Educational polymorphisms of basic life support algorithms George Briassoulis MD PhD, 1 Panagiotis Briassoulis MD 2 and Efrossini Briassouli MD 3 1 Associate Professor, APLS Instructor, Course Director, Co-ordinator, BLS and PLS Instructor, School of Health Sciences, University of Crete, Heraklion, Crete, Greece 2 Postgraduate Student, BLS Instructor, APLS and PLS Provider, Department of Anaesthesiology, School of Medicine, University of Athens, Athens, Greece 3 Postgraduate Student, BLS Instructor, APLS and PLS Provider, 1st Department of Internal Medicine – Propaedeutic, University of Athens, Athens, Greece Keywords basic life support, cardiac arrest, cardiopulmonary resuscitation, providers, training Correspondence George Briassoulis School of Health Sciences University of Crete Voutes Area Heraklion, 71110 Crete Greece E-mail: ggbriass@otenet.gr We authors declare we have no conflicts of interest. Support was not provided for this study from any institutional and/or departmental source. Accepted for publication: 3 February 2010 doi:10.1111/j.1365-2753.2010.01450.x Abstract Background A systematic review of the pooled effect of articles presenting current basic life support (BLS) algorithms for the treatment of cardiac arrest has never been carried. Aims We aimed to record and classify potential inherent factors influencing simplicity negatively in teaching, learning and retention of cardiopulmonary resuscitation (CPR) delivered by health care providers or lay persons. Methods We performed a search of the relevant literature exploring MEDLINE, COCHRANE LIBRARY and SCOPUS databases. Potential inhibitory factors in the struc- ture of available algorithms influencing simplicity in teaching, learning and retention of BLS were recorded and stratified accordingly. In a second phase of this study, we tested the hypothesis that different options of a BLS algorithm might influence CPR retention nega- tively, by asking 348 health care provider participants of our CPR seminars to describe their predicted response in an emergency to: (1) a real-time model implicating the various victims and rescuers; and (2) a hypothetical challenging ‘all-in-one’ BLS algorithm model. Results Fifteen articles presenting current BLS algorithms evidenced 163 suggestions that produced 23 different CPR options: five contrasting algorithms (21.8%); three two-option models (13%); six vague technical or scientific suggestions (26%); and nine multiple choices of action (39.1%). Identified references contributed differently in the development of educationally polymorphic BLS options in each of the four categories (P < 0.0001) and were all brought about by variants of victims and rescuers. Participants of CPR seminars answered that in an emergency they could remember the hypothetical BLS model (90%, P = 0.007) rather than a current BLS algorithm for adults (42.2%) or children (36%). Conclusions Educational polymorphisms of BLS algorithms could build unpredictable barriers between rescuers and cardiac arrest victims and might seriously limit instructors’ educational effectiveness. These findings might support an alternative trial hypothesis of a simple ‘all-in-one algorithm’ educational approach in future. Introduction Overall survival rates for out-of-hospital cardiac arrest rarely exceed 5%, rendering sudden cardiac arrest an unsolved public health problem, with approximately 166 200 cardiac arrests occur- ring annually in the USA [1]. Functional neurological survival for witnessed collapse with bystander cardiopulmonary resuscitation (CPR) was 6%, for witnessed collapse with no-bystander CPR was 3.8% and for unwitnessed collapse with bystander CPR 1.3% [2]. When found in a shockable rhythm, children (<18 years), young adults (18–35 years) and adults (>35 years) with out-of-hospital cardiac arrest survived up to 1 month in 24.5%, 21.2% and 13.6% of cases, respectively [3]. The corresponding figures for non- shockable rhythms were 3.8%, 3.2% and 1.6%, respectively [3]. However, because three-quarters of sudden out-of-hospital cardiac arrests with ischaemic heart disease occur at home, successful resuscitation is typically achieved in only 2% of cases [4]. Improving the quality of interventions is increasingly recog- nized as a key factor for improving 30-day survival after cardiac arrest [5] and advances in resuscitation science and state-of-the-art implementation techniques provide the opportunity for further improvement in outcomes among children after cardiac arrest [6]. Thus, 27% of in-hospital cardiac arrests in persons under 18 years of age have documented ventricular fibrillation or tachycardia Journal of Evaluation in Clinical Practice ISSN 1356-1294 © 2010 Blackwell Publishing Ltd, Journal of Evaluation in Clinical Practice 1