No abstract

Introduction: Since over 75% of sudden cardiac arrest events occur in the home where family members may be first responders, broad cardiopulmonary resuscitation (CPR) training for family members of high-risk cardiac patients represents a promising intervention. The use of mobile application-based (mApp) CPR training may facilitate this, but data on the approach are limited. Objectives: We compared CPR skill retention among those trained with an mApp and hypothesized that training with the mApp would be non-inferior to training with a well-established video self-instruction (VSI) kit. As a secondary analysis, we examined dissemination via the “multiplier rate” (i.e., those additionally trained by primary trainees) by intervention. Methods: We conducted a multicenter pragmatic, randomized control trial assessing non-inferiority of training family members of cardiac patients in CPR with an mApp (video, but no practice manikin) to training with an established VSI method (video and manikin). Subject’s CPR skills were tested 6-months post-training. We hypothesized that mApp training would be non-inferior to VSI training, with a non-inferiority margin set at 5 chest compressions (cc) per min. Results: From 01/2016-01/2018, 1446 subjects were enrolled at 8 hospitals with 685 trained with VSI, and 761 trained with the mApp. Of those, 541 were included in the skills analysis (275 VSI, 266 App). The mean age was 52±16 years and 69% were female. Mean cc rate was 85±34 per min; mean cc depth was 40±14 mm. When stratified by intervention arm, those trained with VSI had a mean rate of 86 per min (83, 90), compared to 88 per min (84, 92) with the mApp; those trained with VSI had a mean depth of 42 mm (41, 44), compared to 39 mm (38, 41) with the mApp. Findings were similar when accounting for loss to follow-up. We concluded non-inferiority of the mApp with a mean difference of 1 (-5, 7) cc per min for rate. Subjects trained with VSI shared with an additional 2±4 individuals compared to 1±2 (p<0.01) of those trained with the mApp. Conclusion: In this large prospective trial of CPR skill retention, the mApp CPR training approach was non-inferior to VSI training for family members of cardiac patients. Future work may include evaluating additional means for adoption and dissemination of the mApp.

No abstract

Background. Get With the Guidelines (GWTG)-Resuscitation (formerly the National Registry of Cardiopulmonary Resuscitation (NRCPR)) is a data registry and quality improvement program for in-hospital cardiac arrest (IHCA). It is unknown if duration of hospital participation in GWTG-Resuscitation is associated with IHCA outcomes. Methods. We analyzed 104,732 adult patients with IHCA from 362 hospitals participating in GWTG-Resuscitation between 2000 and 2009. The association between duration of hospital participation in GWTG-Resuscitation and patient outcomes after IHCA was determined with multiple logistic regression after adjusting for patient and hospital characteristics and secular trends by inclusion of calendar year. We also evaluated the association between duration of participation and factors previously correlated with survival after IHCA, including ECG monitored status, after-hours arrest, and time to defibrillation. All models were constructed as generalized estimating equations to account for clustering of patients at the hospital level. Results. Survival to discharge occurred in 17,646 patients (16.9%). Duration of hospital participation in GWTG-Resuscitation was weakly associated with improved IHCA outcomes (Table). Among factors correlated with IHCA survival, duration of participation was associated with time to defibrillation < 2 minutes (per year of participation, OR 1.06; 95% CI 1.03-1.09; p<0.001), but not ECG monitored status (OR 1.00; 95% CI 0.93-1.06; p=0.90) or survival of after-hours arrest (OR 1.01; 95% CI 0.99-1.03; p=0.41). Inclusion of time to defibrillation attenuated the association between duration of participation and outcomes of ventricular tachycardia or ventricular fibrillation (VT/VF) arrests. Conclusion. Duration of hospital participation in GWTG-Resuscitation is weakly associated with survival of IHCA. In VT/VF arrests, this association may be mediated by improvements in time to defibrillation. Survival by Duration of Hospital Participation in Get With the Guidelines-Resuscitation Odds-Ratio per Year of GWTG-Resuscitation Participation (95% CI) Unadjusted Model 1: Patient and Hospital Characteristics and Calendar Year Model 1 Plus ECG Monitored Model 1 Plus After-Hours Arrest Model 1 Plus Time to Defibrillation All Events Survival of event 1.06
 (1.05-1.07) ‡ 1.02
 (1.00-1.03) * 1.02
 (1.00-1.04) * 1.02
 (1.00-1.04) * N/A Survival to 24 hours 1.03
 (1.02-1.04) ‡ 1.01
 (0.99-1.03) 1.01
 (0.99-1.03) 1.01
 (0.99-1.03) Survival to discharge 1.03
 (1.02-1.04) ‡ 1.02
 (0.99-1.04) 1.02
 (0.99-1.04) 1.02
 (0.99-1.04) No major disability 1.04
 (1.01-1.06) * 1.00
 (0.96-1.05) 1.00
 (0.96-1.05) 1.00
 (0.96-1.05) VT/VF Arrest Events Survival of event 1.06
 (1.04-1.08) ‡ 1.03
 (1.00-1.05) * 1.03
 (1.00-1.05) * 1.03
 (1.00-1.05) * 1.01
 (0.98-1.04) Survival to 24 hours 1.03
 (1.01-1.05) † 1.01
 (0.99-1.04) 1.01
 (0.99-1.04) 1.01
 (0.99-1.04) 1.00
 (0.97-1.02) Survival to discharge 1.03
 (1.01-1.05) † 1.01
 (0.98-1.04) 1.01
 (0.98-1.04) 1.01
 (0.98-1.04) 1.00
 (0.97-1.03) No major disability 1.03
 (1.00-1.07) * 1.00
 (0.95-1.05) 1.00
 (0.95-1.05) 1.00
 (0.95-1.05) 0.99
 (0.94-1.04) All models were constructed as generalized estimating equations with independent correlation matrix and robust variance to account for clustering of patients at the hospital level. * p<0.05; † p<0.01; ‡ p<0.001.

No abstract