European Journal of Cardiovascular Medicine

Human life is precious; therefore, man strives to live healthy as health is an asset that man is blessed with. According to WHO census (2009) in India 4,280 per one lakh people die each year from sudden cardiac arrest.  It is a silent epidemic and 7-10 percent survival chances reduce with every passing minute.¹ Cardio means “of the heart” and pulmonary means “of the lungs”. Resuscitation is a medical word that means “revive” or bring back to life. Cardiac arrest occurs when blood supply to the brain ceases and it leads to depression of breathing. The combination of these two activities, that is no breathing and no circulation, causes myocardial ischemia which provides only 10-minute window period time. Therefore, any rescue procedure has to be done within this frame of time only. According to American Heart Association, CPR should be started within 10 seconds of recognition of cardiac arrest.² Early cardiopulmonary resuscitation (CPR) implementation can increase the survival rate of those suffering cardiac arrest by two to three times.³ Chest compressions have saved lives of many people, the rate of survival can even be three times higher when cardiac arrests are attended by persons who are able to provide immediate resuscitation.⁴ Life-threatening emergencies can occur anytime, anywhere, and to anyone. It is necessary for all medical, nursing and paramedical staff to learn about BLS as they come across life-threatening emergencies in their routine life According to AHA (2019) one to two lakhs lives could be saved every year if CPR is performed immediately after cardiac arrest, 4% - 16% patients who immediately received CPR were eventually discharged from the hospital.^5,6

As office employees and family members are the first responders in many of the cardiac arrest situation he or she should know how to resuscitate and be familiar with resuscitation equipment, and procedures. Thus, cardiopulmonary resuscitation training was given to office employees and the objective of the study was to assess the effectiveness of CPR training program on knowledge and practice employees and to find correlation between the knowledge and practice of employees regarding CPR.

The present study was conducted among different corporate office employees by Webinar with video demonstration (n=178) and live demonstration and hands-on practical with mannequin (n=40). Study was conducted from August 2022 to January 2023. Data was collected using predesigned and pretested questionnaire.

We requested corporate employees all India to attend the CPR training webinar. We wanted to create a framework for these webinars and the framework was awareness generation followed by skills trainings and skill implementation. Now first two aspects awareness generation and skills training is definitely possible when we are doing online webinars. But if we want to call them something different then we can call them as 360⁰ intervention workshops. If we can have the third component also involved, that could be possible if all these employees all over India from various offices could do the webinar training on mannequins for volunteers for our experiment.

Template was generated and analysis was done on SPSS software

The feedback form, a validated questionnaire on feedback was sent and the responses were taken what was the experience of the employees and the results are shared in the tables and some of the comments from the employees is what we like to highlight some of the striking comments. The best part is that employees were very happy with online presentation also. However, some requested that if the online could also be made onsite it would be great. We took that into the consideration and some of the places we could do online with the same faculty with the same. This initial experiment prove that online workshops are very effective provided the faculty explains in a clear manner and demonstrates in a right way. However, an observation is an observation and practical training is practical training, but the fact is there is an incident we would like to share is that you need to ate least know how many chest compressions has to be given per minute. If one does not know that one will do act of CPR in non-scientific way. Furthermore, there is been development now a days mouth to mouth breathing is not given in CPR. All these learning came through webinar which otherwise could not have come. So the latest information was shared with the employees. So these webinars are useful.

We have conducted online webinars as well as live demonstration with mannequin for awareness generation amongst different corporate employees. The study was conducted through online webinar on 24 August 2022 and on 18^th January 2023 with live demonstration and hands on practical with mannequin. Total 178 participants attended in online webinar and 40 participants attended live demonstration and hands on practical with mannequin.

Table 1 : Responses received from participants on “The Webinar and live demonstration content”.

It was observed that overall 95% participants of online webinar and 98% participants of live demonstration workshop opined that webinar and live demonstration content were directly related to content, detailed and simple. (Table 1)

Table 2 : Responses received from participants on “Webinar Videos and Live Demonstration workshop Slides”.

