Cardiopulmonary resuscitation (CPR) and Basic Life Support (BLS) are essential emergency interventions aimed at maintaining airway patency, supporting ventilation, and ensuring effective circulation in patients experiencing cardiac or respiratory arrest [1]. Early recognition of arrest and prompt initiation of high-quality BLS, as emphasized in the American Heart Association (AHA) Emergency Cardiovascular Care (ECC) Guidelines 2025, are critical determinants of survival and favorable neurological outcomes [2]. These guidelines stress timely activation of emergency response systems, delivery of CPR with adequate depth and rate, minimal interruptions, early defibrillation when indicated, and coordinated team-based resuscitation. [1,2]. The success of resuscitative efforts largely depends on the knowledge, skills, and timely actions of first responders, highlighting the importance of structured training and sustained competency in life-saving interventions [3]. BLS forms the foundation of emergency cardiovascular care and underpins advanced interventions such as Advanced Cardiac Life Support (ACLS). In high patient-load and resource-limited settings, prioritizing BLS and ACLS training among healthcare professionals and trainees is particularly crucial [4]. Integrating structured BLS and ACLS programs into undergraduate curricula, reinforced through periodic simulation-based hospital programs, is essential for effective skill acquisition and long-term retention [2, 4]. Despite advances in resuscitative care, cardiac arrest continues to be associated with poor survival outcomes, reflecting gaps in preparedness among healthcare providers [5]. Studies have reported deficiencies in both theoretical knowledge and psychomotor skills, particularly during early training stages, which may lead to delayed or suboptimal interventions [6,7,8]. In teaching hospitals and tertiary care centers, healthcare professionals at multiple levels often act as first responders during cardiac emergencies. Guideline-based, structured, and regularly reinforced life support training ensures their readiness and improves patient outcomes. The present study was conducted to evaluate the theoretical knowledge and practical skills of participants undergoing BLS and ACLS training at a tertiary care teaching hospital. By identifying existing strengths and gaps in resuscitation competencies, this study aims to provide evidence to enhance the quality, effectiveness, and outcomes of life support training programs.

This observational, cross-sectional analytical study was conducted in the Department of Anaesthesiology and Critical Care at Rural Medical College, Pravara Institute of Medical Sciences (PIMS), Loni. The study aimed to evaluate and compare the theoretical knowledge and practical skills of postgraduate residents undergoing structured Basic Life Support (BLS) and Advanced Cardiac Life Support (ACLS) training. A total of 100 postgraduate residents enrolled in the ACLS and BLS training program were included. TRAINING PROGRAM- Participants completed a structured training program comprising: Didactic lectures: Covering adult and pediatric resuscitation, drug administration, ECG rhythm recognition, and updates in ACLS and BLS guidelines. Instructor-led demonstrations and interactive discussions: Reinforcing practical skills. Case-based simulations and hands-on practice sessions: Conducted on manikins to facilitate skill acquisition and confidence. ASSESSMENT METHODOLOGY Theoretical knowledge and practical skills were assessed at three time points: 1. Pre-training (Pre-test) 2. Immediately post-training (Post-test 1) 3. One-month post-training for retention (Post-test 2) Knowledge Assessment Theoretical knowledge was assessed using a structured questionnaire comprising 25 multiple-choice questions (MCQs). Each correct answer received 1 mark, and incorrect responses scored 0. Questions addressed: Adult and pediatric airway management, Chest compression techniques (rate, depth, hand placement), Resuscitation-sequence (CAB/ABC), Drug administration during cardiac arrest, One- and two-rescuer CPR, ECG rhythm recognition, Updates in ACLS and BLS guidelines. For analysis, questions were categorised into three domains: BLS (7 items), ACLS (11 items), and guideline updates (7 items). Practical Skills Assessment Practical skills were assessed by trained ACLS instructors through direct observation of CPR performance on adult manikins using a structured 15-item checklist. The checklist evaluated: • High-quality CPR performance • Identification of reversible causes of cardiac arrest (5Hs and 5Ts) • Appropriate defibrillation/shock delivery • Correct administration of resuscitation drugs • Compression quality (depth, rate, hand position, and chest recoil) • Ventilation parameters (volume and rate) • Compression fraction (percentage of total CPR time performing compressions; normal range: 60–78%) • Overall instructor-assessed skill performance Each correctly performed skill scored 1, while incorrect or omitted skills scored 0, giving a maximum skill score of 15. Standardized tools and scenarios were used across all participants and time points to ensure reliability and reproducibility. Statistical Analysis: Data were recorded using a structured data collection pro forma and entered into Microsoft Excel. Statistical analysis was performed using SPSS software, version 24 (IBM Corp., Armonk, NY, USA). Continuous variables were expressed as mean ± standard deviation (SD). Differences in knowledge and skill scores across the three time points and domains were analyzed using two-way Analysis of Variance (ANOVA). A p-value < 0.05 was considered statistically significant.

