Skip to main content

Volume 3 Supplement 1


Agreement in the assessment of practical skills in basic CPR between observers and a CPR mannequin with a specific software


Conducting a training activity usually involves assessing to students the knowledge and/or the skills acquired. Assessment methods must be objectives and representatives of the item being evaluated and able to ensure their independence from the evaluator. The assessment of practical skills in cardiopulmonary resuscitation (CPR) acquired by a student during a training course conforming the quality criteria for CPR on adults (2010 International Guidelines on Resuscitation 1), continues to be accomplished currently by observers. Increasingly, other objective methods of assessment (CPR manikin with specific 2 software, mechanical devices, etc.) of these skills with an excellent degree of accuracy and feedback, are being extended. The correct evaluation of these practical skills is crucial to ensure their correct acquisition, as a first step to the translation into clinical practice.


To check the agreement between three different observers to each other and with a mechanical device with a specific software for CPR.


Descriptive and univariate analysis according to Cohen´s Kappa coefficient and the intraclass correlation coefficient (ICC). 54 volunteers, health workers, with training and experience in CPR, performed a complete sequence of basic CPR maneuvers in a dummy (Laerdal PC v 4.2.1 Skill Reporting Software) (L). Three expert instructors (A, B and C) in teaching courses in CPR evaluated, visually, the performing of correct external chest compressions regarding the placement of the hands, depth compression and decompression, and rate. We analyze the concordance between the observers (A, B and C) among themselves and with L.


Table 1 shows the mean scores of A, B, C and L for the 54 students. Table 2 shows the crude concordance, the value of Cohen´s kappa coefficient and the ICC. Figure 1 shows the Bland and Altmann graphics. We can observe that the degree of agreement and uniformity among the 4 evaluators are poor, and there is a high degree of dispersion without a defined trend.

Figure 1
figure 1

Bland and Altmann graphics.

Table 1 Mean scores
Table 2 Concordance between pairs of evaluators


The CPR skills assessment in a visual way by expert evaluators is associated with an important lack of agreement and a high dispersion. At present, it must pose routinely the use of mechanical devices for training and evaluation of these skills.


  1. Michael R Sayre, Rudolph W Koster, Martin Botha , Diana M. Cave, Michael T. Cudnik, Anthony J. Handley, Tetsuo Hatanaka , Mary Fran Hazinski , Ian Jacobs , Koen Monsieurs , Peter T. Morley, Jerry P. Nolan, Andrew H. Travers: Part 5: Adult Basic Life Support 2010 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science WithTreatment Recommendations. Circulation. 2010, 122 (S298): S324-

    Google Scholar 

  2. Zhang FL, Yan L, Huang SF, Bai XJ: Correlations between quality indexes of chest compression. World J Emerg Med. 2013, 4: 54-8.

    PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations


Rights and permissions

Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (, which permits use, duplication, adaptation, distribution, and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Sánchez, B., Algarte, R., Cerdà, M. et al. Agreement in the assessment of practical skills in basic CPR between observers and a CPR mannequin with a specific software. ICMx 3 (Suppl 1), A749 (2015).

Download citation

  • Published:

  • DOI: