Video-Only Cardiopulmonary Resuscitation Education for High-Risk Families Before Hospital Discharge: A Multicenter Pragmatic Trial

摘要

Background—CPR training rates in the US are low, highlighting the need to develop CPR educational approaches that are simpler, with broader dissemination potential. The minimum training required to ensure long-term skill retention remains poorly characterized. We compared CPR skill retention among laypersons randomized to training with video-only (VO; no manikin) to those trained with a video serf-instruction kit (VSI; with manikin). We hypothesized that VO training would be non-inferior to the VSI approach with respect to chest compression (CC) rate. Methods and Results—We performed a prospective cluster randomized trial of CPR education for family members of high-risk cardiac patients on hospital cardiac units, using a multicenter pragmatic design. Eight hospitals were randomized to offer either VO or VSI training before discharge using volunteer trainers. CPR skills were assessed six months post-training. Mean CC rate among those trained with VO compared to VSI was assessed with a non-inferiority margin set at 8 CC per min (cpm); as a secondary outcome, mean differences in CC depth were assessed. From 2/2012 to 5/2015, 1464 subjects were enrolled and 522 subjects completed a skills assessment. The mean CC rates were 87.7(VO) cpm and 89.3 (VSI) cpm; we concluded non-inferiority for VO based on a mean difference of -1.6 (90% CI: -5.2, 2.1). The mean CC depth was 40.2 mm (VO) and 45.8 mm (VSI) with a mean difference of-5.6 (95% CI: -7.6, -3.7). Results were similar after multivariate regression adjustment. Conclusions—In this large prospective trial of CPR skill retention, VO training yielded a non-inferior difference in CC rate compared to VSI training. CC depth was greater in the VSI group. These findings suggest a potential trade-off in efforts for broad dissemination of basic CPR skills; VO training might allow for greater scalability and dissemination, but with a potential reduction in CC depth.