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Associate Professor; Residency Director, Department of Family Medicine, University of California, Irvine
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Associate Professor; Residency Director, Department of Family Medicine, University of California, Irvine
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CME Released: 5/1/2007
Valid for credit through: 5/1/2008, 11:59 PM EST
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May 1, 2007 — Children as young as 9 years should be taught to perform cardiopulmonary resuscitation (CPR), including chest compressions, according to the results of an observational study from the Heartstart UK schools training program, published in the April 27 Online First issue of BMJ.
"Resuscitation skills should be learnt at school, since children are easily motivated, learn quickly, and retain skills," write Ian Jones, from the Welsh Ambulance Services National Health Services Trust/Cardiff University, Wales School of Medicine in Cardiff, and colleagues. "In the United Kingdom a national syllabus and training programme, developed by the British Heart Foundation through 'Heartstart UK,' introduces chest compression to schoolchildren at 11 years of age.... No study reports when children are capable of the more physically demanding tasks, particularly chest compression."
At 4 schools in Cardiff, 157 children and adolescents aged 9 to 14 years in 3 school-year groups (ages, 9 - 10, 11 – 12, and 13 - 14 years) were taught basic life support skills in 1 lesson lasting 20 minutes. The primary endpoint was effectiveness of chest compression during 3 minutes' continuous chest compression on a mannequin.
No year 5 pupil (age, 9 - 10 years) could compress the mannequin's chest to the 38- to 51-mm depth recommended in guidelines. However, 19% of pupils in year 7 (age, 11 - 12 years) and 45% in year 9 (age, 13 - 14 years) achieved adequate compression depth. Only the 13- to 14-year-olds performed chest compression as well as adults did in other reported studies.
Compression depth was significantly correlated with age, weight, and height (P < .001). Multivariate analyses revealed that height was no longer significant if the age and weight of the children were both known. There was no observed association between pupils' age, sex, weight, or height and the average rate of chest compressions during the 3-minute period, nor was there a relationship between year group and ability to place the hands in the correct position. During the 3 minutes of compression, compression rate increased, whereas depth decreased.
"The children's ability to achieve an adequate depth of chest compression depended on their age and weight," the authors write. "The ability to provide the correct rate and to employ the correct hand position was similar across all the age ranges tested. Young children who are not yet physically able to compress the chest can learn the principles of chest compression as well as older children."
Study limitations were that a mannequin may offer greater or lesser resistance than a real patient in cardiopulmonary arrest, emotional factors in real-life resuscitation may also affect performance, there was a lack of data on quality of compression beyond 3 minutes, and compressions given in cycles alternating with rescue breaths might be less accurate than continuous compressions.
"Teaching younger children provides knowledge for when they are adequately developed," the authors conclude. "They might also advise an adult or perform adequately on a chest more compliant than that of the manikin [mannequin]. By starting training young, revision is possible at school, with the prospect of greater skill attainment and retention."
The British Heart Foundation supported this study. The authors have disclosed no relevant financial relationships. There was no financial involvement by any medical equipment company.
BMJ. Published online April 27, 2007.
