Resuscitation 82 (2011) 1323–1327 Contents lists available at ScienceDirect Resuscitation jo u rn al hom epage : www.elsevier.com/locate/resuscitation Simulation and education Training to deeper compression depth reduces shallow compressions after six months in a manikin model  N. Mpotos a,∗ , S. Lemoyne a , B. Wyler b , E. Deschepper c , L. Herregods b , P.A. Calle a , M.A. Valcke d , K.G. Monsieurs a a Emergency Department, Ghent University Hospital, De Pintelaan 185, B-9000 Ghent, Belgium b Department of Anaesthesiology, Ghent University Hospital, De Pintelaan 185, B-9000 Ghent, Belgium c Biostatistics Unit, Ghent University, De Pintelaan 185, B-9000 Ghent, Belgium d Department of Educational Studies, Ghent University, H. Dunantlaan 2, B-9000 Ghent, Belgium a r t i c l e i n f o Article history: Received 23 January 2011 Received in revised form 16 April 2011 Accepted 1 June 2011 Keywords: Basic life support Cardiopulmonary resuscitation Compression depth Self-learning Skill retention a b s t r a c t Introduction: Studies show that students, trained to perform compressions between 40 and 50 mm deep, often do not achieve sufficient depth at retention testing. We hypothesized that training to achieve depths >50 mm would decrease the proportion of students with depth <40 mm after 6 months, compared to students trained to a depth interval of 40–50 mm. Methods: A basic life support (BLS) self-learning station was attended by 190 third year medicine stu- dents. They were first offered the possibility to refresh their skills, following the instructions of a 15 min abbreviated Mini Anne TM video (Laerdal, Norway) using a full size torso and a face shield. This was fol- lowed by further training using Resusci Anne Skills Station TM software (Laerdal, Norway). Voice feedback was provided according to randomisation to a standard group (SG) 40–50 mm and a deeper group (DG) >50 mm. Quality of compressions was tested after 6 months. Results: The SG and DG groups consisted of 90 (67% female) and 100 (58% female) participants respectively. At the end of training, all students reached the target depth without overlap between groups. After 6 months, the proportion of students achieving a depth <40 mm was 26/89 (29%) in the SG vs. 12/89 (14%) in the DG (P = 0.01). The proportion of students with a depth >50 mm was 5/89 (6%) for the SG and 44/89 (49%) in the DG (P < 0.001). Conclusions: The educational strategy to train students to a deeper depth, reduced shallow compressions 6 months after training. © 2011 Elsevier Ireland Ltd. All rights reserved. 1. Introduction The European Resuscitation Council (ERC) 2005 Guidelines rec- ommended training to a compression depth of 40–50 mm followed by complete decompression at a rate of 100/min. 1 Already within 3–6 months after training, however, shallow compressions are a major problem. 2–6 This is confirmed by clinical studies demonstrat- ing poor basic life support (BLS) quality, even when performed by trained healthcare providers including nurses and physicians. 7–9 The reason why rescuers deliver shallow compressions is unclear. A possible contributing factor may be the initial learning process, traditionally focussing on achieving compressions within a narrow depth interval and on the avoidance of compressions that are “too  A Spanish translated version of the abstract of this article appears as Appendix in the final online version at doi:10.1016/j.resuscitation.2011.06.004. ∗ Corresponding author. Tel.: +32 9 3320432; fax: +32 9 3324980. E-mail address: nicolas.mpotos@ugent.be (N. Mpotos). deep”. Deeper chest compressions, however, have been associated with a higher rate of defibrillation success and better short term survival compared to shallow compressions. 10,11 We hypothesized that training to a depth of >50 mm in a self-learning (SL) station would result in less shallow compressions at retention testing after 6 months, compared to training following the ERC 2005 guidelines (40–50 mm). 2. Research methods 2.1. Participants The study was approved by the Ethics Committee of Ghent University Hospital. During the academic year 2009–2010, after obtaining their informed consent, 190 third year medicine students were randomly assigned to a standard group (SG: 40–50 mm depth) and a deeper group (DG: >50 mm depth). Students were told that different educational strategies would be applied, but they were not informed about the different compression depths and no exclusion 0300-9572/$ – see front matter © 2011 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.resuscitation.2011.06.004