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Advanced Cardiac Life Support Knowledge among Medical Staff and Residents in University Hospital


Polpun ( พลพันธ์) 1, Suhattaya Boonmak (สุหัทยา บุญมาก) 2, Wanida Chongarunngamsang (วนิดา จงอรุณงามแสง) 3, Kotchapa Maharungruengrat (กชภา มหารุ่งเรืองรัตน์) 4

1. Department of Anesthesiology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand, Boonmak,

1. ภาควิชาวิสัญญีวิทยา คณะแพทยศาสตร์ มหาวิทยาลัยขอนแก่น อ.เมือง จ.ขอนแก่น 40002, บุญมาก,

หลักการและวัตถุประสงค์: ภาวะหัวใจหยุดเต้นเป็นภาวะฉุกเฉินทางการแพทย์ที่สำคัญซึ่งต้องการประสิทธิภาพในการกู้ชีพ แพทย์ที่ทำงานในโรงพยาบาลที่มีความเสี่ยงต่อการเกิดภาวะหัวใจหยุดเต้นสูงจึงควรมีความรู้และทักษะในการกู้ชีพเป็นอย่างดี ดังนั้นจึงต้องการศึกษาระดับความรู้ในการกู้ชีพขั้นสูงของแพทย์ในโรงพยาบาลมหาวิทยาลัยและปัจจัยต่าง ๆ ที่มีผลต่อระดับความรู้

วิธีการศึกษา: ทำการศึกษาแบบไปข้างหน้าในแพทย์ที่ปฏิบัติงานที่โรงพยาบาลศรีนครินทร์ คณะแพทยศาสตร์ มหาวิทยาลัยขอนแก่น ระหว่างเดือนพฤษภาคม ถึงเดือนมิถุนายน 2551 โดยทำการสุ่มแบบแบ่งชั้นภูมิโดยใช้ภาควิชา แพทย์ที่เข้าร่วมวิจัยจะทำแบบทดสอบจำนวน 25 ข้อภายในเวลา 20 นาที ผู้วิจัยทำการเก็บข้อมูลทั่วไปของแพทย์ คะแนนในแต่ละหัวข้อ คะแนนรวมที่มากกว่าร้อยละ 80ถือว่ามีความรู้ในการกู้ชีพขั้นสูงเพียงพอ และปัจจัยที่มีผลต่อคะแนน 

ผลการศึกษา: ผู้เข้าร่วมการศึกษาจำนวน 70 คน โดยมีคะแนนรวมมากกว่าร้อยละ 80 คิดเป็นร้อยละ 15.7 (95% CI 8.1-26.4) ซึ่งคะแนนเฉลี่ย+ค่าเบี่ยงเบนมาตรฐานของคะแนนรวมเป็น58.4 +21.5  ความรู้ในการกู้ชีพขั้นต้นและขั้นสูงเป็น55.9+26.5การอ่านผลคลื่นไฟฟ้าหัวใจเป็น 73.4+26.0 การใช้ยาเป็น51.0+23.5การประยุกต์ใช้เป็น57.5+30.3ปัจจัยที่มีผลต่อความรู้คือ ความถี่ในการฝึกอบรม และความถี่ในการปฏิบัติการ (p<0.05)

สรุป: จำนวนแพทย์ที่มีความรู้ในการกู้ชีพขั้นสูงเพียงพอมีน้อย โดยที่ปัจจัยที่มีผลต่อความรู้ในการกู้ชีพขั้นสูงคือ ความถี่ในการปฏิบัติการและการฝึกอบรมการช่วยฟื้นคืนชีพขั้นสูง ดังนั้นจึงควรมีการฝึกอบรมแพทย์ในโรงพยาบาลอย่างสม่ำเสมอ


Background and Objective :  Advanced cardiac life support (ACLS) is an important knowledge among physicians to deal with cardiac arrest. Medical staff and residents who practice in high risk areas are required to possess ACLS knowledge and skills. To determine knowledge about ACLS in physicians including factors that influence ACLS knowledge in university hospital.

Methods :  A descriptive of study of medical staff and residents who have been working at Srinagarind Hospital, Khon Kaen University, Thailand, between May-July, 2008 was performed by stratified random sampling from the participated 12 clinical department. The test questions were modified from Advanced Cardiovascular life support guideline (American Heart Association). The total score more than 80% was  classified as being with sufficient knowledge whereas below 80% was lacking sufficient knowledge.  

Results : Seventy physicians were enrolled to take the test. Up to 15.7% (95% CI 8.1-26.4) of those participants have scored over 80%. Mean+SD of percent of the total score, concepts of BLS and ACLS score, ECG interpretation score, medication score, and application score were 58.4+21.5, 55.9+26.5, 73.4 +26.0, 51.0+23.5, and 57.5+30.3, respectively. The statistical analysis suggests that physicians with higher frequency of ACLS practice and training had more knowledge on the issue than those with lower frequency of ACLS practice and training (p<0.05).

