Article, Cardiology

The feasibility of a novel method of bystander CPR training: A pilot study

a b s t r a c t

Sudden cardiac arrest is a leading cause of death in the United States, with many occurring out of the hos- pital. Immediate response by bystanders, through the initiation of cardiopulmonary resuscitation (CPR), leads to increased survival; however, many do not respond due to lack of training and education. This study sought to determine the efficacy of a training model developed to rapidly and effectively train large numbers of individuals on Hands-only CPR. Thirty minute training sessions were developed to introduce hands-only CPR to faculty at a university, with questionnaires assessing confidence and knowledge of CPR. Faculty then went on to train their respective students. Ninety-six faculty and staff and 1615 stu- dents were trained within 3 weeks, demonstrating this model was effective in rapidly training large num- bers of individuals in a short period of time while increasing CPR knowledge and confidence. This method may be effective in other community settings.

(C) 2019

Introduction

Every year in the United States, there are over 356,000 cardiac arrests outside of a hospital setting and a survival rate of just 10% [1]. Survival rates improve considerably if the victim receives immediate cardiopulmonary resuscitation (CPR) and defibrillation with an Automated external defibrillator [2,3]. Because med- ical personnel response may take 7-8 min or longer [4], victim sur- vival depends on the ability of the bystander to recognize an emergency and perform CPR until the arrival of trained responders. However, only 15-30% of cardiac arrest victims receive CPR from a bystander [5]. The reluctance in performing CPR is unclear but may be due to fear of liability, fear of transmittED diseases [6], inade- quate training, complicated guidelines, and fear of failure [7]. Bys- tander CPR (CPR without rescue breaths), also called hands-only CPR, has been proven to be as effective as traditional CPR in treat- ing cardiac arrest victims [8,9] and may result in more effective CPR due to uninterrupted chest compressions and reduced time to initiation of chest compressions [10]. Because bystander CPR is easy to perform and recall, individuals trained in this method may be less hesitant to respond to an emergency. However, many people are unaware of hands-only CPR [11] and therefore there is an increased need to educate the public about this method. Due to its straightforward steps, it is simple to teach and can be introduced to large numbers of people with little time burden.

* Corresponding author.

E-mail address: [email protected] (R.M. Kappus).

The primary purpose of this intervention was to determine if short bouts of hands-only CPR and AED training were effective in improving confidence in the ability to perform CPR and use an AED, and if knowledge of CPR and AED procedures increased. A sec- ondary purpose was to determine if the model of training in which the student becomes the teacher, would be effective in introducing large numbers of individuals to hands-only CPR, with minimal bur- den on participants.

Methods

This intervention was implemented in the fall semester of 2018 at Appalachian State University, located in Boone, North Carolina and was approved by the Appalachian State University institu- tional review board (19-0059). The targeted audience was faculty and staff of the Beaver College of Health Sciences at Appalachian State University. Training was available in 30 min sessions over three separate dates. The average number of participants for each training session was approximately 20 participants, and 4 trainers were present per session.

In-person training consisted of a personal story from a car- diac arrest survivor who received bystander CPR, a demonstra- tion with step-by-step descriptions of appropriate hands-only CPR steps and AED usage, and practice of CPR steps and chest compressions on mannequins and practice with an AED trainer, completed under the guidance and instruction of the trainers. Hands-Only CPR utilizes 3 steps based on the American Red Cross instructions: (1) Check/Call; (2) Provide chest

https://doi.org/10.1016/j.ajem.2019.10.003

0735-6757/(C) 2019

R.M. Kappus, G. McCullough / American Journal of Emergency Medicine 38 (2020) 594-597 595

compressions; (3) Don’t stop. The aims of the training session were to emphasize the crucial role of CPR and AED use in a vic- tim’s personal story to highlight the magnitude of simple chest compressions in survival, demonstrate the straight-forward steps in hands-only CPR, and allow participants the opportunity to perform hands-on practice and understand proper execution of chest compressions.

A questionnaire was administered prior to training to determine baseline comfort and knowledge of CPR and AED use

(Fig. 1). The same questionnaire was administered following train- ing to determine the efficacy of the intervention.

