on practice in AED use (practice-whileyou-watch) may be considered as an effective alternative to
instructor-led AED courses.
C2015 PICO
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Among
Population: students who are taking AED courses in
an educational setting (P),
Intervention: does any specific training intervention
(I),
Comparison: compared with traditional
lecture/practice sessions (C),
Outcomes: change clinical outcome, skill performance
in actual resuscitations, skill performance at 1 year, skill
performance at course conclusion, cognitive knowledge,
use of AEDs (O)?
Inclusion/Exclusion
& Articles Found
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Inclusions/Exclusions
Include: studies describing the effect of training interventions on AED
skill acquisition, retention or performance. Also alternative approaches
as non-istructor led training, self-training (kits); also for pediatric AED
use; Not only health care providers also first responders, lay people,
police, fire brigade, first aid providers, swimming pool attendants
Exclude: purely descriptive studies of courses with no evaluation of
training; studies comparing different course duration, studies addressing
refresher training, non-RCT studies; animal and non-human studies;
studies not available except in abstract format
1331 articles from primary search, 40 articles evaluated
as full texts, 7 articles finally included for PICO question
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Draft
Treatment Recommendations
For lay persons we can give a weak suggestion to
combine self-instruction teaching methods of
shorter durations with practical hands-on training.
No recommendation can be given for isolated selfinstruction without involvement of a trainer.
For HCPs we suggest shorter duration of trainings
and/or self-directed teaching methods.
All these suggestions are based on low evidence studies,
due to outcomes with low clinical relevance. We did not
identify any evidence to address the critical outcome of
“neurologically intact survival”.
Risk of Bias in studies
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Evidence profile table(s)
Self instruction without instructor-led practice for lays
subquestion
-1-
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Evidence profile table(s)
Self instruction without instructor-led practice for HCPs
subquestion
-2-
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Evidence profile table(s)
subquestion
-3-
Self instruction combined with instructor-led practice for lays
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Evidence profile table(s)
Self instruction combined with instructor-led practice for HCPs
subquestion
-4-
Proposed Consensus
on Science statements
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Studies related to this PICO question do not describe
outcomes on levels of clinical performance, or patient
outcome.
All studies for this PICO are manikin-based and participants
were all adults. Manikin studies are the standard method for
AED training and assessment.
Substantial heterogeneity was found for interventions and
controls, and for time points of assessment.
Except for one study, none investigated AED alone. All other
studies address the whole sequence of BLS with primary
outcomes on chest compression quality.
Proposed Consensus
on Science statements
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We specified 4 sub-questions to account for the nature of training
alternatives.
1. lay persons: self-instruction without (or with minimal)
instructor involvement vs. traditional instructor led course
2. HCPs: self-instruction without (or with minimal) instructor
involvement vs. traditional instructor led course
3. lay persons: self-instruction combined with instructor led vs.
traditional course.
4. HCPs: self-instruction combined with instructor led vs.
traditional course.
Proposed Consensus
on Science statements
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For 1. “self-instruction without (or with minimal) instructor
involvement vs. traditional instructor led course for lay persons”
we identified important outcomes with low quality of evidence with
the following studies:
De Vries 2010, 1004: For two of the investigated DVD-based teaching
methods, the relative risk to pass the overall test was only 0.36, and 0.35.
Reder 2006, 443 found a small non-significant inferiority for a computerlearning-only course after two months.
Roppolo 2007, 276: described no significant difference of AED
performance (time to first shock and AED placement) for a video-self
learning intervention of 30 min.
Meischke 2001, 216, investigating training for senior citizens (video-selftraining of 11 min + 45 min manikin training + minimal instructor) found
no significant difference compared to the control group. This study also
suggests a saving of resources by the alternative training method.
Proposed Consensus
on Science statements
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For 2. “self-instruction without (or with minimal) instructor
involvement vs. traditional instructor led courses in HCPs” we
identified important outcomes with very low quality of evidence
with the following studies:
Ropollo 2011, 319, showed that a pure self-instructed training was as
efficient as traditional training but testing was limited to the end of the
course.
De Vries 2008, 76, did not find differences between groups, but
reported significant time (and financial) savings. However, sample size
was very low.
Miotto 2010, 328, found worse results with a theory-only training, but
was flawed due to an inadequate control group.
Proposed Consensus
on Science statements
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For 3. “self-instruction combined with instructor led vs.
traditional courses for lay persons” important outcomes were
identified, but the quality of evidence was low for the following
studies:
Reder 2006, 443, showed that interactive computer session of 45 min
+ 45 min instructor based practice led to comparable results as a
traditional course of the same duration. Interestingly, AED skills
remained rather stable over 2 months, while CPR skills deteriorated
significantly.
De Vries 2010, 1004, showed, that a 9 min DVD + manikin training +
scenario training was inferior to traditional training, with a relative risk to
pass the overall test of 0.55, which - notably - increased to 0.84 after
two months. This may indicate a potential learning effect of the short
post-course test
Proposed Consensus
on Science statements
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For 4. “self-instruction combined with instructor led vs.
traditional courses in HCPs” we identified important outcome with
low quality of evidence. A benefit could be shown in terms of
reducing training time, while performance was slightly reduced.
Ropollo 2011, 319 demonstrated that 40 min skills lab + instructor led to
correct AED use, but a higher rate of mistakes in AED operations.
De Vries 2008, 76, did not find differences between groups, but reported
significant time (and financial) savings. However, sample size was very
low.
Dallas 2015
Draft
Treatment Recommendations
For lay persons we can give a weak suggestion to combine
self-instruction teaching methods of shorter durations with
practical hands-on training.
No recommendation can be given for isolated selfinstruction without involvement of a trainer.
For HCPs we suggest shorter duration of trainings and/or
self-directed teaching methods.
All these suggestions are based on low evidence studies,
due to outcomes with low clinical relevance. We did not
identify any evidence to address the critical outcome of
“neurologically intact survival”.
Knowledge Gaps
(AED training methods)
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If isolated questions of AED trainings are to be answered, studies are
needed where the primary objective is AED performance. Study
designs should include adequate sample sizes and participants.
The duration of effective AED training still is unclear.
The effect and proper time point of brief refresher trainings should
be evaluated.
Most suitable methods to train children are not known yet.
Overall, clinical outcomes (ROSC, discharge from hospital, intact
neurological outcome) which may be related to AED training should be
aimed at. However, this might not be feasible given the low probability
of an individual to witness cardiac arrest.
Next Steps
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This slide will be completed during Task
Force Discussion (not EvRev) and should
include:
Consideration of interim statement
Person responsible
Due date