Public Health in Emergency Medicine
Cardiopulmonary Resuscitation Prescription Program: A Pilot Randomized Comparator Trial

https://doi.org/10.1016/j.jemermed.2011.05.078Get rights and content

Abstract

Background

The American Heart Association wants to increase the number of citizens who know how to perform cardiopulmonary resuscitation (CPR). It is unknown whether giving patients a prescription (Rx) to learn CPR is effective. We sought to determine if patients with, or at risk for, heart disease and their families were more likely to follow prescriptive advice to buy a CPR Anytime™ kit (American Heart Association, Dallas, TX) or to take a CPR class.

Methods

This was a prospective randomized pilot study of a convenience sample of 162 patients who presented to one of three recruiting sites: a suburban community emergency department (ED), an office-based primary care (IM), or cardiology (CD) setting. After consent was obtained, CPR-naïve participants aged > 44 years were randomized to one of two study arms. One group received a Rx for a CPR Anytime™ self-learning kit, consisting of a CPR mannequin and a 22-minute DVD. The comparator group was prescribed a CPR class.

Results

At the IM office, 7/29 (24%), at the CD office 3/25 (12%), and at the ED 2/23 (9%) patients purchased the CPR kit. Across both investigational arms, 4 were lost to follow-up, yielding approximately 15% (12/77) who followed Rx advice to purchase the CPR kit and 0% (0/79) who took a CPR class. Cumulatively, a participant was significantly more likely to purchase a kit than to take a class (p = 0.0004).

Conclusion

Patients can be motivated to purchase CPR Anytime™ kits but not to take a CPR class from prescribed advice.

Introduction

Out-of-hospital cardiac arrest affects 180,000–400,000 Americans annually (1). Survival often depends on early bystander cardiopulmonary resuscitation (CPR) 2, 3, 4. The odds of survival from sudden cardiac arrest increase 3.7 times if early bystander CPR is performed (3). Survival is three times greater when effective CPR is given vs. ineffective CPR (4). The proportion of cases of out-of-hospital arrest that receive bystander CPR is 27.4%, and most of those giving CPR are 45 years of age or older 5, 6. Therefore, one strategy for improving survival rates is to increase the proportion of the population trained in CPR, particularly those aged over 45 years.

The Physician CPR Prescription Program is recommended by the American Heart Association (AHA). This initiative asks doctors to “prescribe” CPR to their patients (7). Although the AHA program is admirable, evidence that this prescriptive advice could motivate individuals to learn CPR is lacking. Our primary study aim was to see if physician-prescribed advice to purchase a CPR Anytime™ kit (American Heart Association, Dallas, TX) was more effective than advice to take a CPR class. We set out to determine if providing either a CPR Anytime™ kit or a CPR class “prescription” (Rx) to patients with heart disease or at risk for coronary artery disease (CAD) could motivate them to learn CPR. Because both the kit and class are accepted by the AHA as effective training methods, the measured outcome for this hypothesis was self-reported positive response to purchasing and completing the kit (or taking a class) at telephone follow-up (7).

Secondarily, as part of a “multiplier effect,” an additional 1.5 family members or friends per participant in the kit group were projected to be trained in CPR. Family and friend participation was measured at telephone follow-up by research subject report. Finally, patients and their families might experience a “teachable moment” when their loved one was in the Emergency Department (ED). In comparison to an office setting, this was felt to potentially increase the likelihood that the patient would fill the prescription for CPR Anytime™. The strength of the power of the advice was to be assessed by comparatively measuring subject participation rates in the ED setting to other sites.