In the following semester, trained faculty then taught hands- only CPR to the students enrolled in each of their courses, targeting the American Heart Month of February. Prior to the spring training, faculty were provided a hand-out outlining the steps for CPR and AED use as a refresher, and a short video outlining CPR and AED steps to be shown during class. Mannequins were brought to each classroom for compressions practice.

Fig. 1. Questionnaire Provided Before and Following Training Session.

596 R.M. Kappus, G. McCullough / American Journal of Emergency Medicine 38 (2020) 594-597

Fig. 2. Schematic of training implementation.

Results

Ninety-six faculty and staff filled out the optional question- naires before and following the training; and, of these, 27 partici- pants were currently CPR certified. Prior to training, 52% of participants felt confident in their ability to perform CPR while 45% were confident in their ability to use an AED. Following train- ing, 99% and 97% of participants, respectively, were confident in their ability to perform CPR and use an AED. Participants also improved their knowledge of material, with CPR knowledge improving from 60% to 87% accuracy and AED knowledge improv- ing from 52% to 82% accuracy (Table 1). Of the 27 participants currently CPR certified and confident in their abilities, only 3 answered all questions correctly.

In the spring semester training, over a three week time period, 1615 students in 68 classes in the Beaver College of Health Sciences were trained by 44 faculty on hands-only CPR and AED use.

Discussion

Bystander CPR can significantly improve survival rates of car- diac arrest, which currently hovers around 10%. Enhancing an indi- vidual’s comfort with CPR performance, implementing straight- forward CPR training with minimal steps that are easy to perform and recall, and eliminating mouth-to-mouth contact from rescue breaths may result in increased willingness to respond. Results from this study highlight that effective bystander CPR and AED training can be done in large groups and in a short period of time, resulting in decreased burden on participants and trainers and increasing the number of individuals trained in this life-saving technique. Faculty time burden was 30 min in the fall semester for initial training, and approximately 30 min per class in the spring when training students. Trainer burden was approximately 12 h in the fall semester.

The improvement in scores demonstrates the training was effective in improving confidence and in educating the faculty/staff

Table 1

Questionnaire Results Before and Following Training Session: Percent Correct.

CPR Q1

CPR Q2

CPR Q3

AED Q1

AED Q2

PRE

POST

PRE

POST

PRE

POST

PRE

POST

PRE

POST

Currently CPR certified (%)

63

74

85

96

82

93

85

93

52

74

Not CPR certified (%)

26

78

67

87

70

93

63

83

28

77

R.M. Kappus, G. McCullough / American Journal of Emergency Medicine 38 (2020) 594-597 597

on proper CPR performance and AED use. This may result in increased responsiveness during a cardiac arrest and in more effec- tive CPR, improving a victim’s chance of survival. The implementa- tion of a follow-up survey and skills testing session will be included in future training sessions, in order to assess retention and Quality of CPR skills. Follow up is recommended at 6 and 12 month intervals in order to assure the maintenance of skills and knowledge.

A noteworthy finding is that those individuals currently certi- fied in CPR did not answer questions correctly regarding appropri- ate CPR steps and AED use. These questions are reflective of questions used in a typical CPR training course and therefore would be expected to be answered correctly by the certified group. This finding suggests that participants, despite certification, may have performed incorrectly in an emergency situation, resulting in ineffective CPR and reduced survival. This highlights that this training is beneficial even for those certified in CPR/AED.

Additionally, our training method in which the student becomes the trainer, was effective in training a total of just over 1700 participants in a short period of time with limited burden. When using the proposed training schematic (Fig. 2), this may further increase the number of hands-only CPR/AED trained indi- viduals in a variety of settings. Although this program was imple- mented as a pilot study at a university, our next steps are to spread this training method across an entire college campus, as well as throughout the local community. Outreach in community centers, senior centers, and office settings would lead to a significant increase in the proportion of the population able to respond to car- diac arrest safely and effectively, with minimal time burden on participants. Considering cardiac arrest is a leading cause of death in the United States, the ability to recognize a cardiac arrest and immediately respond will have the potential to save thousands of lives.

Acknowledgements

This study was made possible due to faculty and staff volunteers from the Beaver College of Health Sciences. We thank Dr. Marie Huff, Dean of the Beaver College of Health Sciences, Appalachian

State’s Health Promotion for Faculty and Staff, and the Omar Carter Foundation for their support and assistance.

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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