|Year : 2019 | Volume
| Issue : 4 | Page : 242-246
Knowledge and practice of cardiopulmonary resuscitation among clinical students of a medical school in Kano, Nigeria
Ibrahim Aliyu1, Godpower Chinedu Michael2, Bukar Alhaji Grema2, Zainab F Ibrahim3
1 Department of Paediatrics, Aminu Kano Teaching Hospital, Bayero University, Kano, Nigeria
2 Department of Family Medicine, Aminu Kano Teaching Hospital, Kano, Nigeria
3 Department of Nursing, Aminu Kano Teaching Hospital, Kano, Nigeria
|Date of Submission||01-Oct-2018|
|Date of Acceptance||09-Sep-2019|
|Date of Web Publication||15-Oct-2019|
Dr. Ibrahim Aliyu
Department of Paediatrics, Aminu Kano Teaching Hospital, Bayero University, Kano
Source of Support: None, Conflict of Interest: None
INTRODUCTION: Among common determinants of survival include the ability to effectively execute the basic life support drill during resuscitation. Therefore, this study seeks to determine the knowledge of cardiopulmonary resuscitation (CPR) among medical trainees who are in their clinical years in our tertiary hospital with the aim of identifying knowledge gaps if any.
MATERIALS AND METHODS: The study was cross-sectional and was conducted over 12 weeks from April to June 2017. A pretested self-administered questionnaire which was developed in English language was distributed to the subjects.
RESULTS: There were 118 male (67.4%) and 57 female (32.6%). Furthermore, 95.4% of the respondents were unaware of circulation, airway and breathing sequence (CAB) in adult resuscitation; and 82.3% were aware of ABC steps in pediatric resuscitation; 52% of the respondents were wrong in adult chest compression to ventilation ratio; similarly, 46.3% were incorrect on pediatric chest compression: ventilation ratio. One hundred and forty-six (83.4%) of the respondents had seen a defibrillator; however, only 3 (2.1%) had ever used it. The knowledge score of the respondents ranged from 0.0 to 55.0; while the mean was 19.4 ± 11.8. One hundred and seventy (97.1%) of the respondents scored <50%. The knowledge score was generally poor for all the classes through this observation was not statistically significant (Fisher's exact test = 1.926, P = 0.449); similarly, the timing of CPR training had no relationship with their knowledge score however this finding was not statistically significant (Fisher's exact test = 3.262,P= 1.00).
CONCLUSION: There was poor knowledge of CPR among respondents despite reporting been trained.
Keywords: Basic life support, cardiopulmonary resuscitation, medical students
|How to cite this article:|
Aliyu I, Michael GC, Grema BA, Ibrahim ZF. Knowledge and practice of cardiopulmonary resuscitation among clinical students of a medical school in Kano, Nigeria. Int J Health Allied Sci 2019;8:242-6
|How to cite this URL:|
Aliyu I, Michael GC, Grema BA, Ibrahim ZF. Knowledge and practice of cardiopulmonary resuscitation among clinical students of a medical school in Kano, Nigeria. Int J Health Allied Sci [serial online] 2019 [cited 2020 May 27];8:242-6. Available from: http://www.ijhas.in/text.asp?2019/8/4/242/269252
| Introduction|| |
Knowledge of basic life support (BLS) is the bedrock of effective resuscitation; acquiring this very important skill commences from our medical schools. The benefits of BLS cannot be overemphasized; that is why in most western countries, even secondary school students and laymen are taught and engaged on BLS activities. It is estimated that about 500,000 people die annually in the United State of America,, from cardiac arrest-related events; among common determinants of survival include the ability to effectively execute the BLS drill during resuscitation., Tsegaye et al., in their reported documented a good knowledge of cardiopulmonary resuscitation (CPR) (93.3%) among medical students in Ethiopia; while Suzuki et al. in Japan reported a dismal 20% of respondents with good knowledge of CPR among medical student; however, there is a dearth of studies on CPR among Nigerian medical students. Therefore, this study seeks to determine the knowledge of CPR among medical trainees who are in their clinical years in our tertiary hospital with the aim of identifying knowledge gaps if any; this will assist on overhaul of the medical curriculum.
| Materials and Methods|| |
The study was cross-sectional, carried out in the clinical section of Bayero University Medical School, Kano, Nigeria. This institution is among the third-generation universities in Nigeria while the medical school is the 14th medical school in Nigeria.
The study population was the 4th, 5th, and 6th year medical students with class population of 129, 93, and 82 students, respectively. This study was conducted over a 12-week from April to June 2017.
