|Year : 2019 | Volume
| Issue : 4 | Page : 160-164
Practice of cardiopulmonary resuscitation among health care providers in a tertiary health centre in a semi-urban setting
Ibrahim Aliyu1, Godpower Chinedu Michael2, Haliru Ibrahim3, Zainab F Ibrahim4, Umma Idris5, Bashir Mariat Zubayr6, Halima Umar Ibrahim5
1 Department of Paediatrics, Consultant Paediatrician, Aminu Kano Teaching Hospital/Bayero University Kano, Nigeria
2 Department of Family Medicine, Aminu Kano Teaching Hospital, Kano, Nigeria
3 Department of Medicine, Federal Medical Centre; Birnin Kudu, Jigawa State, Nigeria
4 Nursing Department, Aminu Kano Teaching Hospital, Kano, Nigeria
5 Department of Paediatrics, Federal Medical Centre, Birnin Kudu, Jigawa State, Nigeria
6 Institute of Human Virology, Nigeria
|Date of Submission||28-May-2019|
|Date of Decision||16-Jul-2019|
|Date of Acceptance||20-Jul-2019|
|Date of Web Publication||02-Aug-2019|
Department of Paediatrics, Aminu Kano Teaching Hospital, Kano
Source of Support: None, Conflict of Interest: None
Objectives: To assess the basic knowledge of cardiopulmonary resuscitation (CPR) among health workers in a tertiary health facility in a semi-rural county.
Methods: A questionnaire based, cross sectional study involving health care professionals was performed in Federal Medical Centre, Birnin Kudu, Jigawa State, Nigeria from April to July 2017. A purposive sampling method was adopted for subject selection. A pretested self-administered questionnaire was distributed; this included knowledge on basic life support; participation in basic life supportand outcomes. It was adopted from the American Heart Association guidelines for CPR and emergency cardiac care.
Results: One hundred and two respondents were recruited (40 doctors and 62 nurses). There were 50 males (49%) and 52 females (51%). Their age ranged from 23 to 54 years with mean of (34.9± 7.4) years. Only 20% of the respondents were aware of circulation, airway and circulation in adult resuscitation; however, 61.0% of all respondents were aware of airway, breathing and circulation of resuscitation in children. Furthermore, only 10% of the respondents were aware of the correct steps of single rescuer resuscitation. Their knowledge was poor about chest compression and ventilation for both adult and children resuscitation. The overall knowledge score ranged from 0.0% to 100% with mean knowledge score of (21.2±18.6)%. The date of last training about CPR had no relationship with the knowledge scores (χ2=2.951, P=0.300). The cadre of the respondents (doctors and nurses) had no relationship with their knowledge score (χ2=0.100, P=0.633 for doctors and nurses; ,χ2=7.074, P=0.225 for doctors cadre; XX2=3.868, P=0.677 for nurses cadre) respectively.
Conclusions: The knowledge about CPR among health workers is poor; furthermore, the last date of training about CPR and the cadre of staffs have no relationship with knowledge of CPR.
Keywords: Cardiopulmonary resuscitation, Health workers, Knowledge
|How to cite this article:|
Aliyu I, Michael GC, Ibrahim H, Ibrahim ZF, Idris U, Zubayr BM, Ibrahim HU. Practice of cardiopulmonary resuscitation among health care providers in a tertiary health centre in a semi-urban setting. J Acute Dis 2019;8:160-4
|How to cite this URL:|
Aliyu I, Michael GC, Ibrahim H, Ibrahim ZF, Idris U, Zubayr BM, Ibrahim HU. Practice of cardiopulmonary resuscitation among health care providers in a tertiary health centre in a semi-urban setting. J Acute Dis [serial online] 2019 [cited 2022 May 22];8:160-4. Available from: https://www.jadweb.org/text.asp?2019/8/4/160/263709
| 1. Introduction|| |
Basic life support (BLS) in cardiopulmonary resuscitation (CPR) consists of chest compressions and assisted ventilation to maintain circulation and oxygenation during resuscitation. CPR does not require specialized equipment. It is contraindicated only on very few instances when there is a do-not-resuscitate order; or when the attending physician believes the outcome of such resuscitation will be associated with profound morbidity based on clinical judgment, such as severe neurologic defect (vegetative state). BLS is the bedrock of effective resuscitation, and health providers should be acquainted with the knowledge. However, the current situation is not optimistic. Marzooq et al. from Bahrain, Ragavan et al. from South Africa and Sadoh et al. from Nigeria all documented the poor knowledge about BLS among health professionals. About 500 000 people die annually in the United State of America,, from cardiac arrest related events. Effective BLS during resuscitation could significantly improve the survival rate,. Therefore, this study seeks to determine the knowledge about CPR among medical professionals in our tertiary hospital, and to promote more trainings involving CPR if the knowledge gaps are identified.
| 2. Materials and methods|| |
2.1. Study site
The hospital is located in Birnin Kudu which is the headquarter of Birnin Kudu Local Government Area of Jigawa state North-western Nigeria. It provides healthcare services to patients from the study area and neighboring local governments of Kano state and beyond.
