Video-Only Cardiopulmonary Resuscitation Education for High-Risk Families Before Hospital Discharge

Prompt delivery of cardiopulmonary resuscitation (CPR) increases the probability of survival from sudden cardiac arrest (SCA) by 2to 3-fold, yet >60% of SCA victims in the United States do not receive bystander CPR. Despite the availability of CPR certification programs for the lay public, a recent investigation documented that training rates in the United States are strikingly low. Given that >75% of SCA events occur in the home environment, training family members of patients with at-risk cardiac conditions could have a significant impact on initial care and survival from SCA, which leads to >200 000 out-of-hospital deaths each year in the United States. Highlighting the public health burden of SCA, the Institute of Medicine recently published a report entitled Strategies to Improve Cardiac Arrest Survival: A Time to Act that includes a call for increased engagement of the lay public as SCA first responders. 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. (Circ Cardiovasc Qual Outcomes. 2016;9:740-748. DOI: 10.1161/CIRCOUTCOMES.116.002493.)