Sample size estimation
The sample size will be calculated using the formula:
n = N
1 + N (e) 2
n = desired minimum sample size (when population is <10,000)
N = population size (304 students)
e = level of precision usually set at 5% = 0.05.
Therefore, 173 subjects were recruited with proportionate sampling based on the respective class population; from the 4th year, (129/304 × 173 = 73), 5th year (93/304 × 173 = 53), and 6th year (82/304 × 173 = 47) students.
All students in the respective classes were included.
- Students who declined consent
- Students who were absent during the study.
The study was cross-sectional.
The subjects were recruited using simple random sampling technique.
A pretested self-administered questionnaire which was developed in English language was distributed to the subjects; relevant information on knowledge of BLS; activities in BLS were contained. This was adopted from the American Heart Association (AHA) Guidelines for CPR and emergency cardiac care.,, The questionnaire was pretested among volunteers in the 4th year to ascertain the internal consistency; and a Cronbach's alpha value of 0.8 was derived. In clinical practice, a minimum score of 84% was defined as adequate knowledge score; this is outlined in the AHA BLS courses, and this was adopted in this study.,, Knowledge score in medical students has been classified severally but in Bayero University and most Nigerian University; the pass mark in clinical examination is considered as 50%; therefore, the knowledge score was additionally classification into <50% (failure), 50%–<69% (pass mark), and ≥70 (excellent).
Permission to conduct the study was obtained from the Ethical Committee of Aminu Kano Teaching Hospital, Kano, Nigeria.
All data obtained were analyzed using statistical package for social sciences (SPSS) version 16 (SPSS Inc., Chicago Illinois, USA). Qualitative variables such as place and time of training on CPR were summarized as frequencies, percentages while quantitative variables such as age were summarized as means and standard deviations while the Chi-square or Fisher's exact tests were used to compare qualitative variables such as the knowledge score and class, time of training with P < 0.05 being set as statistically significant.
| Results|| |
There were 118 male (67.4%) and 57 female (32.6%); male:female ratio of 2:1. Forty-seven (26.9%) were in 600 level, 54 (30.9%) were in 500 level while 74 were in 400 level. Their age ranged from 19 years to 37 years, and the mean age was 24.7 ± 2.8 years. One hundred and forty-six (83.4%) of the respondents had heard of CPR, while 29 (16.6%) had not.
Most respondents (73.3%) had their training on CPR in <1 year before the commencement of this study, and majority had their exposure to CPR at the hospital. Furthermore, 95.4% of the respondents were unaware of CAB in adult resuscitation; however, 82.3% were aware of ABC steps in pediatric resuscitation [Table 1]. One hundred and thirty-six (93.2%) of the respondents reported that they benefitted from the training, while 10 (6.8%) did not. Thirty-two (18.3%) of the respondents were aware of a single rescuer resuscitation while 143 (81.7%) were not.
|Table 1: Training of respondents on the steps in adult and childhood resuscitation|
Click here to view
Majority of respondents were not sure (56.3%) of the steps in single-rescuer resuscitation; however, 52.0% of the respondents were wrong in adult chest compression and ventilation ratio; similarly, 46.3% and 50.3% were incorrect and not sure of pediatric chest compression: ventilation ratio, respectively. One hundred and forty-six (83.4%) of the respondents had seen a defibrillator, while 29 (16.6%) had not; however, only 3 (2.1%) had ever used it while 143 (97.9%) had not. The knowledge score of the respondents ranged from 0.0 to 55.0; while the mean was 19.4 ± 11.8. One hundred and seventy (97.1%) of the respondents scored <50% while only 5 (2.9%) of them scored between 50% and 69%. However, none had up to 84% [Table 2].
|Table 2: Knowledge of the procedure in single rescuer resuscitation, chest and ventilation|
Click here to view
The knowledge score was generally poor for all the classes with majority scoring <50% and none scoring up to 70%; though this observation was not statistically significant (Fisher's exact test = 1.926, P = 0.449) [Table 3]; similarly, the timing of CPR training had no relationship with their knowledge score because irrespective of the time of training most scored <50%; however, this finding was not statistically significant (Fisher's exact test = 3.262, P = 1.00).
|Table 3: Comparing the classes of the respondent, the time of training on cardiopulmonary resuscitation and knowledge score|
Click here to view
Only a single 400 level was aware of CAB in adult resuscitation, while majority of them were aware of ABC of resuscitation in children; though these were not statistically significant (Fisher's exact test = 2.173, P = 0.952 and Fisher's exact test = 5.930, P = 0.131, respectively), [Table 4]. Furthermore, most of the respondents in all the classes were either not sure or incorrect in the ratio of chest compression to ventilation in both adults and children; and these observations were statistically significant (χ2 = 24.964, df = 4, P = 0.00; Fisher's exact test = 69.258, P = 0.00).
