Effect of a low-cost instruction card for automated external defibrillator operation in lay rescuers: a randomized simulation study

Abstract

BACKGROUND: To evaluate whether a simplified self-instruction card can help potential rescue providers use automated external defibrillators (AEDs) more accurately and quickly. METHODS:From June 1, 2018, to November 30, 2019, a prospective longitudinal randomized controlled simulation study was conducted among 165 laypeople (18-65 years old) without prior AED training. A self-instruction card was designed to illuminate key AED operation procedures. Subjects were randomly divided into the card (n=83) and control (n=82) groups with age stratification. They were then individually evaluated in the same simulated scenario to use AED with (card group) or without the self-instruction card (control group) at baseline, posttraining, and at the 3-month follow-up. RESULTS:At baseline, the card group reached a significantly higher proportion of successful defibrillation (31.1% vs. 15.9%, P=0.03), fully baring the chest (88.9% vs. 63.4%, P<0.001), correct electrode placement (32.5% vs. 17.1%, P=0.03), and resuming cardiopulmonary resuscitation (CPR) (72.3% vs. 9.8%, P<0.001). At post-training and follow-up, there were no significant differences in key behaviors, except for resuming CPR. Time to shock and time to resume CPR were shorter in the card group, while time to power-on AED was not different in each phase of tests. In the 55-65 years group, the card group achieved more skill improvements over the control group compared to the other age groups. CONCLUSION:The self-instruction card could serve as a direction for first-time AED users and as a reminder for trained subjects. This could be a practical, cost-effective way to improve the AED skills of potential rescue providers among different age groups, including seniors.

Cognitive aids used in simulated resuscitation: A systematic review

“…For the important outcome of adherence to a protocol or process assessed by a performance score, we identified very low certainty evidence (downgraded for very serious risk of bias, serious inconsistency and very serious impression) from five RCTs. 42 , 43 , 44 , 45 , 46 Three studies 42 , 43 , 44 investigating the use of mobile phone applications, demonstrated improved adherence to a process measured using a checklist or performance score. One study 45 investigating a mobile phone application using yes/no questions found no significant improvement.…”

“…One study investigating the use of an instruction card by individuals found improved adherence to the sequence of AED use and improved time to shock. 46 …”