Elsevier

Resuscitation

Volume 67, Issue 1, October 2005, Pages 31-43
Resuscitation

Effectiveness of a 30-min CPR self-instruction program for lay responders: a controlled randomized study

https://doi.org/10.1016/j.resuscitation.2005.04.017Get rights and content

Abstract

Background:

The length of current 4-h classes in cardiopulmonary resuscitation (CPR) is a barrier to widespread dissemination of CPR training. The effectiveness of video-based self-instruction (VSI) has been demonstrated in several studies; however, the effectiveness of this method with older adults is not certain. Although older adults are most likely to witness out-of-hospital cardiac arrests, these potential rescuers are underrepresented in traditional classes. We evaluated a VSI program that comprised a 22-min video, an inflatable training manikin, and an audio prompting device with individuals 40–70 years old. The hypotheses were that VSI results in performance of basic CPR skills superior to that of untrained learners and similar to that of learners in Heartsaver classes.

Methods:

Two hundred and eighty-five adults between 40 and 70 years old who had had no CPR training within the past 5 years were assigned to an untrained control group, Heartsaver training, or one of three versions of VSI. Basic CPR skills were measured by instructor assessment and by a sensored manikin.

Results:

The percentage of subjects who assessed unresponsiveness, called the emergency telephone number 911, provided adequate ventilation, proper hand placement, and adequate compression depth was significantly better (P < 0.05) for the VSI groups than for untrained controls. VSI subjects tended to have better overall performance and better ventilation performance than did Heartsaver subjects.

Conclusions:

Older adults learned the fundamental skills of CPR with this training program in about half an hour. If properly distributed, this type of training could produce a significant increase in the number of lay responders who can perform CPR.

Introduction

Increasing the frequency and effectiveness of bystander cardiopulmonary resuscitation (CPR) are fundamental goals of the American Heart Association (AHA) and other health organizations [1], [2]. Although bystander CPR is an effective treatment for cardiac arrest, the proportion of citizens trained to perform CPR is small [3], [4], [5]. The typical witness to an out-of-hospital arrest is over 50 years old [6] and the typical learner in lay CPR courses is about 20 years younger [7], [8], [9]. Impediments to attending traditional CPR courses, for learners of all ages, include time and logistics [10] and anxiety or other aversive psychological responses to classroom settings [11]. Courses that include much information irrelevant to learning CPR [8], [12], [13] may also dissuade learners from returning for refreshers. Researchers have sought alternative training formats for potential learners who are reticent to attend CPR courses [4], [6], [8], [10], [14], [15]. While some shorter self-led, video-based courses have been piloted with good results [4], [5], [15], [16], [17], [18], the materials and methods of video self-instruction (VSI) continue to be refined; for example, the Laerdal Family Trainer™ manikin (Laerdal Medical Corporation, Stavanger, Norway) used in many earlier studies has been discontinued and replaced by a new generation of Mini Anne™ manikins. A newly developed instructional video, with a run time of 22 min, is approximately 40% shorter than that in any VSI course previously tested. Ours is the first study of VSI with older laypersons that uses a controlled, randomized design to determine whether this much-abbreviated training can transmit basic CPR skills as well as a traditional Heartsaver course does.

Section snippets

Study design and participant recruitment

The study was conducted in 2004 in Portland, Oregon. The study conformed to the principles of the Declaration of Helsinki and the protocol was approved by Portland State University's Human Subjects Research Review Committee. Informed consent was obtained from both instructors and subjects. Individuals between 40 and 70 years of age were chosen as the target subject population for two reasons: older adults are relatively more likely to live with a high-risk person and therefore are more likely

Results

Cronbach's alpha, a conservative estimate of reliability for tests with dichotomously scored items, was computed for the quick assessment at 0.81. Fig. 5 shows, for each group, the percentage of subjects whose overall performance was rated adequate by the Examiners. ST-Combined subjects were more likely than C subjects (P < 0.001; effect size = 1.17) and HS subjects (P = 0.031; effect size = 0.34) to be rated adequate in their overall performance of CPR. HS subjects were more likely than C subjects to

Discussion

Whether skills were assessed by CPR instructors who were experimentally blind or whether skills were measured objectively by the manikin, self-training produced an effect on skill acquisition that was at least as great as the effect seen with traditional Heartsaver training, but in about one-eighth the time. Further, traditional training failed to show a reliable advantage over self-training for any of the skills tested by either method or for overall adequate performance as assessed by

Conflict of interest statement

This research was funded by the American Heart Association and the Laerdal Medical Corporation.

Acknowledgements

We thank the American Heart Association's National Center and the Laerdal Medical Corporation for financial support. We thank Jerry Potts for substantive contributions to all phases of the study, Tom Rea and Mickey Eisenberg for helpful comments on the design, Alan Braslow and Robert Brennan for advice on the assessment, and two anonymous reviewers for their careful attention to all aspects of the manuscript. The authors gratefully acknowledge Gwen Hyatt's database expertise and the high level

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A Spanish translated version of the Abstract of this article appears as Appendix at 10.1016/j.resuscitation.2005.04.017.

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