|Table 4: Comparing the classes of the respondents with knowledge of resuscitation|
Click here to view
| Discussion|| |
Despite that 73.3% of respondents in this study reported undertaking training on CPR barely <1 year before commencing this research, there was poor knowledge of CPR and poor clinical practice of CPR among respondents; this observation was similar to that reported by Mendhe et al., and Suzuki et al. However, Tsegaye et al. reported that 98% of respondents in Ethiopia had good knowledge of BLS. Furthermore, this finding in our study which showed that 73.3% of respondents had taken a course on BLS differed from those of Zaheer and Haque; and Okonta and Okoh who reported only 14.7% and 26% of their respondents, respectively, have taken a course on BLS. In spite of this disparity, the knowledge base was generally poor in all the study populations. This observation was similarly reported by Olajumoke et al. and Boyde et al. Most respondents were not aware of recent changes in CPR such as the change from ABC to CAB in adult BLS; this observation was also reported by Sadoh et al. who documented that 6 years after a change in the AHA in 2005 most health-care professionals (88.3%) were unaware of the changes in AHA 2005 guideline on CPR. This highlights the need for lecture topics to be in tune with current concepts; and teachers should constantly review information delivered to students, and avoid recirculation of old topics.
Most respondents in our study had seen a defibrillator in their various departments, but majority of them (97.8%) had never operated any; this observation was similar to observations of Moura et al., in their study on Brazilian students, they documented that 83.8% of their respondents had never operated a defibrillator. This figure is frightening, and if not addressed, it may result in producing poorly trained and incompetent health professionals. Promes et al., in their study reported that 36% of the American student were not involved in CPR maneuvers, such as cardioversion. Unlike in Moura et al.'s report (28.11%); 48% of our respondents gave correct answers on the required ratio of chest compression to ventilation during CPR procedure.
All the clinical classes in our study had poor knowledge of CPR; this observation was different from that of Zamir et al. who reported increasing knowledge of CPR among medical students from the 2nd year up to the final year. Tsegaye et al., Chandrasekaran et al., and Okonta and Okoh also reported similar experiences among students in Ethiopia, India, and Nigeria, respectively; therefore, a good curriculum, good clinical exposure, and repeated hands-on training improves the knowledge base and clinical skills on CPR. Hence, we need to improve our teaching methodology. Owojuyigbe et al. reported the benefits of efficient training on BLS among dental students with increasing posttest mean score; however, repeated training and retraining are necessary to ensure the confidence required in performing CPR during real-life situation. The AHA guideline identified the need for frequent recertification; it stated that even two-yearly recertification was suboptimal to achieve the desired clinical.
This study assessed the theoretical knowledge base of the respondents; however, the result was dismally poor which would have translated to a poor practice score.
We also advocate the recommendation of Pande et al.; BLS training should start from the 1st year medical training with hands-on simulation training inclusive; and this should be reinforced in all the successive classes; this will improve their competence and their confidence of performing CPR. If possible this training should start from secondary schools through the active participation of the education sector; this will form a solid knowledge base which should improve the outcome of out of hospital CPR.
| Conclusion|| |
There was poor knowledge of CPR despite majority of respondents reporting having been trained on BLS within 1 year before the commencement of this study. Furthermore, few respondents were actively participating in CPR in their clinical programs; and the class of the respondents had no relationship with improving knowledge score.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Chamberlain DA, Hazinski MF, European Resuscitation Council, American Heart Association, Heart and Stroke Foundation of Canada, Resuscitation Council of Southern Africa. Education in resuscitation: An ILCOR symposium: Utstein Abbey: Stavanger, Norway: June 22-24, 2001. Circulation 2003;108:2575-94.
Travers AH, Perkins GD, Berg RA, Castren M, Considine J, Escalante R, et al.
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:S51-83.
Dumas F, Rea TD, Fahrenbruch C, Rosenqvist M, Faxén J, Svensson L, et al.
Chest compression alone cardiopulmonary resuscitation is associated with better long-term survival compared with standard cardiopulmonary resuscitation. Circulation 2013;127:435-41.
Morley PT, Lang E, Aickin R, Billi JE, Eigel B, Ferrer JM, 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:S40-50.
Roger VL, Go AS, Lloyd-Jones DM, Adams RJ, Berry JD, Brown TM, et al.
