Education in resuscitation.

The value of bystander cardiopulmonary resuscitation (CPR) has been well defined by studies in many countries and communities. Randomized clinical trials are inappropriate in this setting and cannot determine accurately the degree of benefit conferred, but observational data from 17 papers published before 1991 [1] and two nationwide studies since that time [2,3] suggest that the odds ratio for improved survival of victims of collapse is :/2.5. This benefit is achieved principally by extending the period for which defibrillation can be successful in cases of ventricular fibrillation or pulseless ventricular tachycardia. These are not grounds for complacency, however. Even in countries or areas where emergency services are well developed, most victims of cardiac arrest do not receive bystander CPR, and when it is given, the quality is generally far from ideal. The need, therefore, is not only for more CPR but also for better-quality CPR. Both skills acquisition and skills retention have been shown to be poor after conventional training in CPR for