Effectiveness of a 30-min CPR self-instruction program for lay responders: a controlled randomized study☆
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.
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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
References (23)
- et al.
Simple CPR: a randomized, controlled trial of video self-instructional cardiopulmonary resuscitation training in an African American church congregation
Ann Emerg Med
(1999) - et al.
Randomized, controlled trial of video self-instruction versus traditional CPR training
Ann Emerg Med
(1998) - et al.
CPR instruction by videotape: results of a community project
Ann Emerg Med
(1995) - et al.
A survey of participants in a mass CPR training course
Ann Emerg Med
(1987) Student, instructor, and course factors predicting achievement in CPR training classes
Am J Emerg Med
(1991)- et al.
Are we training the right people yet? A survey of participants in public cardiopulmonary resuscitation classes
Resuscitation
(1998) - et al.
A peer-training model for instruction of basic cardiac life support
Resuscitation
(1995) - et al.
Education in adult basic life support training programs
Ann Emerg Med
(1993) - et al.
The problem of poor retention of cardiopulmonary resuscitation skills may lie with the instructor, not the learner or the curriculum
Resuscitation
(1991) - et al.
Teaching adult resuscitation in the United States—time for a rethink
Resuscitation
(1998)
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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.