As shown in table 1,2,3 Pre-test knowledge scores were low across all domains (total score 7.25 ± 1.80). Immediate post-training assessment showed a significant improvement in BLS, ACLS, update, and total scores (24.55 ± 1.15; P1 < 0.001). At one-month follow-up, scores declined compared to immediate post-test (P2 < 0.001) but remained significantly higher than pre-test values (16.60 ± 2.05; P3 < 0.001). As shown in Table 4,5,6 compression score/ventilation score/compression fraction and instructor skill assessed for immediate posttest was significantly higher than the pretest score. One month posttest total score was significantly higher than the pretest total score but was significantly lower than posttest score. Comparison of Theoretical Knowledge: Table 1. Comparison of Theoretical Knowledge: Pre-test vs Immediate Post-test (P1) Parameter Pre-test (Mean ± SD) Immediate Post-test (Mean ± SD) p-value(P1) Significance BLS score 2.15 ± 0.90 6.85 ± 0.50 <0.001 Significant ACLS score 3.10 ± 1.00 11.00 ± 0.65 <0.001 Significant Update score 2.00 ± 0.85 6.70 ± 0.60 <0.001 Significant Total score 7.25 ± 1.80 24.55 ± 1.15 <0.001 Significant Table 2. Comparison of Theoretical Knowledge: Immediate Post-test vs One-Month Post-test (P2) Parameter Immediate Post-test (Mean ± SD) One-Month Post-test (Mean ± SD) p-value(P2) Significance BLS score 6.85 ± 0.50 4.95 ± 1.10 <0.001 Significant ACLS score 11.00 ± 0.65 7.25 ± 1.30 <0.001 Significant Update score 6.70 ± 0.60 4.40 ± 1.05 <0.001 Significant Total score 24.55 ± 1.15 16.60 ± 2.05 <0.001 Significant Table 3. Comparison of Theoretical Knowledge: Pre-test vs One-Month Post-test (P3) Parameter Pre-test (Mean ± SD) One-Month Post-test (Mean ± SD) p-value(P3) Significance BLS score 2.15 ± 0.90 4.95 ± 1.10 <0.001 Significant ACLS score 3.10 ± 1.00 7.25 ± 1.30 <0.001 Significant Update score 2.00 ± 0.85 4.40 ± 1.05 <0.001 Significant Total score 7.25 ± 1.80 16.60 ± 2.05 <0.001 Significant Graph-1: Comparison of Theoretical Knowledge: Pre-test, Immediate post and Post-test Comparison of Skills Scores: Table 4. Comparison of Skills Scores: Pre-test vs Immediate Post-test(P4) Skill Parameter Pre-test Mean ± SD Immediate Post-test Mean ± SD P value (P4) Significance Compression Score (%) 25.9 ± 5.9 87.9 ± 5.3 <0.001 Significant Ventilation Score (%) 24.7 ± 6.0 86.8 ± 5.4 <0.001 Significant Compression Fraction (%) 44.8 ± 9.6 66.4 ± 7.1 <0.001 Significant Instructor-Assessed Skill 4.2 ± 1.3 12.6 ± 1.1 <0.001 Significant Table 5. Comparison of Skills Scores: Immediate Post-test vs One-Month Post-test (P5) Skill Parameter Immediate Post-test Mean ± SD One-Month Post-test Mean ± SD P value (P5) Significance Compression Score (%) 87.9 ± 5.3 65.6 ± 5.7 <0.001 Significant Ventilation Score (%) 86.8 ± 5.4 64.2 ± 5.6 <0.001 Significant Compression Fraction (%) 66.4 ± 7.1 60.1 ± 6.2 <0.001 Significant Instructor-Assessed Skill (Marks out of 15) 12.6 ± 1.1 9.8 ± 1.4 <0.001 Significant Table 6. Comparison of Skills Scores: Pre-test vs One-Month Post-test(P6) Skill Parameter Pre-test Mean ± SD One-Month Post-test Mean ± SD P value (P6) Significance Compression Score (%) 25.9 ± 5.9 65.6 ± 5.7 <0.001 Significant Ventilation Score (%) 24.7 ± 6.0 64.2 ± 5.6 <0.001 Significant Compression Fraction (%) 44.8 ± 9.6 60.1 ± 6.2 <0.001 Significant Instructor-Assessed Skill (Marks out of 15) 4.2 ± 1.3 9.8 ± 1.4 <0.001 Significant Graph-2:Comparison of Skills Scores between pre, immediate and post test.