Heart disease and stroke statistics-2011 update: A report from the American Heart Association. Circulation 2011;123:e18-e209.
Rea TD, Fahrenbruch C, Culley L, Donohoe RT, Hambly C, Innes J, et al.
CPR with chest compression alone or with rescue breathing. N
Engl J Med 2010;363:423-33.
Tsegaye W, Tesfaye M, Alemu M. Knowledge, attitude and practice of cardiopulmonary resuscitation and associated factors in Ethiopian university medical students. Gen Pract 2015;3:4. Available from: http://dx.doi.org/10.4172/2329-9126.1000206
. [Last assessed 21/12/2017].
Suzuki A, Suzuki Y, Takahata O, Fujimoto K, Nagashima K, Mamiya K, et al
. A survey of 3,303 6th
-year medical students from 36 universities concerning knowledge of resuscitation – More than 80% of medical students can not perform standard cardiopulmonary resuscitation? Masui 2001;50:316-22.
Tanimu TS, Michael GC, Ibrahim A, Grema BA, Mohammed AA. Awareness of family medicine discipline among clinical medical students of Bayero university, Kano, Nigeria. S Afr Fam Pract 2017;59:160-5.
Kasiulevicius K, Sapoka V, Filipaviciute R. Sample size calculation in epidemiological studies. Gerontologija 2006;7:225-31.
American Heart Association. Basic Life Support (BLS) for Healthcare Professionals. Available from: https://www.onlineaha.org/courses
. [Last acsessed on 2017 Oct 12].
American Heart Association. Advanced Cardiovascular Life Support (ACLS) Resource for Training Instructors. Available from: https://www.onlineaha.org/courses
. [Last assessed on 2017 Oct 12].
Botha L, Geyser MM, Engelbrecht A. Knowledge of cardiopulmonary resuscitation of clinicians at a South African tertiary hospital. S Afr Fam Pract 2012;54:447-54.
Mendhe HG, Burra L, Singh D, Narni H. Knowledge, attitude and practice study on cardiopulmonary resuscitation among medical and nursing interns. Int J Community Med Public Health 2017;4:3026-30.
Okonta KE, Okoh BA. Theoretical knowledge of cardiopulmonary resuscitation among clinical medical students in the University of Port Harcourt, Nigeria. Afr J Med Health Sci 2015;14:42-6. [Full text]
Zaheer H, Haque Z. Awareness about BLS (CPR) among medical students: Status and requirements. J Pak Med Assoc 2009;59:57-9.
Olajumoke TO, Afolayan JM, Raji SA, Adekunle MA. Cardiopulmonary resuscitation – Knowledge, attitude & practices in Osun state, Nigeria. J West Afr Coll Surg 2012;2:23-32.
Boyde M, Wotton K. A review of nurses' performance of cardiopulmonary resuscitation at cardiac arrests. J Nurses Staff Dev 2001;17:248-55.
Sadoh WE, Osariogiagbon W. Knowledge and practice of cardiopulmonary resuscitation amongst doctors and nurses in Benin City, Nigeria. Nigerian hospital Practice 2009; 3:1-2.
Moura FS, de Carvalho FV, Martins MC, Vasconcelos GM, Mello PM. Knowledge of guidelines for cardiopulmonary resuscitation among Brazilian medical students. Rev Bras Educ Méd 2016;40:77-85.
Promes SB, Chudgar SM, Grochowski CO, Shayne P, Isenhour J, Glickman SW, et al.
Gaps in procedural experience and competency in medical school graduates. Acad Emerg Med 2009;16 Suppl 2:S58-62.
Zamir Q, Nadeem A, Rizvi AH. Awareness of cardiopulmonary resuscitation in medical-students and doctors in Rawalpindi-Islamabad, Pakistan. J Pak Med Assoc 2012;62:1361-4.
Chandrasekaran S, Kumar S, Bhat SA, Saravanakumar A, Shabbir PM, Chandrasekaran V. Awareness of basic life support among medical, dental, nursing students and doctors. Indian J Anaesth 2010;54:121-6.
] [Full text]
Owojuyigbe AM, Adenekan AT, Faponle AF, Olateju SO. Impact of basic life support training on the knowledge of basic life support in a group of Nigerian dental students. Niger Postgrad Med J 2015;22:164-8.
] [Full text]
Pande S, Pande S, Parate V, Pande S, Sukhsohale N. Evaluation of retention of knowledge and skills imparted to first-year medical students through basic life support training. Adv Physiol Educ 2014;38:42-5.
[Table 1], [Table 2], [Table 3], [Table 4]