It was observed that overall 95% participants of online webinar and 98% participants of live demonstration workshop opined that webinar videos and live demonstration workshop slides were supported presentation material, enriched knowledge of participants and were precise and very clear. (Table 2)

Table 3 : Responses received from participants on Webinar pace & precision, timing and good mix of listening and activities.

It was observed that overall 95% participants of online webinar opined that webinar conducted efficiently and it was an innovative learning experience and 92% opined that time was adequate for webinar. Overall 98% participants of live demonstration workshop opined that conducted efficiently, time was adequate and it was an innovative learning experience. (Table 3)

Figure 1: Responses received from participants on whether “The webinar and live demonstration workshop learning were extremely practical and will be useful for implementing if emergency situation arises”.

It was observed from figure 1 that that overall 95% participants of online webinar and 98% participants of live demonstration workshop were agree that the webinar and live demonstration workshop learning were extremely practical and will be useful for implementing if emergency situation arises. (Figure 1)

Table 4 : Responses received from participants about facilitator.

It was observed that overall 95% participants of online webinar and 98% participants of live demonstration workshop opined that facilitator was knowledgeable, well-prepared and responsive to participants. (Table 4)

Table 5 : Responses received from participants about rating of webinar and live demonstration.

Overall 69% participants of online webinar and 91% participants of live demonstration workshop rated webinar and live demonstration 9 on 10 and above. (Table 5)

Feedback from respondents regarding what they like best about this webinar and live demonstration?

• Good information
• Factual information
• Question and answer session
• Overall session
• The CPR method and how to identify its heart attack, difference between cardiac and heart attack
• Learnt actual difference between cardiac arrest and heart attack and how to respond in this type of situation
• Preparedness for emergency situation at any place, this basic knowledge can save precious lives.
• The webinar was practical and will be useful for implementing.

Feedback from respondents regarding how could this webinar and live demonstration be improved ?

• It was informative and precise doesn't require any improvements.
• More videos can be included
• No lengthy talks, need to give breaks in between before each session starts
• Required little more interactive
• To conduct offline demonstration and give chance to trainees to do the CPR

CPR is an important procedure in the event of a sudden cardiac arrest in order for the patient to survive. This process is usually carried out with the assistance of breathing and chest compressions. Structured training in increasing self-efficacy, knowledge and performance that was normally conducted during face- to-face learning in classes was constrained by the COVID-19 pandemic. This made people carry out social distancing in order to prevent further spread of the virus.^7,8 Online learning-based education was carried out to improve the skills and abilities of nursing students in performing CPR even though it was done remotly.⁷ Factors that affect the efficacy and knowledge of performing CPR through online learning include difficulty to simulate the correct performance of the procedure, the compression rhythm and depth are difficult to realistically assess, and the ventilation provided is difficult to simulate.⁹ Then analyzing the effects of online learning in performing CPR on the efficacy and the knowledge of nursing students, there was an increase in their skills and simulation via video and web-based lectures. This learning method makes it easier for students to follow because of the flexibility of space and time compared to direct training. In addition, online learning methods attract young people and should be used as a means of training.^8,9

According to Akhu-Zaheya et al.,¹⁰ self-efficacy could be obtained, changed, increased or decreased through several sources, due to performance accomplishment, social persuasion and emotional states. In an empirical research, it was proven that self-efficacy is still a major predictor of success in online learning compared to traditional face-to-face learning in classes. Furthermore, the small group discussion (SGD) renewal program was more effective than watching the (PWW) program.¹¹

Based on the research statement by Park,¹² blended E-learning with self-directed repeated learning is more effective in improving nursing competence, self-efficacy, problem solving, and psychomotor skills for cardiopulmonary resuscitation and defibrillation. Rather than conventional practical education. This is similar to a research conducted by Moon and Hyun,⁸ on 120 respondents, using the CPR blended learning program method that integrates video and face-to-face lectures effectively in increasing the knowledge and attitudes of nursing students. Effective training involving emergency treatment through online learning is very effective and affects the self-efficacy, knowledge, problem solving and actual clinical practice performance skills required by nurses.¹² This is in line with Chien and colleagues’ research, which states that the mixed CPR training program is not inferior to the ones done traditionally, and integrates online learning and simulation in order for assessment of compression depth, CPR knowledge, practicality, quality of CPR performance, and skill retention becomes a significant result.¹³

