Video-Only Cardiopulmonary Resuscitation Education for High-Risk Families Before Hospital Discharge: A Multicenter Pragmatic Trial

Abstract

Background: Cardiopulmonary resuscitation (CPR) training rates in the United States are low, highlighting the need to develop CPR educational approaches that are simpler, with broader dissemination potential. The minimum training required to ensure long-term skill retention remains poorly characterized. We compared CPR skill retention among laypersons randomized to training with video-only (VO; no manikin) with those trained with a video self-instruction kit (VSI; with manikin). We hypothesized that VO training would be noninferior to the VSI approach with respect to chest compression (CC) rate.

Methods and results: We performed a prospective, cluster randomized trial of CPR education for family members of patients with high-risk cardiac conditions on hospital cardiac units, using a multicenter pragmatic design. Eight hospitals were randomized to offer either VO or VSI training before discharge using volunteer trainers. CPR skills were assessed 6 months post training. Mean CC rate among those trained with VO compared with those trained with VSI was assessed with a noninferiority margin set at 8 CC per min; as a secondary outcome, mean differences in CC depth were assessed. From February 2012 to May 2015, 1464 subjects were enrolled and 522 subjects completed a skills assessment. The mean CC rates were 87.7 (VO) CC per min and 89.3 (VSI) CC per min; we concluded noninferiority for VO based on a mean difference of -1.6 (90% confidence interval, -5.2 to 2.1). The mean CC depth was 40.2 mm (VO) and 45.8 mm (VSI) with a mean difference of -5.6 (95% confidence interval, -7.6 to -3.7). Results were similar after multivariate regression adjustment.

Conclusions: In this large, prospective trial of CPR skill retention, VO training yielded a noninferior difference in CC rate compared with VSI training. CC depth was greater in the VSI group. These findings suggest a potential trade-off in efforts for broad dissemination of basic CPR skills; VO training might allow for greater scalability and dissemination, but with a potential reduction in CC depth.

Clinical trial registration: URL: https://www.clinicaltrials.gov. Unique identifier: NCT01514656.

Keywords: cardiopulmonary resuscitation; cardiovascular diseases; heart arrest; randomized controlled trial; resuscitation.

Conflict of interest statement

Conflict of Interst Disclosures: Ms. Blewer has received research funding from the American Heart Association. Ms. Leary serves on the advisory committee of the American Heart Association’s Emergency Cardiovascular Care committee, and has research funding from the American Heart Association and the Laerdal Foundation. Dr. Abella has received research funding from Medtronic Foundation, the American Heart Association, PCORI and the NIH, research funding and honoraria from CR Bard, honoraria from Physio-Control, and in-kind research support from Laerdal Medical Corporation. The other authors report no relevant conflicts of interest.

© 2016 American Heart Association, Inc.

Figures

Figure 1

Consort diagram of the pragmatic clinical trial randomization and subsequent subject follow-up.

Figure 2

Histograms of A) chest compression rate and B) depth in VO and VSI stratified by training group. Vertical dashed lines show target rates of 100 compressions per minute and 50 mm respectively. The lower panel in each frame conveys the data from the two histograms overlaid, and smoothed with a kernel density estimator

Figure 2

Histograms of A) chest compression rate and B) depth in VO and VSI stratified by training group. Vertical dashed lines show target rates of 100 compressions per minute and 50 mm respectively. The lower panel in each frame conveys the data from the two histograms overlaid, and smoothed with a kernel density estimator