Fatores envolvidos na capacitação cognitiva e manutenção da habilidade psicomotora de curto e médio prazo para a realização de ressucitação cardiopulmonar

Abstract

Five studies were conducted, in this thesis, in order to evaluate factors related the learning of motor skills and theoretical knowledge. The first study evaluated the ability to perform good cardiopulmonary resuscitation (CPR) after CPR class using only theoretical training versus traditional theoretical and practical training. There was no difference in the theoretical evaluation (p = 0.144), but the practical assessment was consistently worse in the theoretical group (p< 0.0001). We concluded that the use of CPR videos and lectures did not improve the ability to perform good quality CPR. The second article entitled "The best length of training in Advanced Life Support in Cardiology (ACLS): Two days versus four days." aimed to assess whether gradual training could improve theoretical and practice skills. Approval in the practical and theoretical evaluations and mean theoretical score were similar for both groups. We concluded that the 16-hour-theoretical-teaching in Advanced Life Support training did not alter the outcome of practical and theoretical evaluations if given either in 2 days or in 4 days. In the third study entitled "Is simplifying the CPR sequence associated with better retention of motor skills?", we compared the retention using 2005 AHA guidelines (group A) with 2010 AHA guidelines (group B). The number of correct ventilations was better for group A after 30 and 60 days (p= 0.03 and p=0.04). In contrast, the compression depth for group B was better immediately and after 30 and 60 days (p=0.007; p=0.02 e p=0.03). Practical score evaluation was initially better in group B by 50% instructors (p=0.02 e p=0.06) with a tendency of superiority at 30 and 60 days by 3 of 4 instructors. We concluded that the simplification of CPR, based on the guidelines 2010 (CAB sequence), was associated with better chest compression. The fourth study entitled "Effect of physiological understanding of cardiopulmonary resuscitation on cognitive capacity and long term motor skill retention for performing good quality cardiopulmonary resuscitation" tested laypeople versus health care providers. In the practical evaluation laypeople scored lower than medical students at 30 and 60 days and also presented retention loss of the primary sequence of the CPR. Nevertheless, they presented CPR parameters similar to those of medical students. The conclusion was that laypeople learn CPR but lose CPR sequence faster than health care providers. The fifth paper entitled: Factors influencing learning during Advanced Cardiac Life Support and Basic Life Support courses sought to assess factors which could interfere in skills acquisition during ACLS and BLS courses. Overall analysis by logistic regression showed negative influence on practical approval: residence outside big cities, work in a pre-hospital care system, antidepressant medication use and older age; and for global theoretical approval: older age and inadequate sleep in the night before (p <0.05). Multivariable logistic regression analyses for ACLS showed significant negative factors: residence outside big cities, antidepressant medication use, work in a pre-hospital care system and older age; and for negative theoretical approval: residence outside big cities and older age. Only older age had significant negative factor for theoretical approval in the BLS courses. In conclusion: older age represented a negative factor in all analyses, followed by the use of antidepressant drugs. Residence outside big cities directly influenced the theoretical and practical approval. For BLS only older age represented a negative factor for theoretical approval.