Enhancing EMS readiness: a pilot evaluation of CPR proficiency and training dynamics among paramedics in Poland

Effective Cardiopulmonary Resuscitation (CPR) is crucial for improving outcomes in cardiac arrest situations. This study aims to assess the proficiency of paramedics in the Lubelskie Voivodeship, Poland, in performing CPR, focusing on compression depth and ventilation techniques. A cohort of 69 paramedics was engaged in this analysis, utilizing an Ambu manikin to simulate CPR scenarios. This setup allowed for a comprehensive assessment of each participant’s technique, focusing on compression depth consistency and the efficiency and accuracy of ventilation techniques. The study revealed that paramedics demonstrated commendable proficiency in chest compression, achieving an average depth of 58.48 mm, which falls within the recommended range of 50 mm to 60 mm. However, there was a notable variation in compression depths, ranging from 47 mm to 72 mm. Additionally, ventilation techniques displayed significant inconsistencies, with 87.4% of ventilations performed below the recommended volume range. Many participants also deviated from the advised compression-to-ventilation ratio, further indicating the need for enhanced guidelines adherence. While paramedics exhibit a strong foundation in CPR techniques, the observed variations and inconsistencies underline the importance of continuous and focused training. This study advocates for the development and implementation of targeted training programs to address these gaps. Such initiatives should reinforce adherence to established CPR guidelines and emphasize integrating realistic simulation experiences to improve overall CPR performance, ultimately contributing to better patient outcomes in emergencies.

Cardiopulmonary resuscitation; Paramedic training; Chest compression; Ventilation techniques; Emergency medical services; Sudden cardiac arrest; CPR effectiveness

[1] Gräsner J, Wnent J, Herlitz J, Perkins GD, Lefering R, Tjelmeland I, et al. Survival after out-of-hospital cardiac arrest in Europe— results of the EuReCa TWO study. Resuscitation. 2020; 148: 218–226.

[2] Malik A, Gewarges M, Pezzutti O, Allan KS, Samman A, Akioyamen LE, et al. Association between sex and survival after non-traumatic out of hospital cardiac arrest: a systematic review and meta-analysis. Resuscitation. 2022; 179: 172–182.

[3] Allan KS, Mammarella B, Visanji M, Moglica E, Sadeghlo N, O’Neil E, et al. Methods to teach schoolchildren how to perform and retain cardiopulmonary resuscitation (CPR) skills: a systematic review and meta-analysis. Resuscitation Plus. 2023; 15: 100439.

[4] Kuang J, Yang J, Wang Q, Yu C, Li Y, Fan R. A preoperative mortality risk assessment model for Stanford type A acute aortic dissection. BMC Cardiovascular Disorders. 2020; 20: 508.

[5] Considine J, Gazmuri RJ, Perkins GD, Kudenchuk PJ, Olasveengen TM, Vaillancourt C, et al. Chest compression components (rate, depth, chest wall recoil and leaning): a scoping review. Resuscitation. 2020; 146: 188–202.

[6] Semeraro F, Greif R, Böttiger BW, Burkart R, Cimpoesu D, Georgiou M, et al. European resuscitation council guidelines 2021: systems saving lives. Resuscitation. 2021; 161: 80–97.

[7] Lott C, Truhlář A, Alfonzo A, Barelli A, González-Salvado V, Hinkelbein J, et al. European resuscitation council guidelines 2021: cardiac arrest in special circumstances. Resuscitation. 2021; 161: 152–219.

[8] Gässler H, Kurka L, Rauch S, Seewald S, Kulla M, Fischer M. Mechanical chest compression devices under special circumstances. Resuscitation. 2022; 179: 183–188.

[9] Gianni A, Botteri M, Stirparo G, Mattesi G, Zorzi A, Villa GF. The impact of the Italian law mandating an automatic external defibrillator in all sports venues on sudden cardiac arrest resuscitation rates. European Journal of Preventive Cardiology. 2024; 31: e16–e18.

[10] Dewi AK, Putri FF, Hakim MT, Putri RS, Santosa CR, Jannata AM, et al. Literature review cardiopulmonary resuscitation management for sudden cardiac arrest on field sport activity. Surabaya Physical Medicine and Rehabilitation Journal. 2023; 5: 117–129.

[11] Danış F, Kudu E. The evolution of cardiopulmonary resuscitation: global productivity and publication trends. The American Journal of Emergency Medicine. 2022; 54: 151–164.

[12] Schnaubelt S, Garg R, Atiq H, Baig N, Bernardino M, Bigham B, et al. Cardiopulmonary resuscitation in low-resource settings: a statement by the international liaison committee on resuscitation, supported by the AFEM, EUSEM, IFEM, and IFRC. The Lancet Global Health. 2023; 11: e1444–e1453.

[13] Bednarz K, Goniewicz K, Al-Wathinani AM, Goniewicz M. Emergency medicine perspectives: the importance of bystanders and their impact on on-site resuscitation measures and immediate outcomes of out-of-hospital cardiac arrest. Journal of Clinical Medicine. 2023; 12: 6815.

