Basic life support training in out-of-hospital cardiac arrest: From the youth to a special "Senior Force Against Cardiac Arrest".

The annual incidence of out-of-hospital cardiac-arrest (OHCA) in Europe is between 67 to 170 per 100,000 inhabitants.1.Perkins G.D. Gräsner J.-T. Semeraro F. et al.Executive summary.Resuscitation. 2021; https://doi.org/10.1016/j.resuscitation.2021.02.003Abstract Full Text Full Text PDF Scopus (119) Google Scholar Survival is still low, estimated between 4.6 and 8%, and justifies a rapid implementation of the survival chain and a perfect application of its components.2.Hubert H. Tazarourte K. Wiel E. et al.Rationale, Methodology, Implementation, and First Results of the French Out-of-hospital Cardiac Arrest Registry.Prehospital Emergency Care. 2014; 18: 511-519https://doi.org/10.3109/10903127.2014.916024Crossref PubMed Scopus (54) Google Scholar Cardiopulmonary resuscitation techniques have continued to evolve, improving overall survival.3.Wissenberg M. Lippert F.K. Folke F. et al.Association of national initiatives to improve cardiac arrest management with rates of bystander intervention and patient survival after out-of-hospital cardiac arrest.JAMA. 2013; 310: 1377-1384Crossref PubMed Scopus (776) Google Scholar However, although very codified, these “basic life support” (BLS) techniques are still insufficiently implemented by first lay rescuers/First Aiders.2.Hubert H. Tazarourte K. Wiel E. et al.Rationale, Methodology, Implementation, and First Results of the French Out-of-hospital Cardiac Arrest Registry.Prehospital Emergency Care. 2014; 18: 511-519https://doi.org/10.3109/10903127.2014.916024Crossref PubMed Scopus (54) Google Scholar Recent European resuscitation guidelines for the management of cardiac arrest have reminded us the major determinants of a return of spontaneous circulation (ROSC). One is the earliest possible implementation of the BLS by the CPR lay rescuers.1.Perkins G.D. Gräsner J.-T. Semeraro F. et al.Executive summary.Resuscitation. 2021; https://doi.org/10.1016/j.resuscitation.2021.02.003Abstract Full Text Full Text PDF Scopus (119) Google Scholar For this system to work and to increase survival of OHCA, it is essential that a maximum number of citizens are trained to perform BLS. This number depends directly on the government’s policies to promote initial training and develop these skills. Thus, in many countries, CPR training is focused on young people, at schools or early active working life.4.Lewis R.M. Fulstow R. Smith G.B. The teaching of cardiopulmonary resuscitation in schools in Hampshire.Resuscitation. 1997; 35: 27-31https://doi.org/10.1016/S0300-9572(97)00027-0Abstract Full Text Full Text PDF PubMed Scopus (38) Google Scholar However, the rate of first aid training remains very low in industrialized countries, and particularly among the elderly.5.Blewer A.L. Ibrahim S.A. Leary M. Dutwin D. McNally B. Anderson M.L. et al.Cardiopulmonary Resuscitation Training Disparities in the United States.J Am Heart Assoc. 2021; 6 (e006124)https://doi.org/10.1161/JAHA.117.006124Crossref Scopus (56) Google Scholar We have reason to believe that policies of BLS training must be intensified with this population for several reasons among elderly (age > 65 years old):-Younger elderly people (age of 65–75 y.o.) are usually on the front line of the OHCA of people in their age groups;-The ability to perform BLS is achievable by all ages outside of pediatrics, regardless of age6.Neset A. Birkenes T.S. Furunes T. et al.A randomized trial on elderly laypersons’ CPR performance in a realistic cardiac arrest simulation.Acta Anaesthesiol Scand. 2012; 56: 124-131https://doi.org/10.1111/j.1399-6576.2011.02566.xCrossref PubMed Scopus (18) Google Scholar;-The CPR level is of acceptable quality for elderly laypersons with CPR training7.Nebsbjerg M.A. Rasmussen S.E. Bomholt K.B. et al.Skills among young and elderly laypersons during simulated dispatcher assisted CPR and after CPR training.Acta Anaesthesiol Scand. 2018; 62: 125-133https://doi.org/10.1111/aas.13027Crossref PubMed Scopus (5) Google Scholar;-Elderly rescuers have less muscle strength but could, with alternative techniques like “changing their roles sooner than every 2 minutes” or a “four-hand CPR”, performed an efficient basic life support8.Chen K.-Y. Ko Y.-C. Hsieh M.-J. Chiang W.-C. Ma M.-M. Lin S. Interventions to improve the quality of bystander cardiopulmonary resuscitation: A systematic review.PLoS One. 2019; 14 (e0211792)https://doi.org/10.1371/journal.pone.0211792Crossref Scopus (27) Google Scholar;-Older people now master the means of telecommunications that enable them to be alerted by modern digital tools like younger citizens;-Elderly could activate speaker function quickly for continuous telephone CPR.9.Birkenes T.S. Myklebust H. Kramer-Johansen J. Time delays and capability of elderly to activate speaker function for continuous telephone CPR.Scand J Trauma Resusc Emerg Med. 2013; 21: 40https://doi.org/10.1186/1757-7241-21-40Crossref PubMed Scopus (17) Google Scholar While CPR training is facilitated at school and in the working population, one of the most appropriate ways to promote BLS among the elderly would be to train them as late as possible in their working life, i.e., in “pre-retirement”. In France, a recent decree made mandatory for employers to promote BLS training to pre retirees.10.Décret n° 2021-469 du 19 avril 2021 relatif à la sensibilisation à la lutte contre l’arrêt cardiaque et aux gestes qui sauvent. 2021.Google Scholar Approximately 650 000 active workers are retiring every year in France. Their employers will need to provide them the possibility to have BLS training. Public and private training organizations will therefore have to adapt to ensure this new training load. The effects of this policy will have to be studied, but and we feel this should be implemented in all countries with similar emergency care training systems. In conclusion, France intends to have, in the coming years a “Senior Force Against Cardiac Arrest” in addition to youth training at school. The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. We thank all the team of the Centre for Emergency Care Teaching (CESU 49) of the University Hospital of Angers, especially Damien Chauvat, Aurélien Marquis and Aurélien Sechet, who are particularly implicated in basic life support training.