The success of the CPR procedure was supported by good comprehensive training facilities through online learning because of the advantages of it being more practical, and professionals find it more flexible to use. A research conducted by Napp and colleagues showed that preparing BLS instructors with online learning was more effective than face-to-face training in class.¹⁴ In Nord and co-authors’ study, an interactive web course using e- learning simulation software preparation by a health care provider does not improve practical CPR skills, but knowledge about increasing knowledge of acute myocardial infarction (AMI), stroke and lifestyle factors; this learning flexibility is seen in terms of location and time and cost.¹⁵ Factors that influence self- efficacy in online learning experiences are age, level of education, and experience.¹⁶ The study by Boada et al.¹⁷ evaluates how characteristics of the sex of the victim in a scenario designed to practice cardiopulmonary resuscitation protocol (CPR) affected performance student nurses, the result is a virtual scenario can be an appropriate strategy to reduce gender differences in gender sensitive situations such as CPR performance. Online learning is an effective method for learning-teaching skills where students BLS able to apply the BLS procedure accurately during CPR simulation. According to AHA, preparation and qualification resolution assistance significantly affects success resuscitation and increase the chances of survival.¹⁸ In line with Twohig et al.’s study, reviewing evidence comparing ECPR results with conventional CPR (CCPR), before examining resuscitation-specific parameters to assess patient. Where are the results ECPR is a sophisticated treatment option that can improve outcomes in certain patient populations in refractory heart attack.¹⁹

An overall 100% rated Webinar and live demonstration as 8/10 and above. An overall 95% rated that: Dr Kishore Madhwani was responsive to participants. An overall 95% found: the webinar was a good mix between listening and activities. An overall 95 % found:  the webinar an extremely useful learning experience. A little over 92% reported that: timing allotted for the webinar was sufficient (One hour). An overall 90% found: the webinar simple, clear and very easy to understand.

The latest information can be shared online and that is useful otherwise that information will not reach them so they are abraise with the latest knowledge. Technique is well understood by them. The only thing is left out is practical experience. That could be overcome if mannequins could be purchased. So this also motivates the person to do the act of CPR which otherwise they would not have been motivated. Because we have two instructors one was a doctor and other was a paramedical trainer and both these dis the workshop so well. They explained in such a simple manner that anybody could understand whether is was a manager or an officer or a security guard. So basically the method of online training is good because observation is definitely there. Only it has to be supplemented if possible by onsite training. Online training is effective provided you have a framework and the framework is awareness generation. This should be followed imparting skill training and then skill implementation. Just awareness generation do not solve the problem. Awareness generation solved 50% of the problem only, 25% is further solved by giving skills training and another 25% is solved by skill implementation. Hence, we would say if we follow this model that we are at least 75% effective in the training and 25% can be done by onsite.  

Acknowledgements : Authors would like to acknowledge the patients who participated in this research study. 

Funding: No funding sources 

Conflict of interest: None declared  

1. http://www.business-standard.com/article/press-releases/sudden-cardiac-rrestclaiming-about-4-280-lives-from-every-1-lakh-of-population-annually109072000082_1.html
2. American Heart Association- BLS for Health care Providers-Students manual. Delhi; 2013. Part one, p-3.
3. Herlitz J, Holmberg M, Holmberg S. Effect of bystander cardiopulmonary resuscitation in out of hospital cardiac arrest patients in Sweden. Resuscitation [Internet], 2000;47(1):59-70
4. Hazinsk MF et al. Highlights of the 2015 American Heart Association Guidelines Update for CPR and ECC. Circulation [Internet]. 2015; P1-36.
5. Online CPR certification and training center. Key CPR facts and stats 2018-2019. Canada; 2018. Available from: https://www.cprcertificationonlinehq.com/cpr-factsstats/