Pre-publication history The pre-publication history for this paper can be accessed here: http://www.biomedcentral.com/1471-227X/13/2/prepub

Supplementary Material Additional file 1: A pdf file with the Authorized Portuguese translation of the CAM-ICU. Click here for file(74K, pdf) Additional file 2: A pdf file with the EDIMCU clinical protocol. Click here for file(206K, pdf) Additional file 3: A pdf file of the blood biochemical/clinical parameters at EDIMCU admission Inhibitors,research,lifescience,medical and discharge. Click here for file(200K, pdf) Acknowledgements We are thankful to the staff at the EDIMCU of Hospital de Braga. NCS is supported by the post-doctoral fellowship UMINHO/BPD/013/2011 by the European Commission (FP7) “SwitchBox” Project (Contract HEALTH-F2-2010-259772). No other financial support was provided to conduct this investigation.

Widespread effective training in cardiopulmonary resuscitation (CPR) can save countless lives. Nearly 80% of cardiac arrests are

witnessed by a family member and occur in one’s home. The survival rate of victims of sudden Inhibitors,research,lifescience,medical cardiac arrest Inhibitors,research,lifescience,medical may be no more than five percent, because the overwhelming majority of bystanders who witness the event do not know how to perform CPR [1]. Less than one-third of victims of sudden cardiac arrest receive CPR from bystanders, and even fewer receive adequate quality CPR [2]. Often lay responders, despite U0126 cost having a desire to provide basic life support, lack the skill to correctly provide this service [3]. Moreover, training alone may not be enough to ensure that individuals are willing and able to effectively administer CPR [4-6]. Those who have been trained in CPR may show a decrease in Inhibitors,research,lifescience,medical essential knowledge and skills within just a few months after training [7-12]. Further, lack of confidence in conducting CPR [13], Inhibitors,research,lifescience,medical as well as lack of willingness to attempt it [14], may be impediments to intervening in a crisis. Currently the American Red Cross requires individuals to renew their CPR certification annually; this often requires a 4- to 8-hour refresher course. However, it is neither feasible Liothyronine Sodium nor cost-effective to conduct frequent in-person recertification

courses. Studies show that frequent refresher courses can help both medical and lay personnel maintain CPR skills [15-19]. Smaller-scale refresher materials, presented to trainees between certifications and re-certifications, could fill in memory and confidence gaps, but only if the effort is made to use them [20,21]. Poster-based refreshers were equally as effective as instructor-led refreshers in relation to skill retention one year post training [22]. Moreover, additional training for people previously certified in CPR led to lesser declines over time in willingness to perform CPR [23]. Actual skill is only one of the factors that can make the difference between a passive bystander during an emergency and an effective administrator of CPR.