This is a cross sectional study involving health care professionals in Federal Medical Centre, Birnin Kudu, Jigawa State, Nigeria conducted from April to July 2017. A purposive sampling method was adopted for the subject selection.
2.2. Sample size calculation
Sample size shall be determined using the formula: (Z1-α/2 )2* P(1-P) /d2.
Z1-α/2 =standard normal variate, which is 1.96 at 95% confidence interval. P=expected proportion of health worker with good knowledge of CPR, based from previous study was 11.7%. d= margin of error, which was chosen as 5 based on findings from previous studies. So the result should be: 1.962x0.117 x0.883I0.052= 159.
The population of health workers in our institution during the period of the study was less than 10 000, therefore the actual sample size calculated was: n/1+n/N [n=calculated sample size; N= health professional available for recruitment into the study (200)], 159/1+159/200 =88.
Additional 14 health workers were added making an attrition rate of 15%, bring the sample size to 102.
Convenient sampling method was adopted; however 40 doctors and 62 nurses were consecutively selected (ratio of 1:1.6) [Figure 1].
2.3. Inclusion and exclusion criteria
The subjects who declined consent or were not at work during the study period were excluded.
2.4. Survey tool
A pretested self-administered questionnaire was distributed including the knowledge about BLS and the participation in BLS and the outcomes. The questionnaire was developed in English language, and was adopted under the American Heart Association (AHA) guidelines for CPR and emergency cardiac care,,. The questions were based on the AHA BLS courses, and were pretested among 10 volunteers to ascertain the internal consistency; and a Cronbach’s alpha value of 0.75 was obtained. A minimum score of 84% was defined as adequate knowledge as was outlined in the AHA BLS courses,.
2.5. Ethical approval
Permission to conduct the study was obtained from the Human Research and Ethics Committee of Federal Medical Centre, Birnin Kudu, Jigawa State, Nigeria on the 28th of November, 2016 (FMCI BKD/CLN/HREC/136- HREC/009/2016).
2.6. Statistical analysis
All data obtained were analyzed using SPSS version 16. (SPSS Inc. Illinois Chicago, United State of America). Qualitative variables were summarized as frequencies, percentages while quantitative variables were summarized as means ± standard deviations while the chi square (χ2) was used to test for associations between variables; and P value < 0.05 was considered statistically significant.
| 3. Results|| |
3.1. Demographic characteristics
One hundred and two respondents were recruited for this study (40 doctors and 62 nurses). There were 50 males (49%) and 52 females (51%), including 34 (85%) male doctors and 6(15%) female doctors; 16 (25.8%) male nurses and 46 (74.2%) female nurses. The age ranged from 23 to 54 years with mean of (34.9±7.4) years; the age range of the doctors was from 24 years to 50 years with mean of (32.8±6.4) years, while the age range of the nurses was 23 to 54 years with mean (36.2±7.8) years. Overall working experiences ranged from 1 to 30 years with mean of (8.6+7.0) years; the working experience of the doctors was from 1 to 15 years with mean of (4.2±2.4) years, while the working experience of the nurses ranged from 2 to 30 years with mean of (11.5±6.9) years.
There were 19(47.5%) house officers, 12(30.0%) medical officers, 6(15.0%) senior medical officers, 1 (2.5%) principal medical officer and 2 (5.0%) consultants; while the nurses were: 18 (29.0%) nursing officers, 20 (32.3%) senior nursing officers, 12 (19.4%) principal nursing officers, 6 (9.7%) assistant chief nursing officers and 6 (9.7%) chief nursing officers. The staff distribution is as presented in [Table 1]; those of the dental, ear, nose and throat, and paediatrics were most represented followed by those from the surgery department.
3.2. Training on CPR
Sixty-three (61.8%) of all the respondents had heard of CPR (33 doctors and 30 nurses), while 39 (38.2%) subjects had not (7 doctors and 32 nurses); therefore among the doctors, 33 (82.5%) doctors were aware of CPR, while 7 (17.5%) were not; while among the nurses, 30 (48.4%) nurses were aware of CPR while 32 (51.6%) were not. A total of 36.5% of the respondents had their last training on CPR between 1-3 years before commencement of this study and mainly during their school days (54.0%). Sixty-three respondents reported benefitting from their training on CPR [Table 2].