[14] Considine J, Gazmuri RJ, Perkins GD, Kudenchuk PJ, Olasveengen TM, Vaillancourt C, et al. Chest compression components (rate, depth, chest wall recoil and leaning): a scoping review. Resuscitation. 2020; 146: 188–202.

[15] Hellevuo H, Sainio M, Nevalainen R, Huhtala H, Olkkola KT, Tenhunen J, et al. Deeper chest compression—more complications for cardiac arrest patients? Resuscitation. 2013; 84: 760–765.

[16] Zubrzycki W, Przyjemczak J, Świeczko-Żurek B. The effectiveness of basic resuscitation activities carried out by combat paramedics of the police, as exemplified by polish counterterrorist units. Internal Security. 2021; 13: 285–298.

[17] Dudzinski DM. Pulmonary embolism-related cardiac arrest. PERT Consortium Handbook of Pulmonary Embolism. 2023; 45: 1–9.

[18] ALQarni BD, Qarni AL, Ayed F, Rashidi AL, Mueallath A, Mutairi AL. The effects and challenges faced by health practitioners in dealing with emergency cases. International Journal. 2022; 10: 102–109.

[19] Al-Jaafreh A, Saifan AR, Mosleh SM, Al-Yateem N, Al-Momani MM. Experience of health professionals in caring for patients with chest trauma. Dimensions of Critical Care Nursing. 2023; 42: 153–162.

[20] Hinkelbein J, Kerkhoff S, Adler C, Ahlbäck A, Braunecker S, Burgard D, et al. Cardiopulmonary resuscitation (CPR) during spaceflight—a guideline for CPR in microgravity from the German Society of Aerospace Medicine (DGLRM) and the European Society of Aerospace Medicine Space Medicine Group (ESAM-SMG). Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine. 2020; 28: 108.

[21] Kong Y, Guo W. Respiratory support strategy for sudden cardiac death. Sudden Death. 2021; 23: 217–240.

[22] Panchal AR, Bartos JA, Cabañas JG, Donnino MW, Drennan IR, Hirsch KG, et al. Part 3: adult basic and advanced life support: 2020 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation. 2020; 142: S366–468.

[23] Palisch AC. Airway management of the cardiac arrest victim. Emergency Medicine Clinics. 2023; 41: 543–558.

[24] Davis DP, Peay J, Sise MJ, Kennedy F, Simon F, Tominaga G, et al. Prehospital airway and ventilation management: a trauma score and injury severity score-based analysis. Journal of Trauma: Injury, Infection & Critical Care. 2010; 69: 294–301.

[25] Kopra J, Litonius E, Pekkarinen PT, Laitinen M, Heinonen JA, Fontanelli L, et al. Ventilation during continuous compressions or at 30:2 compression-to-ventilation ratio results in similar arterial oxygen and carbon dioxide levels in an experimental model of prolonged cardiac arrest. Intensive Care Medicine Experimental. 2023; 11: 1–4.

[26] Dronamraju VA, Chilamakuru R, Gara HK, Vanamali DR, Kasibhotla VC. Assessment of knowledge, attitude, and practices of basic life support among interns and residents in a tertiary care hospital. European Journal of Cardiovascular Medicine. 2023; 13: 1248–1260.

[27] Mariano S. Preparing paramedic graduates for independent practice: an assessment of the effectiveness of a paramedicine degree from a university in KwaZulu-Natal [Doctoral thesis]. University of KwaZulu-Natal, South Africa. 2022.

[28] Merchant RM, Becker LB, Brooks SC, Chan PS, Del Rios M, McBride ME, et al. The American heart association emergency cardiovascular care 2030 impact goals and call to action to improve cardiac arrest outcomes: a scientific statement from the American heart association. Circulation. 2024; 149: e914–e933.

[29] Sumera K, Ilczak T, Bakkerud M, Lane JD, Pallas J, Martorell SO, et al. CPR quality officer role to improve CPR quality: a multi-centred international simulation randomized control trial. Resuscitation Plus. 2024; 17: 100537.

[30] Goniewicz K, Khorram-Manesh A, Burkle FM, Hertelendy AJ, Goniewicz M. The European Union’s post-pandemic strategies for public health, economic recovery, and social resilience. Global Transitions. 2023; 5: 201–209.

[31] Khorram-Manesh A, Gray L, Goniewicz K, Cocco A, Ranse J, Phattharapornjaroen P, et al. Care in emergencies and disasters: can it be person-centered? Patient Education and Counseling. 2024; 118: 108046.

[32] Martin-Conty JL, Martin-Rodríguez F, Criado-Álvarez JJ, Romo Barrientos C, Maestre-Miquel C, Viñuela A, et al. Do rescuers’ physiological responses and anxiety influence quality resuscitation under extreme temperatures? International Journal of Environmental Research and Public Health. 2020; 17: 4241.

[33] Silverplats J, Strömsöe A, Äng B, Södersved Källestedt ML. Attitudes towards cardiopulmonary resuscitation situations and associations with potential influencing factors—a survey among in-hospital healthcare professionals. PLOS ONE. 2022; 17: e0271686.