CARDIOPULMONARY RESUSCITATION - KNOWLEDGE, ATTITUDE & PRACTICES IN OSUN STATE, NIGERIA

Abstract

Background

Cardiopulmonary arrest is not an uncommon event in the medical practice with the causes ranging from reversible to irreversible causes. Therefore the skill in the performance of effective cardiopulmonary resuscitation is an essential part of successful medical practice. In some developed countries the CPR Training programmes were mandatory for all health care givers and even for non medical workers. However in the setting of ours, the situation is not so as most heath workers go for CPR Training programmes by wish except in some few centres were it is mandatory.

Aim & Objectives

To assess the knowledge, attitudes and practices of medical practitioners in relation to cardiopulmonary resuscitation and defibrillation

Setting

The study was carried out among medical practitioners in Osun State, Southwest Nigeria.

Methods

The study was conducted through a survey of medical practitioners in Osun state during an annual general meeting using a self administered questionnaire

Results

The response rate was 65% with 65 out of 100 physicians returning the completed questionnaire. Only 40% of respondents had attended a basic and an advanced life support training programme while 30% knew how to operate an automated external defribellator (AED), seventy percent knew the meaning of AED. Most of the respondents that had attended a basic and an advanced life support programme were residents (80%) while 16% were consultants and the remaining 4% were general practitioners. More males (67%) among the respondents that knew how to operate an AED and majority (56%) were in the age range of 30-40years. Eighty two percent of the respondents would prefer to do a chest compression only resuscitation of which 44% were

Conclusion

Most of the medical practitioners in Osun State were not knowledgeable about cardiopulmonary resuscitation and defibrillation . The few with the knowledge were from the tertiary institutions. There is therefore the need for the creation of more awareness among medical practitioners, especially among those outside tertiary health facilities.

Introduction

Early intervention, the quality of cardiopulmonary resuscitation and time to defibrillation (CPR) determines survival after cardiopulmonary arrest, survival is however very low1-4 .Basic life support (BLS), a key component of the chain of survival strategies decreases the arrest- CPR interval and increases hospital discharge3.The need for health professionals to know how to perform basic and advanced life support cannot be over-emphasized as they often encounter such a situation in their practice 5.

Demand for courses in CPR is increasing worldwide. However in developing countries like ours, standardized resuscitation training is not yet a routine. Only a few reports from developing countries have addressed the level of awareness, knowledge and practice of health care professionals in the performance of CPR 6.

This study was aimed at exploring the level of knowledge, attitude and practices of health care professionals in Osun State in CPR. This was to serve as a guide for the future planning of CPR training programmes in the state.

Methods

The study was conducted through a survey on medical practitioners in Osun state during an annual general meeting using a self administered questionnaire

Study tool

The questionnaire was prepared encompassing three areas.

1. The demography and professional qualification of the participants

2. Experience, level of training, attitude of the participants to CPR.

3. Theoretical and practical knowledge of the participants in CPR

The validity of the questionnaire was determined by doing a pilot study within the general hospital Asubiaro in the state capital, after which appropriate changes were made in the questionnaire. The names of the participants were not requested for in the questionnaire thus the confidentiality of the participants was maintained.

The questionnaire were distributed at the start of the general meeting and were collected back at the end of the meeting but those leaving before the end of the meeting were asked to submit them to the administrative officer of the association holding the meeting.

The collected data were analysed with the Statistical Package for Social Sciences (SPSS) version 16.

Descriptive and frequency analysis was made for counts and percentages and mean and median. Data were represented as tables, bar chart and pie chart as appropriate.

Results

The response rate was 65% with 65 out of 100 physicians returning completed questionnaire. Of the respondents 39(60%) were from the two teaching hospitals in the state, 21(32.31%) working with the state Hospital Management Board in either a local government health centre or general hospitals, while 5(7.69%) were private practitioners (Table 1) .The age of the participants ranged from 27-60years (mean 32±6) .The total number of females in the respondents was 25(38.46%) while males were 40(61.54%).

TABLE 1. Place of work .

	FREQUENCY		PERCENTAGE
TEACHING HOSPITAL		39	60
STATE MANAGEMENT BOARD		21	32.31
PRIVATE		5	7.69
TOTAL 65 100

In terms of clinical experience and qualifications, 7(6.15%) of the respondents were house officers, 20(30.77%) were medical, senior medical or principal medical officers, 28(43.08%) were residents and10 (15.39%) were consultants (Table 2). Only 40% of respondents had attended a basic and an advanced life support training programme while only 30% knew how to operate an AED device .Seventy percent were able to know the meaning of AED. Most of the respondents that had attended a basic and an advanced life support training programmes were residents (80%) while 16% were consultants and the remaining 4% were general practitioners (Fig 2).