3.3. Knowledge on CPR
Thirty-eight (37.3%) respondents were aware of single rescuer resuscitation, while 64 (62.7%) were not; 50% of doctors were aware and 50% unaware of single rescuer resuscitation; however, 18 (29.0%) of the nurses were aware but 44 (71.0%) were unaware. Fifty-five (54.5%) respondents had seen a defibrillator, while 47 (45.5%) had not. Among those who had seen a defibrillator, 29 (52.7%) were doctors, while 26 (47.2%) were nurses. Furthermore among those who had not seen a defibrillator, 10 (21.3%) were doctors while 37 (78.7%) were nurses. Among those who had seen a defibrillator, only 11 (20.0%) of the respondents had ever operated a defibrillator, while 44 (80.0%) had not. Among doctors (29) who had ever seen a defibrillator, only 4 (13.8%) of them had ever operated a defibrillator, while 25 (86.2%) had not; while among the 26 nurses who had seen a defibrillator only 7 (26.9%) nurses had operated a defibrillator, and 19 (73.1%) had not. Only 20 (19.6%) of all the respondents were aware of the sequence of circulation, airway, breathing (CAB) sequencing in adult resuscitation; this poor understanding was witnessed in 10 doctors (25%) and 10 nurses (16.1%) sub-group. However 61 (59.80%) of all respondents were aware of airway, breathing and circulation (ABC) sequencing of resuscitation in children; a fair response was noted in both the doctors and nurses subgroups. Furthermore among the 38 respondents who were aware of single rescuer resuscitation, only 5.2% of the respondents reported the steps correctly, and this observation was similar in both subgroups. Again their knowledge about chest compression and ventilation was poor for both adult and children resuscitation [Table 3].
3.4. Knowledge score on CPR
The mean knowledge score was (21.2±18.6)%; the mean knowledge score of the doctors was (26.5±19.9)%; while the mean knowledge score of the nurses was (17.7±7.0)%. Knowledge score of the respondents was generally poor, majority (98%) of them scoring below 84% [Table 4].
3.5. Influence of department and time of training on knowledge score
Majority of respondents from all department had poor knowledge score, and only paediatrics and obstetrics and gynaecology recorded a score of 100%, but the difference was not statistically significant (χ2=7.448. P=0.098). Furthermore, the time of training had no relationship with the knowledge score (χ2=2.951, P=0.300) [Table 5].
|Table 5: Relationship of department and time of training of the respondents with their knowledge score (n).|
Click here to view
3.6. Influence of status of respondents on knowledge score
The knowledge scores of the doctors, and nurses were generally poor irrespective of their cadre; however, these observations were not statistically significant (χ2=0.100, P=0.633 for doctors and nurses; χ2=7.074, P=0.225 for doctors cadre; χ=3.868, P=0.677 for nurses cadre) [Table 6].
| 4. Discussion|| |
The overall knowledge about CPR among respondents is poor in this study, and the similar results have been reported in previous reports by Sadoh et al., and Olajumoke et al., which were observed mostly among nurses. In our study, only 61.8% of respondents had training on CPR, higher than 40% reported by Olajumoke et al.. It is still worrisome, for this means clearly 39.2% of respondents were either not involved in resuscitation or they were not doing CPR correctly. Furthermore, the majority had their last CPR training while they were students, with limited hands-on exposure. This is against the AHA guideline which recommends frequent training and retraining of healthcare providers. According to 2015 updated guideline, even a 2-yearly retraining was sub-optimal in achieving the desired skill and confidence required for efficient CPR.
Awareness of common resuscitative procedures such as single rescuer resuscitation, use of defibrillator was generally poor; only 20% of respondents had ever operated a defibrillator which was lower than the 30% reported by Olajumoke et al..
The 2010 AHA guideline changed the BLS sequence of CPR and emergency cardiovascular care from the traditional ABC to CAB in adult resuscitation, therefore laying greater emphasis on chest compression and early defibrillation,. However, our study showed that majority of respondents were not aware of this change six years after, and this observation was similar to that reported by Sadoh et al. way back in 2009; they noted that most healthcare professionals (88.3%) were unaware of the AHA 2005 guideline on CPR. Therefore, there is need for regular certification and recertification of healthcare professionals. This requirement should be considered as a prerequisite for registration of annual practicing license to ensure strict compliance, so it should be taken seriously.
The knowledge mean scores of both doctors and nurses were generally poor irrespective of their cadre, time of training on CPR, and department of practice, which was similar to previous reports,. Olajumoke et al. reported that younger doctors had better knowledge of CPR and the use of defibrillators. However, Bankole et al. in their study observed that the cadre of their participant did not significantly influence their knowledge score. But Cowie reported consultants to have the lowest knowledge score.
This study was questionnaire based, and the practical aspect of CPR was not assessed. The respondents had a poor theoretical base which would have resulted in poor clinical performance; furthermore, the convenience sampling method adopted could have introduced systematic bias.
