title: Video-Only Cardiopulmonary Resuscitation Education for High-Risk Families Before Hospital Discharge: A Multicenter Pragmatic Trial.
abstract: Cardiopulmonary resuscitation (CPR) training rates in the United States 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) with those trained with a video self-instruction kit (VSI; with manikin). We hypothesized that VO training would be noninferior to the VSI approach with respect to chest compression (CC) rate.
  
  
  
  We performed a prospective, cluster randomized trial of CPR education for family members of patients with high-risk cardiac conditions 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 6 months post training. Mean CC rate among those trained with VO compared with those trained with VSI was assessed with a noninferiority margin set at 8 CC per min; as a secondary outcome, mean differences in CC depth were assessed. From February 2012 to May 2015, 1464 subjects were enrolled and 522 subjects completed a skills assessment. The mean CC rates were 87.7 (VO) CC per min and 89.3 (VSI) CC per min; we concluded noninferiority for VO based on a mean difference of -1.6 (90% confidence interval, -5.2 to 2.1). The mean CC depth was 40.2 mm (VO) and 45.8 mm (VSI) with a mean difference of -5.6 (95% confidence interval, -7.6 to -3.7). Results were similar after multivariate regression adjustment.
  
  
  
  In this large, prospective trial of CPR skill retention, VO training yielded a noninferior difference in CC rate compared with 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.
  
  
  
