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The use of a ‘pillow partner’ as a simple, cost-effective, and accessible tool to teach bystander cardiopulmonary resuscitation skills

      Letter to the editor
      Community cardiopulmonary resuscitation training (CPR) can help increase effective bystander CPR delivery. CPR mannequins can be expensive, require transportation arrangements or infer accessibility issues. Difficulty in resource procurement, lack of models and dissemination logistics have been highlighted with the demand for training increasing. In conjunction with Resuscitation Council UK, the British Islamic Medical Association (BIMA) trialled the use of the ‘pillow partner’, developed by the Yorkshire Ambulance Service. A simple, low-cost pillowcase with surface markings of the human thorax, as well as simplified instructions on how to what to do during an emergency including provide chest compressions, with translation into 4 different languages on the other side of the pillow. This was used during the annual BIMA Lifesavers programme delivered through mosques in the UK and abroad.
      • Khanji M.Y.
      • Waqar S.
      • Khawaja Z.
      • Ali B.
      How delivering cardiopulmonary resuscitation and basic life support skills training through places of worship can help save lives and address health inequalities.
      We assessed how useful the ‘pillow partner’ was for volunteers delivering the training through an online questionnaire. A rating scale was used to determine its usefulness, from 1 to 10 (1 = not useful, 10 = very useful) and option for free text comments.
      Across 81 UK mosques, 336 volunteers completed the feedback; 172 were from mosques that had trialled the ‘pillow partner’. Over 87% gave a usefulness ranking of 7 or more (Fig. 1). The overall reception of the ‘pillow partner’ was very positive. Within community teaching, the ‘pillow partner’ provided a visual stimulus of the human thorax, to aid the learning experience, highlighting the location to begin CPR. The main comments are summarised and stratified as ‘advantages’ and ‘disadvantages’ (Fig. 1):
      Figure thumbnail gr1
      Fig. 1Using a ‘pillow partner’ for delivering community CPR training. Panel A – Poster with an image of the pillow partner pillow case, produced in collaboration between Yorkshire Ambulance Service, Resuscitation Council UK and the British Islamic Medical Association. Panel B – advantages and disadvantages of its use. Panel C – usefulness rating for the pillow partner when teaching CPR, based on feedback from volunteers delivering training.
      Use of low-cost alternatives where mannequins or more advanced equipment is not available, can have the potential for equitable and widening access of high-quality CPR training, particularly in lower resource settings. Although mannequins provide kinaesthetic feeling and depth perception, using ‘pillow partner’ may act as a gateway and foundation to learning basic CPR. Although there is no feedback technology or internal mechanism for formal assessment of the effectiveness of chest compressions, this feedback could be provided by the trainer.
      There is also scope for pre-event distribution of ‘pillow partner’ to delegates, combined with preparatory information as well as consolidatory post-event learning, such as when teaching is delivered virtually during a pandemic.
      • Khanji M.Y.
      • Ali B.
      • Ahmed S.
      Virtual delivery of cardiopulmonary resuscitation training for the public: how to make it work.
      Additionally, the pillowcases can be individually owned training aids negating the need for manikin cleaning or infection risk and allows cascade training at home.
      The cost and delivery logistics associated the ‘pillow partner’ is much less than incurred with mannequins with reduced requirement for storage space. The apparatus is also easy to set-up and can be easily washed to maintain hygiene and infection control standards.

      Pillow partner [Internet]. [cited 2022 May 24]. Available from: https://restartaheart.yas.nhs.uk/get-involved/pillow-partner/.

      Formal comparison to assess impact on participants’ learning and CPR quality could be undertaken with this simple aid versus mannequins.
      In conclusion, the use of a CPR training pillowcase can be a useful, low-cost tool for teaching bystander CPR skills. It reduces the need for more expensive mannequins, with increased accessibility and acts as a visual and physical aid. Although it has some limitations, it provides a good alternative and be particularly useful in low resource or low-middle income settings.

      Acknowledgements

      We would like to thank all the volunteers who supported and delivered BIMA Lifesavers over the years and to all who continue to provide such life-saving skills.

      Conflict of interest

      U.S. has been the National Training Lead for BIMA Lifesavers in the year 2022 and Teesside Coordinator in the year 2021.
      B.A. has been the national director for BIMA Lifesavers during the year 2021 and 2022.
      M.Y.K. has been BIMA Lifesavers National Academic Lead during the year 2021 and 2022.
      A.M.B.M had no conflicts of interests.
      All roles are in a voluntary, unpaid capacity. The BIMA is an independent, not-for-profit organization offering free basic life support training to the community.

      References

        • Khanji M.Y.
        • Waqar S.
        • Khawaja Z.
        • Ali B.
        How delivering cardiopulmonary resuscitation and basic life support skills training through places of worship can help save lives and address health inequalities.
        Eur Heart J. 2022; ehac190
        • Khanji M.Y.
        • Ali B.
        • Ahmed S.
        Virtual delivery of cardiopulmonary resuscitation training for the public: how to make it work.
        Eur Heart J. 2021; 42: 4710-4712
      1. Pillow partner [Internet]. [cited 2022 May 24]. Available from: https://restartaheart.yas.nhs.uk/get-involved/pillow-partner/.