TABLE 2. Level of experience.

	FREQUENCY		PERCENTAGE
HOUSE OFFICERS	7		6. 15
MO,SMO,PMO		20		30.77
RESIDENTS		28		43.08
CONSULTANTS		10		15.10
TOTAL	65		100

Out of the respondents 35(53.85%) had been actively involved in the resuscitation of patients, 27(41.54%) were rarely involved in the resuscitation of patients while 3(4.62%) had never been involved in the resuscitation of patients after their graduation from medical school (Fig 2).

Though a total of 40 (61.54%) of the participants knew the year of the latest guidelines of the American Heart Association only 25 (38.46%) agreed to start CPR on patients with agonal breathing .Thirty five (53.85%) got the compression to ventilation ratio of 30:2 for adult single or double resuscitator right while only 26 (40%) got the rate and accurate depth of compression right. Sixty seven percent of the respondents that knew how to operate an AED device were males and majority (62%) were in the age range 30-40years. Most of the respondents will prefer to do a chest compression only resuscitation.

Over all only 24 (36.9%) of the respondents got above average in the correct answers to questions on CPR, 20 (83.33%) of whom had attended a training programme in CPR.

FIGURE 1 . ATTENDANCE OF LIFE SUPPORT TRAINING PROGRAMME.

FIGURE 2 . LEVEL OF INVOLVEMENT IN CPR .

Discussion

It is very important that medical practitioners are competent in the performance of CPR with requisite knowledge and information as cardiopulmonary arrest is common in our daily practice. The response rate of 65 %( 65 of 100 returned completed questionnaire) though was low, this may not be unconnected with the long duration of the meeting and extensive movements due to some politicking during the meeting. Despite this, the study has shown that most of the medical practitioners in Osun state were not competent in the performance of cardiopulmonary resuscitation.

A study also demonstrated inadequate knowledge in CPR among health care professionals7. This inadequate knowledge is principally due to limited attendance of medical practitioners at seminars and workshops on CPR as shown in the results where only 40% of the respondents have attended workshops on CPR.The majority of the respondents that have attended CPR training programmes were residents and consultants 96 and 16% against 4% in general practitioners. The location of most of the training programme in CPR at tertiary hospitals may be responsible for the high percentage attendance by residents and consultants as against the low percentage of attendance by general practitioners .The general practitioners work in the local government hospitals which are mostly found in the rural areas. Most of the respondents that knew how to operate an AED device were of young ages 30-40, this was also corroborated by another study done in Benin City Nigeria where it was also found out that knowledge on CPR and AED was better among young doctors and nurses. Overall they also found out that the general knowledge on CPR was poor among health workers, though more poor among nurses 8. A study by Solagberu also found the knowledge of CPR to be low among doctors and also attributed the cause of this to lack of materials or aids in cardiopulmonary resuscitation9 .

A total of 35 of the respondents were actively involved in CPR out of which 30 of them were from the teaching hospitals while of the 27 respondents that were rarely involved in CPR 20 are from the general and local government hospitals indicating that the referral of critical patients to the tertiary hospital were responsible for the low involvement of general practitioners in CPR.

Only 24 of the respondents got above average in questions asked about CPR of which 20 of them belong to the class of respondents that have attended training in CPR .This shows the knowledge acquired during the training was responsible for the better performance in the questionnaires.Chaudhari A and colleagues demonstrated improvement of knowledge and skill of CPR following training10. In another study by Elif and colleagues they also concluded that the knowledge of trained personnel was better than the untrained ones11 . Most of the respondents that got above average in the questionnaires are also involved actively in CPR indicating that their practical exposure and participation in CPR might have contributed to their better knowledge of CPR. Elif and Muhamed in separate studies also observed that previous experience in resuscitation improved the percentage of answers to questions on CPR11,12 .

Despite the inability of most of the respondents to answer the questions on CPR correctly, 61(93.87%) were willing to perform CPR if the need arose while 4(6.13%) were not willing to perform CPR.The main reason for not willing to perform CPR by the few respondents is the fear of it not been effective from their experience in the past. All of the respondents were in support of the need to include training in CPR in the curriculum of the medical school.

In conclusion, most of medical practitioners in the Osun state of study are not competent in the performance of cardiopulmonary resuscitation and defibrillation while the few with the knowledge are from the tertiary institutions. There is the need to create more awareness especially outside tertiary health facilities. Since prior CPR training and exposure influence the retention of knowledge there is need for all health care professionals to have regular CPR training and assessment which should be reviewed from time to time as new guidelines emerges. It is also recommended that the state government should come out with a policy that will make attendance of CPR training programme mandatory for all health care givers in the state.