Section snippets

Methods

This was a pilot prospective randomized comparator study of a convenience sample of patients who already had, or were at risk for, CAD. Subjects presented to one of three recruiting sites: an ED, an office-based primary care (IM), or a cardiology (CD) setting during weekday business hours. The study was approved after Institutional Review Board review and clinical trial registry were completed (NCT00570947). The suburban community ED is a Level I trauma center with an annual census of over

Results

One hundred sixty two subjects were enrolled over the course of 1 year, from July 2008 to July 2009, and telephone follow-up occurred approximately 90 days thereafter. Eighty one subjects were randomized to the CPR Anytime™ arm and 81 subjects to the CPR class group. Flow of enrollment, allocation, and analysis is illustrated in Figure 1. Eligibility failure (e.g., too young, no cardiac risk factor) in prescreening occurred in 82% (ED), 19% (CD), and 11% (IM); IM and CD settings were not

Discussion

Across all investigational study participants, approximately 15% (12/77) were motivated to follow physician prescriptive advice to purchase the CPR kit. It is even more encouraging that crossover occurred in the comparator arm. The potential impact of this program is illustrated as follows. The Centers for Disease Control and Prevention states that 82% of adults had contact with a health care provider in the last year, and the number of ambulatory care visits (to physician offices, hospital

Conclusion

This pilot study suggests that outpatient physician prescribing may motivate patients and their family members to purchase CPR Anytime™ kits. In contrast, prescribed advice to take a CPR class does not seem to be effective at motivating patients to learn CPR.

Article Summary

1. Why is this topic important?

  1. The American Heart Association (AHA) wants to increase the number of citizens who know how to perform cardiopulmonary resuscitation (CPR). It is unknown whether prescribed advice to patients to learn CPR is effective.

2. What does this study attempt to show?
  1. We sought to determine

References (11)

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

Cited by (12)

  • 2022 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations: Summary From the Basic Life Support; Advanced Life Support; Pediatric Life Support; Neonatal Life Support; Education, Implementation, and Teams; and First Aid Task Forces

    2022, Resuscitation
    Citation Excerpt :

    The full text of this CoSTR is on the ILCOR website.270 The SysRev performed as part of the 2015 ILCOR review265,266 identified 32 studies relating to BLS training in likely rescuers (eg, family or caregivers) of high-risk OHCA groups.273–304 One study298 from the 2015 review was not relevant for the revised outcomes in this update and was not included in this updated review.

  • European Resuscitation Council Guidelines for Resuscitation 2015. Section 1. Executive summary

    2015, Resuscitation
    Citation Excerpt :

    For high-risk populations (e.g. areas where there is high risk of cardiac arrest and low bystander response), recent evidence shows that specific factors can be identified which will enable targeted training based on the community's unique characteristics.911,912 There is evidence that likely rescuers in these populations are unlikely to seek training on their own but that they gain competency in BLS skills and/or knowledge after training.913–915 They are willing to be trained and are likely to share training with others.913,914,916–918

  • Part 8: Education, implementation, and teams. 2015 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations

    2015, Resuscitation
    Citation Excerpt :

    Although these studies used different methods for CPR training and assessment, they consistently report competent CPR performance and/or knowledge immediately after training,33,73,78,81–90 which is usually retained in the short term71,73,85,88 but declines over longer periods of follow-up without retraining or reminders.84 For the important outcome of number of people trained, we identified low-quality evidence (downgraded for risk of bias and indirectness) from 2 RCTs71,79 and very-low-quality evidence (downgraded for risk of bias) from 4 non-RCTs.74,75,78,80 The heterogeneous nature of the studies prevents pooling of data, but overall the data suggest that family members and caregivers are unlikely to seek training on their own63,79 but, when trained, are likely to share the training with others.71,74,75,78

  • European Resuscitation Council Guidelines for Resuscitation 2015. Section 10. Education and implementation of resuscitation

    2015, Resuscitation
    Citation Excerpt :

    There is evidence that likely rescuers in these populations are unlikely to seek training on their own but that they gain competency in BLS skills and/or knowledge after training.16–18 They are willing to be trained and are likely to share training with others.16,17,19–21 Most research in the teaching of resuscitation has been based on training adult rescuers in adult resuscitation skills.

View all citing articles on Scopus
View full text