Training hospital providers in basic CPR skills in Botswana: Acquisition, retention and impact of novel training techniques

Peter A. Meaney, Robert M. Sutton, Billy Tsima, Andrew P. Steenhoff, Nicole Shilkofski, John R. Boulet, Amanda Davis, Andrew M. Kestler, Kasey K. Church, Dana E. Niles, Sharon Y. Irving, Loeto Mazhani, Vinay M. Nadkarni

Research output: Contribution to journalArticlepeer-review

27 Scopus citations


Objective: Globally, one third of deaths each year are from cardiovascular diseases, yet no strong evidence supports any specific method of CPR instruction in a resource-limited setting. We hypothesized that both existing and novel CPR training programs significantly impact skills of hospital-based healthcare providers (HCP) in Botswana. Methods: HCP were prospectively randomized to 3 training groups: instructor led, limited instructor with manikin feedback, or self-directed learning. Data was collected prior to training, immediately after and at 3 and 6. months. Excellent CPR was prospectively defined as having at least 4 of 5 characteristics: depth, rate, release, no flow fraction, and no excessive ventilation. GEE was performed to account for within subject correlation. Results: Of 214 HCP trained, 40% resuscitate ≥1/month, 28% had previous formal CPR training, and 65% required additional skills remediation to pass using AHA criteria. Excellent CPR skill acquisition was significant (infant: 32% vs. 71%, p<0.01; adult 28% vs. 48%, p<0.01). Infant CPR skill retention was significant at 3 (39% vs. 70%, p<0.01) and 6. months (38% vs. 67%, p<0.01), and adult CPR skills were retained to 3. months (34% vs. 51%, p=0.02). On multivariable analysis, low cognitive score and need for skill remediation, but not instruction method, impacted CPR skill performance. Conclusions: HCP in resource-limited settings resuscitate frequently, with little CPR training. Using existing training, HCP acquire and retain skills, yet often require remediation. Novel techniques with increased student: instructor ratio and feedback manikins were not different compared to traditional instruction.

Original languageEnglish (US)
Pages (from-to)1484-1490
Number of pages7
Issue number12
StatePublished - Dec 2012
Externally publishedYes


  • Basic life support
  • CPR
  • Cardiopulmonary resuscitation
  • Chest compression
  • Competence
  • Developing countries
  • Emergency training
  • Manikin
  • Resource-limited setting
  • Resuscitation education

ASJC Scopus subject areas

  • Emergency Medicine
  • Emergency
  • Cardiology and Cardiovascular Medicine


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