International guidelines for CPR focused on methods of high quality cardiopulmonary resuscitation (HQCPR) in ensuring return of spontaneous circulation. Currently there is a large gap between knowledge and practical implementation. Environmental factors such as static and moving environment contribute to the competency in performing HQCPR. This study aimed to assess and compare the knowledge and psychomotor skill of pre hospital care (PHC) provider in performing HQCPR in controlled and uncontrolled environment at 2 minutes.
MATERIAL AND METHODS
This is a cross sectional study conducted in Emergency Department Hospital Kuala Lumpur on July 2014 until May 2015. Forty PHC providers were enrolled into the study. The first part involved knowledge assessment using multiple choice questions. The second part involved objective and subjective assessments of psychomotor component in CPR within 2 minutes on a manikin in a controlled (static) and uncontrolled environment (moving ambulance and trolley). The objective assessment was measured with percentage of accurate compression and ventilation using a software program. The subjective assessment was conducted by two independent assessors following a modified standardised checklist.
In the knowledge assessment 30% scored satisfactory. The objective assessment showed accuracy of HQCPR was significantly effective in controlled environment (p ≤ 0.01). The subjective assessment revealed most participants were able to perform satisfactorily in a controlled environment. Assistant medical officer were more competent in delivering a HQCPR compared to staff nurse (p≤ 0.01). There were significant association between knowledge and competency on performing HQCPR among the PHC providers (p≤ 0.01)
There were minimal interruptions of chest compression in the controlled environment. The instability factor along with small closed compartment and variability of speed of the ambulance may affect the performance of HQCPR. Another contributing factor is lack of knowledge update among providers. Standardised training and frequent evaluation of knowledge and skill is needed to maintain performance.