The present study evaluated the theoretical knowledge and practical skills of postgraduate residents undergoing structured Basic Life Support (BLS) and Advanced Cardiac Life Support (ACLS) training at DVPRMC, Loni. The findings demonstrate significant improvement in both cognitive understanding and psychomotor performance immediately after training, followed by partial decline at one-month follow-up. These results underscore the effectiveness of structured life support training while highlighting the persistent challenge of skill retention over time. Pre-training assessment revealed limited competence across all domains, with a total knowledge score of 7.25 ± 1.80 (BLS: 2.15 ± 0.90; ACLS: 3.10 ± 1.00; guideline updates: 2.00 ± 0.85) and suboptimal practical skills (compression: 25.9 ± 5.9%; ventilation: 24.7 ± 6.0%; compression fraction: 44.8 ± 9.6%; instructor-assessed skill: 4.2 ± 1.3/15). These findings reflect gaps between theoretical understanding and hands-on performance, consistent with prior studies among healthcare trainees. Bhavar TD et al. (2021) [6] reported similarly low baseline knowledge among MBBS interns, while Somaraj V et al., (2017) [9]. observed that 39.89% of dental interns in India had below-average BLS knowledge. Collectively, these data highlight the pressing need for structured, guideline-based training programs at the postgraduate level to ensure preparedness for cardiac emergencies. Following structured training, total post-test knowledge scores increased significantly to 24.55 ± 1.15 (BLS: 6.85 ± 0.50; ACLS: 11.00 ± 0.65; guideline updates: 6.70 ± 0.60; P1 < 0.001). Practical skills improved markedly: compression 87.9 ± 5.3%, ventilation 86.8 ± 5.4%, compression fraction 66.4 ± 7.1%, and instructor-assessed skill 12.6 ± 1.1/15 (P4 < 0.001). These results are consistent with Bhavar TD et al., (2021) [6] who reported significant enhancement in both theoretical knowledge and psychomotor skills immediately after ACLS/BLS workshops, and Ajjappa AK, et al., (2015) [10] who observed substantial gains in CPR performance following structured workshops. The immediate improvements in compression quality, ventilation, and overall instructor-assessed performance underscore the effectiveness of integrating didactic lectures, interactive discussions, and hands-on simulation to build both competence and confidence in resuscitation protocols. At one-month follow-up, both theoretical and practical scores declined significantly compared to immediate post-training values (P2 < 0.001), though they remained above baseline (P3 < 0.001). Total knowledge decreased to 16.60 ± 2.05, with domain-wise scores of BLS 4.95 ± 1.10, ACLS 7.25 ± 1.30, and guideline updates 4.40 ± 1.05. Practical skills declined to compression 65.6 ± 5.7%, ventilation 64.2 ± 5.6%, compression fraction 60.1 ± 6.2%, and instructor-assessed skill 9.8 ± 1.4/15. This pattern aligns with previous reports documenting the rapid decay of psychomotor skills relative to theoretical knowledge without reinforcement. Dal and Sarpkaya (2013) [11] observed similar declines, and multiple studies have confirmed that practical CPR skills deteriorate if not regularly practiced. These findings highlight the critical need for ongoing refresher training and simulation-based practice to maintain competency, in accordance with American Heart Association (AHA) recommendations. Our results mirror the findings of Bhavar TD et al. (2021) [6], who reported low baseline knowledge and skill, significant immediate improvement after ACLS/BLS workshops, and partial retention over six months. Saquib SA, et al. (2019) [12] observed that only 28.5% of participants correctly identified the compression-airway-breathing sequence prior to training, with substantial post-training improvement. Similarly, Aroor AR, et al. (2014) [13] found that only 10% of participants were aware of updated CPR sequences before instruction. Regarding practical skills, both Bhavar TD et al. (2021) [6] and Ajjappa AK, et al., (2015) [10] reported low baseline performance, significant immediate gains, and partial retention over time. The present study reflects a similar trajectory, demonstrating substantial immediate gains and partial one-month retention across compression, ventilation, and instructor-assessed performance. These findings reinforce the critical importance of structured BLS and ACLS training in preparing healthcare professionals for cardiac emergencies. High-quality chest compressions, effective ventilation, and competent psychomotor execution are directly associated with improved patient survival and neurological outcomes. Integration of guideline-based training with simulation exercises and periodic assessment is essential for sustaining competency. Previous studies by Nambiar M, et al., (2016) [7] and Roshana S, et al., (2012) [14] similarly demonstrated that CPR quality, rhythm recognition, drug administration, and identification of reversible causes deteriorate without ongoing reinforcement. Collectively, these data underscore that resuscitation proficiency is not permanent and requires continuous practice and refresher training to maintain clinical readiness. Strengths of this study include objective assessment using standardized checklists, evaluation at multiple time points, and inclusion of both theoretical and practical domains. Limitations include the single-center design, short follow-up period, and absence of real-life resuscitation outcome assessment. Future multicentric studies with extended follow-up and integration of clinical outcomes are warranted to validate and generalize these findings.

The present study demonstrates that structured Basic Life Support (BLS) and Advanced Cardiac Life Support (ACLS) training significantly enhances both theoretical knowledge and practical skills among postgraduate residents. Immediate post-training assessments showed marked gains across all domains (BLS, ACLS, guideline updates; p < 0.001) and practical competencies, including compression quality, ventilation, compression fraction, and instructor-assessed performance (p < 0.001). Although scores declined at one-month follow-up (p < 0.001), they remained well above baseline, indicating partial retention of skills. These findings underscore that structured ACLS and BLS programs effectively improve cognitive and psychomotor performance, highlighting the critical need for periodic refresher training and simulation-based practice to maintain clinical competence and readiness for cardiac emergencies.

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