Conclusions: The number of physicians who had sufficient knowledge was low. Factors that influence the ACLS knowledge appeared to be the frequency of ACLS practice and training. From the data gathered,  the others recommends that ACLS training program should be incorporated into the routine works of physicians in our hospital in order to increase frequency of ACLS training. 

Keywords: advanced cardiac life support; knowledge; physicians; university hospitals



Cardiac arrest is one of the most critical conditions found in medical care. It is an emergence, life-threatening conditions which requires rapid responses by an efficient team. Advanced cardiac life support (ACLS) is an important knowledge among physicians to deal with cardiac arrest. ACLS® guideline (American Heart Association guideline 2005 for cardiopulmonary resuscitation and emergency cardiovascular care) was launched in the year 2005.1 The Guideline, which outlines skill and treatment of arrest ACLS to help performance resuscitation in patients, is our hospital’s standard practice for cardiac arrest.

Medical staff and residents who practice in high risk areas are required to possess ACLS knowledge and skills. Physicians who have been taught about ACLS knowledge and skill have shown to perform well and, hence, increase survival rate, decrease morbidity and mortality.2-4 

At our hospital, physicians, especially the new personnel, have been taught about ACLS in terms of information and skill. They are required to pass ACLS program every year. However, from previous study knowledge and skill on ACLS seem to be waning within 3-6 months after ACLS training.5-6

We studied ACLS knowledge among physicians in our hospital. Data were invaluable to improve training process and we are required to look for new strategies to improved patient care. Our primary objective was to determine whether the physician had sufficient ACLS knowledge. Secondary objective was to survey factors that influenced ACLS knowledge.

Materials and Methods

After receiving approval from institution’s research ethics board, we conducted a prospective, descriptive study (between May-July, 2008) at Srinagarind Hospital, Faculty of Medicine, Khon Kaen University. This study aim was to evaluate ACLS knowledge for future use among medical staff and residents working at Srinagarind Hospital during study period using ACLS test. 

The authors’ team conducted the ACLS test. ACLS instructor evaluated the content validity of the questions. American Heart Association guideline 2005 for cardiopulmonary resuscitation and emergency cardiovascular care was used as a reference. The test (Figure 1), 25 questions, consisted of 4 parts, each aims to evaluate the ACLS knowledge based on the ACLS training program, i.e. 1) knowledge of concept of basic life support (BLS) and ACLS (10 questions), 2) electrocardiogram (ECG) interpretation (5 questions), 3) medication (6 questions), and 4) clinical application (4 questions).

The test has been tested for reliability. Thirty physicians at Khon Kaen provincial center Hospital (tertiary care hospital) have been selected to test the reliability. The data showed that 45% of physician had total score more than 80%. This was the sufficient benchmark for ACLS knowledge. 

We included all medical staff and residents who have been working at Srinagarind Hospital during the study period. We enrolled medical staff and residents using stratified random sampling technique by the department. Exclusion criteria were inability to answer the test. After consent has been obtained, the test was given to medical staff and residents to complete within 20 minutes.

We recorded gender, age, department, working duration as demographic data. We also recorded factors that may influence the knowledge and classified into two groups for comparison, i.e. 1) frequency of participation in ACLS in the previous year (< 3 or > 3 times), 2) frequency of ACLS training within 3 years (< 2 or >2 times), 3) duration after ACLS practice (< 0.5 or > 0.5 year), 4) duration since the last ACLS training (< 0.5 or > 0.5 year), and 5) working area (low risk area (eye, general practitioner, radiology, rehabilitation, psychiatry) or high risk area (anesthesiology, internal medicine, obstetrics, orthopedics, otorhinolaryngology, pediatrics, surgery).

Total score and score in each part were recorded. Total score of more than 80% was classified as sufficient ACLS knowledge. Data analysis was performed by using STATA for Windows version 8.0 (Stata Corporation, TX, USA). Sufficient ACLS knowledge was reported as percentage and 95% CI. The mean and SD, median and range were used where appropriated. Chi square’s test was used to analyzed the comparison. The sample size required was based on, 1) sufficient ACLS knowledge in pilot study (0.45), 2) a Type I error of 0.05, 3) an absolute precision of 0.11, 4) an 80% power, and 5) population size was 461.

Figure 1 ACLS test Modified from Advanced Cardiovascular Life Support 2005 guideline (American Heart Association).



Seventy physicians were included in the study. Return rate of the test was 100%. Demographic data showed (Table 1). Sufficient ACLS knowledge was 15.7% (95% CI 8.1-26.4) (Table 2). Mean+SD of total score, concept of BLS and ACLS score, ECG interpretation score, medication score, application score were 58.4+21.5, 55.9+26.5, 73.4+26.0, 51.0+23.5, and 57.5+30.3, respectively. Factors that influence the ACLS knowledge was reported (Table 3). Higher frequency of ACLS practice and training showed more proficiency than those with less frequency in ACLS practice and training (p<0.05).


Table 1 Demographic data

Demographic data


Gender (M/F)


Age (mean+SD; years)








Working duration (median (range))

3 (0.8, 26)

Department (%)







general practitioner



internal medicine



























Table 2    ACLS score results.




Our hospital provides ACLS training program by the CPR unit for medical staff and residents, especially new residents every year. We tested the knowledge and skill after ACLS training. Most of them passed ACLS training program. The program curriculum based on American Heart Association guideline 2005 for cardiopulmonary resuscitation and emergency cardiovascular care. However, the data showed only 15.7% of medical staff and residents in our hospital have sufficient knowledge. Mean+SD in total score is 58.4+21.5. Passing level in our study was 80%, which was higher than previous studies.7 Although passing level depends on the table specification of each test. The ECG interpretation part is where examinees score the highest. Mean+SD of that part is 73.4+26.0. Physicians having always been required to utilize knowledge about ECG interpretation in daily practices may be the of this performance. 

Medical staff and residents with higher frequency of ACLS practice have more knowledge than those with less exposure to ACLS practice. Previous data also showed that frequency of ACLS practice is an important factor in maintaining knowledge.7-9 Those who have been trained on ACLS more frequently had more knowledge on the subject than those who have been trained less often. Previous study showed that frequency of ACLS training can improve CPR knowledge.10 Six months apart is the most appropriate duration for ACLS training. Re-training should take place within 3-6 months in order to maintain ACLS skills and knowledge.2, 6, 10 However, our study showed that the duration between ACLS trainings does not show any significance in improving ACLS knowledge. There are multiple factors influencing ACLS knowledge beside the duration between each ACLS training course. From our result, CPR rapid response teams in university hospital are important for ACLS management by experience personnel required to deal the cardiac arrest condition.


Of all the medical staff and residents taken the examinations, 15.7% (95% CI 8.1-26.4) had sufficient knowledge of ACLS. The factor that influenced the ACLS knowledge was frequency of ACLS training. From our data, ACLS training program should be incorporated into works of all physicians at our hospital and there should be more ACLS trainings organized for staff and residents. 


          The authors are grateful for cooperation and assistance of personnel at the CPR unit, Srinagarind Hospital. We are ever so grateful to Emeritus Professor Dr. Somboon SrungBoonmee for his constructive editing of this manuscript.


1.      American heart association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care 2005. Part 7.2: Management of cardiac arrest. Circulation 2005; 112 Suppl 1:IV-58-IV-66.

2.      Dane FC, Russell-Lindgren KS, Parish DC, Durham MD, Brown TD. In-hospital resuscitation: association between ACLS training and survival to discharge. Resuscitation 2000; 47:83-7.

3.      Dine CJ, Gersh RE, Leary M, Riegel BJ, Bellini LM, Abella BS. Improving cardiopulmonary resuscitation quality and resuscitation training by combining audiovisual feedback and debriefing. Crit Care Med 2008; 36:2817-22.

4.      Moretti MA, Cesar LA, Nusbacher A, Kern KB, Timerman S, Ramires JA. Advanced cardiac life support training improves long-term survival from in-hospital cardiac arrest. Resuscitation 2007; 72:458-65.

5.      Chamberlain D, Smith A, Woollard M, Colquhoun M, Handley AJ, Leaves S, et al. Trials of teaching methods in basic life support (3): comparison of simulated CPR performance after first training and at 6 months, with a note on the value of re-training. Resuscitation 2002; 53:179-87.

6.      Boonmak P, Boonmak S, Srichaipanha S, Poomsawat S. Knowledge and skill after brief ACLS training. J Med Assoc Thai 2004; 87:1311-4.

7.      Noordergraaf GJ, Be WK, Sabbe M, Diets RF, Noordergraaf A, Van Hemelrijck J. Training needs and qualifications of anaesthesiologists not exposed to ALS. Resuscitation 1999; 40:79-80.

8.      Quiney NF, Gardner J, Brampton W. Resuscitation skills amongst anaesthetists. Resuscitation 1995; 29:215-8.   

9.      Kiyan S, Yanturali S, Musal B, Gursel Y, Aksay E, Turkcuer I. Determination of advanced life support knowledge level of residents in a Turkish university hospital. J Emerg Med 2008; 35:213-22.

10.  Goodwin AP. Cardiopulmonary resuscitation training revisited. J R Soc Med 1992; 85:452-3.


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