The Effectiveness of Ultrabrief and Brief Educational Videos for Training Lay Responders in Hands-Only Cardiopulmonary Resuscitation: Implications for the Future of Citizen Cardiopulmonary Resuscitation Training

Background— Bystander cardiopulmonary resuscitation (CPR) improves survival from out-of-hospital cardiac arrest (OHCA) but often is not performed. We hypothesized that subjects viewing very short Hands-Only CPR videos will (1) be more likely to attempt CPR in a simulated OHCA scenario and (2) demonstrate better CPR skills than untrained individuals. Methods and Results— This study is a prospective trial of 336 adults without recent CPR training randomized into 4 groups: (1) control (no training) (n=51); (2) 60-second video training (n=95); (3) 5-minute video training (n=99); and (4) 8-minute video training, including manikin practice (n=91). All subjects were tested for their ability to perform CPR during an adult OHCA scenario using a CPR-sensing manikin and Laerdal PC SkillReporting software. One half of the trained subjects were randomly assigned to testing immediately and the other half after a 2-month delay. Twelve (23.5%) controls did not even attempt CPR, which was true of only 2 subjects (0.7%; P=0.01) from any of the experimental groups. All experimental groups had significantly higher average compression rates (closer to the recommended 100/min) than the control group (P<0.001), and all experimental groups had significantly greater average compression depth (>38 mm) than the control group (P<0.0001). Conclusions— Laypersons exposed to very short Hands-Only CPR videos are more likely to attempt CPR and show superior CPR skills than untrained laypersons. Clinical Trial Registration— URL: http://www.clinicaltrials.gov. Unique identifier: NCT01191736.

[1]  D J Roe,et al.  Estimating effectiveness of cardiac arrest interventions: a logistic regression survival model. , 1997, Circulation.

[2]  K. Roberts,et al.  "Rolling Refreshers": a novel approach to maintain CPR psychomotor skill competence. , 2009, Resuscitation.

[3]  D. Mozaffarian,et al.  Heart disease and stroke statistics--2009 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. , 2009, Circulation.

[4]  L. Wik,et al.  A peer-training model for instruction of basic cardiac life support. , 1995, Resuscitation.

[5]  Graham Nichol,et al.  Effectiveness of a 30-min CPR self-instruction program for lay responders: a controlled randomized study. , 2005, Resuscitation.

[6]  R. Newcombe,et al.  To blow or not to blow: a randomised controlled trial of compression-only and standard telephone CPR instructions in simulated cardiac arrest. , 2003, Resuscitation.

[7]  C. Callaway,et al.  Regional variation in out-of-hospital cardiac arrest incidence and outcome. , 2008, JAMA.

[8]  Ahmet Ok,et al.  The effects of different instructional methods on students' acquisition and retention of cardiopulmonary resuscitation skills. , 2010, Resuscitation.

[9]  H. Chung,et al.  Animation-assisted CPRII program as a reminder tool in achieving effective one-person-CPR performance. , 2009, Resuscitation.

[10]  L. Bossaert,et al.  Quality and efficiency of bystander CPR , 1993 .

[11]  Greg Sinibaldi,et al.  Incidence of EMS-treated out-of-hospital cardiac arrest in the United States. , 2004, Resuscitation.

[12]  Nancy C. Zajano,et al.  The problem of poor retention of cardiopulmonary resuscitation skills may lie with the instructor, not the learner or the curriculum. , 1991, Resuscitation.

[13]  R. Berg,et al.  The Save Hearts in Arizona Registry and Education (SHARE) program: who is performing CPR and where are they doing it? , 2007, Resuscitation.

[14]  M. Eisenberg,et al.  Disagreeable physical characteristics affecting bystander CPR. , 1989, Annals of emergency medicine.

[15]  G. Lombardi,et al.  Outcome of Out-of-Hospital Cardiac Arrest in New York City: The Pre-Hospital Arrest Survival Evaluation (PHASE) Study , 1994 .

[16]  R. Newcombe,et al.  Optimal refresher training intervals for AED and CPR skills: a randomised controlled trial. , 2006, Resuscitation.

[17]  J. Herlitz,et al.  Effect of bystander cardiopulmonary resuscitation in out-of-hospital cardiac arrest patients in Sweden. , 2000, Resuscitation.

[18]  Roger D. White,et al.  Hands-only (compression-only) cardiopulmonary resuscitation: a call to action for bystander response to adults who experience out-of-hospital sudden cardiac arrest: a science advisory for the public from the American Heart Association Emergency Cardiovascular Care Committee. , 2008, Circulation.

[19]  Carolyn L Cason,et al.  A randomized cross-over study of the quality of cardiopulmonary resuscitation among females performing 30 : 2 and hands-only cardiopulmonary resuscitation , 2009 .

[20]  Arthur L. Kellermann,et al.  Predictors of Survival From Out-of-Hospital Cardiac Arrest A Systematic Review and Meta-Analysis , 2013 .