Based on our findings, we advice there should be a regular structured CPR educational programme, which should be didactic and hands-on based. It will ensure that the appropriate skills are developed and the confidence to execute the procedure during an emergency. Furthermore, health institutions should have certified CPR instructors who will routinely organized effective programmes.
The poor knowledge of CPR among the respondents raises concern of patient safety, and health providers need certification and regular recertification on proficiency on CPR.
Conflict of interest statement
The authors report no conflict of interest.
| References|| |
Lyneham J, Marzooq H. Cardiopulmonary resuscitation knowledge among nurses working in Bahrain. Intern J Nurs Pract
2009; 15(4): 294-304.
Ragavan S, Schneider H, Kloeck WGJ. Basic resuscitation: knowledge and skills of full-time medical practitioners at public hospitals in Northern Province. S Afr Med J
2000; 90(5): 504-508.
Sadoh WE, Osariogiagbon W. Knowledge and practice of cardiopulmonary resuscitation amongst doctors and nurses in Benin City, Nigeria. Niger Hosp Pract
2009; 3: 1-2.
Travers AH, Perkins GD, Berg RA, Castren M, Considine J, Escalante R, et al. On behalf of the basic life support chapter collaborators. Part 3: adult basic life support and automated external defibrillation: 2015 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations. Circulation
2015; 132(suppl 1): S51-S83.
Kyriacou DN, Arcinue EL, Peek C, Kraus JF. Effect of immediate resuscitation on children with submersion injury. Pediatrics
1994; 94(2 Pt 1): 137-142.
Morley PT, Lang E, Aickin R, Billi JE, Eigel B, Ferrer JME, et al. Part 2: evidence evaluation and management of conflicts of interest: 2015 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations. Circulation
2015; 132(suppl1): S40-S50.
Mogayzel C, Quan L, Graves JR, Tiedeman D, Fahrenbruch C, Herndon P. Out-of-hospital ventricular fibrillation in children and adolescents: causes and outcomes. Ann Emerg Med
1995; 25(4): 484-491.
Stockinger ZT, McSwain NE Jr. Prehospital endotracheal intubation for trauma does not improve survival over bag-valve-mask ventilation. J Trauma
2004; 56(3): 531-536.
Araoye MO. Research methodology with statistics for health and social sciences
. Ilorin, Nigeria: Nathadex; 2004, p. 123-129.
Olajumoke TO, Afolayan JM, Adekunle MA. Cardiopulmonary resuscitation-knowledge, attitude and practices in Osun State, Nigeria. J West Coll Surg
2012; 2(2): 23-31.
American Heart Association. Basic Life Support (BLS) for healthcare professionals
.[Online]. Avaliale from: https://www.onlineaha.org/courses
. [Assessed on 12/10/2017].
American Heart Association. Advanced cardiovascular life support (ACLS) resource for training instructors
. [Online]. Available from: https://www. onlineaha.org/courses
. [Assessed on 12/10/2017].
Botha L, Geyser MM, Engelbrecht A. Knowledge of cardiopulmonary resuscitation of clinicians at a South African tertiary hospital. South Afr Family Pract
2012; 54(5): 447-454.
Bhanji F, Donoghue AJ, Wolff MS, Flores GE, Halamek LP, Berman JM, et al. Part 14: education: 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation
2015; 132(suppl 2): S561-S573.
Marsch S, Tschan F, Semmer NK, Zobrist R, Hunziker PR, Hunziker S. ABC versus CAB for cardiopulmonary resuscitation: a prospective, randomized simulator-based trial. Swiss Wkly
2013; 143: w13856. doi: 10.4414/smw.2013.13856.
Khalid U, Juma AAM. Paradigm shift: ‘ABC’ to ‘CAB’ for cardiac arrests. Scandinavian J Trau Resuscit Emerg Med
2010; 18: 59.
Wollard M, Whitfield R, Smith A, Colquhoun M, Newcombe RG, Vetteer N, et al. Skill acquisition and retention in automated external defibrillator (AED) use and CPR by lay responders: A prospective study. Resuscitation
2004; 60: 17-28.
Boyde M, Wotton K. A review of nurses’ performance of cardiopulmonary resuscitation at cardiac arrest. J Nurses Staff Develop
2000; 17: 248-255.
Bankole OB, Desalu I, Olatosi JO, Bello BT, Akanmu ON. Grade of a doctor does not influence acquisition of knowledge and skill during CPR training in a developing country. J Clin Sci
2014; 11: 12-16.
Cowie DA, Story DA. Knowledge of cardiopulmonary resuscitation protocols and level of anaesthetic training. Anaesth Intensive Care
2000; 28: 687-691.
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]