Elsevier

Resuscitation

Volume 115, June 2017, Pages 116-119
Resuscitation

Short paper
Passive ultra-brief video training improves performance of compression-only cardiopulmonary resuscitation

https://doi.org/10.1016/j.resuscitation.2017.04.008Get rights and content

Abstract

Background

Bystander compression-only cardiopulmonary resuscitation (CPR) improves survival after out-of-hospital cardiac arrest. To broaden CPR training, 1–2 min ultra-brief videos have been disseminated via the Internet and television. Our objective was to determine whether participants passively exposed to a televised ultra-brief video perform CPR better than unexposed controls.

Methods

This before-and-after study was conducted with non-patients in an urban Emergency Department waiting room. The intervention was an ultra-brief CPR training video displayed via closed-circuit television 3–6 times/hour. Participants were unaware of the study and not told to watch the video. Pre-intervention, no video was displayed. Participants were asked to demonstrate compression-only CPR on a manikin. Performance was scored based on critical actions: check for responsiveness, call for help, begin compressions immediately, and correct hand placement, compression rate and depth. The primary outcome was the proportion of participants who performed all actions correctly.

Results

There were 50 control and 50 exposed participants. Mean age was 37, 51% were African-American, 52% were female, and 10% self-reported current CPR certification. There were no statistically significant differences in baseline characteristics between groups. The number of participants who performed all actions correctly was 0 (0%) control vs. 10 (20%) exposed (difference 20%, 95% confidence interval [CI] 8.9–31.1%, p < 0.001). Correct compression rate and depth were 11 (22%) control vs. 22 (44%) exposed (22%, 95% CI 4.1–39.9%, p = 0.019), and 5 (10%) control vs. 15 (30%) exposed (20%, 95% CI 4.8-35.2%, p = 0.012), respectively.

Conclusion

Passive ultra-brief video training is associated with improved performance of compression-only CPR.

Introduction

Out-of-hospital cardiac arrest is a major public health crisis, with an annual incidence of 395,000 in the United States [1]. Bystander cardiopulmonary resuscitation (CPR) can significantly improve the likelihood of survival after cardiac arrest by maintaining blood flow to vital organs until the arrival of trained medical professionals. However, only 41% of patients in cardiac arrest receive bystander CPR [1]. In addition, only 3% of the population is trained in how to perform bystander CPR annually [1].

Traditional CPR courses require a significant time commitment and are poorly targeted to those individuals most likely to witness a cardiac arrest event [1], [2]. As such, shortened 30-min courses have been developed that have demonstrated equivalent efficacy in training bystanders to perform CPR correctly [3]. When compared to traditional courses that include mouth-to-mouth breathing, compression-only CPR has equivalent efficacy in achieving survival after cardiac arrest [4]. Thus, brief compression-only bystander CPR courses have been advocated for as a means to increase rates of bystander CPR and improve survival [5], [6].

Ultra-brief videos have recently been introduced as a means to more broadly disseminate CPR training. These 1–2-minute videos briefly teach how to perform compression-only CPR and emphasize its importance in improving survival. Preliminary studies have demonstrated efficacy for ultra-brief videos when used as teaching adjuncts within an educational framework [7], [8]. Taking this a step further, the American Heart Association has developed a national television and Internet advertising campaign using similar videos [9]. However, no evidence currently exists demonstrating that passive exposure to an ultra-brief video, removed from an explicit educational experience, improves bystander CPR.

The objective of this study was to determine if non-patients passively exposed to an ultra-brief CPR training video shown intermittently on an Emergency Department (ED) waiting room television would perform compression-only CPR better than unexposed controls.

Section snippets

Study design and setting

This was a prospective controlled before-and-after study conducted in 2013 in the waiting room of a large, urban, academic ED that sees 90,000 patients annually. Institutional Review Board approval was obtained (#2013-0158). Informed consent was obtained from all participants.

Conducting this study in an ED waiting room provided a feasible way to ensure passive exposure to an ultra-brief video. In addition, ED visits provide an opportunity to reach vulnerable segments of the population, and

Results

100 people were enrolled (Fig. 1). Baseline demographics and data on prior experience with CPR are shown in Table 1. There were no statistically significant differences between the two groups. Seventeen total participants recalled specifically watching the video, with one in the control group.

Primary and secondary outcomes are shown in Table 2. Participants passively exposed to the ultra-brief video demonstrated a statistically significant improvement in the primary outcome compared to the

Discussion

Our data suggest that passive exposure to an ultra-brief CPR training video improves the ability of participants to correctly perform compression-only CPR. This study was designed to be an effectiveness study conducted in an unstructured real-world setting. Our findings are consistent with two prior studies that demonstrated efficacy for ultra-brief videos in training bystanders within an educational framework [7], [8]. We observed similar improvements in CPR quality with similar effect sizes,

Conclusion

Passive exposure to an ultra-brief CPR training video in an ED waiting room is associated with improved short-term performance of compression-only CPR.

Conflicts of interest

None.

Acknowledgements

This project was supported by a Society for Academic Emergency Medicine Foundation grant, RF2015-001, and an Institutional Clinical and Translational Science Award, NIH/NCRR 5ULIRR026314-03.

References (10)

There are more references available in the full text version of this article.

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A Spanish translated version of the abstract of this article appears as Appendix in the final online version at http://dx.doi.org/10.1016/j.resuscitation.2017.04.008.

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