[21]  J Barrett,et al.  Outcome of CPR in a large metropolitan area--where are the survivors? , 1991, Annals of emergency medicine.

[22]  R. Berg,et al.  Bystander cardiopulmonary resuscitation. Concerns about mouth-to-mouth contact. , 1996, Archives of internal medicine.

[23]  T. Rea,et al.  Increasing Use of Cardiopulmonary Resuscitation During Out-of-Hospital Ventricular Fibrillation Arrest: Survival Implications of Guideline Changes , 2006, Circulation.

[24]  T. Rea,et al.  Ventricular fibrillation in King County, Washington: a 30-year perspective. , 2008, Resuscitation.

[25]  A. Handley,et al.  Randomised controlled trials of staged teaching for basic life support. 1. Skill acquisition at bronze stage. , 2000, Resuscitation.

[26]  Samuel J Stratton,et al.  Cardiac Arrest Resuscitation Evaluation in Los Angeles: CARE-LA. , 2005, Annals of emergency medicine.

[27]  Karen Pierce,et al.  Evaluation of staff's retention of ACLS and BLS skills. , 2008, Resuscitation.

[28]  I. Stiell,et al.  Cardiac arrest witnessed by emergency medical services personnel: descriptive epidemiology, prodromal symptoms, and predictors of survival. , 2000, Annals of emergency medicine.

[29]  A Smith,et al.  Randomised controlled trials of staged teaching for basic life support: 2. Comparison of CPR performance and skill retention using either staged instruction or conventional training. , 2001, Resuscitation.

[30]  A. Hallstrom,et al.  Predicting survival from out-of-hospital cardiac arrest: a graphic model. , 1993, Annals of emergency medicine.

[31]  J. Forrester,et al.  Mouth-to-mouth ventilation: the dying art. , 1992, The American journal of emergency medicine.

[32]  P. Pepe,et al.  Prospective, randomized trial of the effectiveness and retention of 30-min layperson training for cardiopulmonary resuscitation and automated external defibrillators: The American Airlines Study. , 2007, Resuscitation.

[33]  P. Steen,et al.  bystander cardiopulmonary resuscitation influences outcome after prehospital cardiac arrest , 1994 .

[34]  K. Nagao.  Cardiopulmonary resuscitation by bystanders with chest compression only (SOS-KANTO): an observational study , 2007, The Lancet.

[35]  N. Pijls,et al.  Resuscitation skills of lay public after recent training. , 1994, Annals of Emergency Medicine.

[36]  R. Berg,et al.  Effectiveness of Bystander-Initiated Cardiac-Only Resuscitation for Patients With Out-of-Hospital Cardiac Arrest , 2007, Circulation.

[37]  E. Gallagher,et al.  Effectiveness of bystander cardiopulmonary resuscitation and survival following out-of-hospital cardiac arrest. , 1996, JAMA.

[38]  Johan Herlitz,et al.  Survival Is Similar After Standard Treatment and Chest Compression Only in Out-of-Hospital Bystander Cardiopulmonary Resuscitation , 2007, Circulation.

[39]  R. Waalewijn,et al.  Bystander initiated actions in out-of-hospital cardiopulmonary resuscitation: results from the Amsterdam Resuscitation Study (ARRESUST). , 2001, Resuscitation.

[40]  R. Berg,et al.  Minimally interrupted cardiac resuscitation by emergency medical services for out-of-hospital cardiac arrest. , 2008, JAMA.

[41]  A. Day,et al.  Bystander cardiopulmonary resuscitation. , 1993, The New Zealand medical journal.

[42]  K. Kelly,et al.  Education in adult basic life support training programs. , 1993, Annals of emergency medicine.

[43]  I. Stiell,et al.  Improved Out-of-Hospital Cardiac Arrest Survival Through the Inexpensive Optimization of an Existing Defibrillation Program: OPALS Study Phase II , 1999 .

[44]  W. Kaye,et al.  Retention of cardiopulmonary resuscitation skills by physicians, registered nurses, and the general public , 1986, Critical care medicine.

[45]  T. Aufderheide,et al.  Retention of CPR skills learned in a traditional AHA Heartsaver course versus 30-min video self-training: a controlled randomized study. , 2007, Resuscitation.

[46]  Frank LoVecchio,et al.  Chest compression-only CPR by lay rescuers and survival from out-of-hospital cardiac arrest. , 2010, Journal of the American Medical Association (JAMA).

[47]  D. Mozaffarian,et al.  Heart disease and stroke statistics--2009 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. , 2009, Circulation.

[48]  M. Copass,et al.  Cardiopulmonary resuscitation by chest compression alone or with mouth-to-mouth ventilation. , 2000, The New England journal of medicine.

[49]  Vinay Nadkarni,et al.  Reducing Barriers for Implementation of Bystander–Initiated Cardiopulmonary Resuscitation: A Scientific Statement From the American Heart Association for Healthcare Providers, Policymakers, and Community Leaders Regarding the Effectiveness of Cardiopulmonary Resuscitation , 2008, Circulation.