  URL: https://www.clinicaltrials.gov. Unique identifier: NCT01514656.
authors.affiliation: From the Department of Emergency Medicine and Center for Resuscitation Science (A.L.B., L.B.B., M.L., B.S.A.), Department of Biostatistics and Epidemiology (A.L.B., M.E.P., J.L.), School of Nursing (B.J.R., M.L.), New Courtland Center for Transitions and Healthy (B.J.R.), Department of Medicine (J.A.S., J.N.K., P.W.G.), Department of Anesthesiology and Critical Care (R.A.B.), University of Pennsylvania, Philadelphia; The Children's Hospital of Philadelphia, Pennsylvania (R.A.B., V.M.N.); and Philadelphia Veterans Affairs Medical Center, Pennsylvania (P.W.G.).
authors.forename: Audrey L
authors.initials: AL
authors.lastname: Blewer
authors.affiliation: From the Department of Emergency Medicine and Center for Resuscitation Science (A.L.B., L.B.B., M.L., B.S.A.), Department of Biostatistics and Epidemiology (A.L.B., M.E.P., J.L.), School of Nursing (B.J.R., M.L.), New Courtland Center for Transitions and Healthy (B.J.R.), Department of Medicine (J.A.S., J.N.K., P.W.G.), Department of Anesthesiology and Critical Care (R.A.B.), University of Pennsylvania, Philadelphia; The Children's Hospital of Philadelphia, Pennsylvania (R.A.B., V.M.N.); and Philadelphia Veterans Affairs Medical Center, Pennsylvania (P.W.G.).
authors.forename: Mary E
authors.initials: ME
authors.lastname: Putt
authors.affiliation: From the Department of Emergency Medicine and Center for Resuscitation Science (A.L.B., L.B.B., M.L., B.S.A.), Department of Biostatistics and Epidemiology (A.L.B., M.E.P., J.L.), School of Nursing (B.J.R., M.L.), New Courtland Center for Transitions and Healthy (B.J.R.), Department of Medicine (J.A.S., J.N.K., P.W.G.), Department of Anesthesiology and Critical Care (R.A.B.), University of Pennsylvania, Philadelphia; The Children's Hospital of Philadelphia, Pennsylvania (R.A.B., V.M.N.); and Philadelphia Veterans Affairs Medical Center, Pennsylvania (P.W.G.).
authors.forename: Lance B
authors.initials: LB
authors.lastname: Becker
authors.affiliation: From the Department of Emergency Medicine and Center for Resuscitation Science (A.L.B., L.B.B., M.L., B.S.A.), Department of Biostatistics and Epidemiology (A.L.B., M.E.P., J.L.), School of Nursing (B.J.R., M.L.), New Courtland Center for Transitions and Healthy (B.J.R.), Department of Medicine (J.A.S., J.N.K., P.W.G.), Department of Anesthesiology and Critical Care (R.A.B.), University of Pennsylvania, Philadelphia; The Children's Hospital of Philadelphia, Pennsylvania (R.A.B., V.M.N.); and Philadelphia Veterans Affairs Medical Center, Pennsylvania (P.W.G.).
authors.forename: Barbara J
authors.initials: BJ
authors.lastname: Riegel
authors.affiliation: From the Department of Emergency Medicine and Center for Resuscitation Science (A.L.B., L.B.B., M.L., B.S.A.), Department of Biostatistics and Epidemiology (A.L.B., M.E.P., J.L.), School of Nursing (B.J.R., M.L.), New Courtland Center for Transitions and Healthy (B.J.R.), Department of Medicine (J.A.S., J.N.K., P.W.G.), Department of Anesthesiology and Critical Care (R.A.B.), University of Pennsylvania, Philadelphia; The Children's Hospital of Philadelphia, Pennsylvania (R.A.B., V.M.N.); and Philadelphia Veterans Affairs Medical Center, Pennsylvania (P.W.G.).
authors.forename: Jiaqi
authors.initials: J
authors.lastname: Li
authors.affiliation: From the Department of Emergency Medicine and Center for Resuscitation Science (A.L.B., L.B.B., M.L., B.S.A.), Department of Biostatistics and Epidemiology (A.L.B., M.E.P., J.L.), School of Nursing (B.J.R., M.L.), New Courtland Center for Transitions and Healthy (B.J.R.), Department of Medicine (J.A.S., J.N.K., P.W.G.), Department of Anesthesiology and Critical Care (R.A.B.), University of Pennsylvania, Philadelphia; The Children's Hospital of Philadelphia, Pennsylvania (R.A.B., V.M.N.); and Philadelphia Veterans Affairs Medical Center, Pennsylvania (P.W.G.).
authors.forename: Marion
authors.initials: M
authors.lastname: Leary
authors.affiliation: From the Department of Emergency Medicine and Center for Resuscitation Science (A.L.B., L.B.B., M.L., B.S.A.), Department of Biostatistics and Epidemiology (A.L.B., M.E.P., J.L.), School of Nursing (B.J.R., M.L.), New Courtland Center for Transitions and Healthy (B.J.R.), Department of Medicine (J.A.S., J.N.K., P.W.G.), Department of Anesthesiology and Critical Care (R.A.B.), University of Pennsylvania, Philadelphia; The Children's Hospital of Philadelphia, Pennsylvania (R.A.B., V.M.N.); and Philadelphia Veterans Affairs Medical Center, Pennsylvania (P.W.G.).
authors.forename: Judy A
authors.initials: JA
authors.lastname: Shea
authors.affiliation: From the Department of Emergency Medicine and Center for Resuscitation Science (A.L.B., L.B.B., M.L., B.S.A.), Department of Biostatistics and Epidemiology (A.L.B., M.E.P., J.L.), School of Nursing (B.J.R., M.L.), New Courtland Center for Transitions and Healthy (B.J.R.), Department of Medicine (J.A.S., J.N.K., P.W.G.), Department of Anesthesiology and Critical Care (R.A.B.), University of Pennsylvania, Philadelphia; The Children's Hospital of Philadelphia, Pennsylvania (R.A.B., V.M.N.); and Philadelphia Veterans Affairs Medical Center, Pennsylvania (P.W.G.).
authors.forename: James N
authors.initials: JN
authors.lastname: Kirkpatrick
authors.affiliation: From the Department of Emergency Medicine and Center for Resuscitation Science (A.L.B., L.B.B., M.L., B.S.A.), Department of Biostatistics and Epidemiology (A.L.B., M.E.P., J.L.), School of Nursing (B.J.R., M.L.), New Courtland Center for Transitions and Healthy (B.J.R.), Department of Medicine (J.A.S., J.N.K., P.W.G.), Department of Anesthesiology and Critical Care (R.A.B.), University of Pennsylvania, Philadelphia; The Children's Hospital of Philadelphia, Pennsylvania (R.A.B., V.M.N.); and Philadelphia Veterans Affairs Medical Center, Pennsylvania (P.W.G.).
authors.forename: Robert A
authors.initials: RA
authors.lastname: Berg
authors.affiliation: From the Department of Emergency Medicine and Center for Resuscitation Science (A.L.B., L.B.B., M.L., B.S.A.), Department of Biostatistics and Epidemiology (A.L.B., M.E.P., J.L.), School of Nursing (B.J.R., M.L.), New Courtland Center for Transitions and Healthy (B.J.R.), Department of Medicine (J.A.S., J.N.K., P.W.G.), Department of Anesthesiology and Critical Care (R.A.B.), University of Pennsylvania, Philadelphia; The Children's Hospital of Philadelphia, Pennsylvania (R.A.B., V.M.N.); and Philadelphia Veterans Affairs Medical Center, Pennsylvania (P.W.G.).
authors.forename: Vinay M
authors.initials: VM
authors.lastname: Nadkarni
authors.affiliation: From the Department of Emergency Medicine and Center for Resuscitation Science (A.L.B., L.B.B., M.L., B.S.A.), Department of Biostatistics and Epidemiology (A.L.B., M.E.P., J.L.), School of Nursing (B.J.R., M.L.), New Courtland Center for Transitions and Healthy (B.J.R.), Department of Medicine (J.A.S., J.N.K., P.W.G.), Department of Anesthesiology and Critical Care (R.A.B.), University of Pennsylvania, Philadelphia; The Children's Hospital of Philadelphia, Pennsylvania (R.A.B., V.M.N.); and Philadelphia Veterans Affairs Medical Center, Pennsylvania (P.W.G.).
authors.forename: Peter W
authors.initials: PW
authors.lastname: Groeneveld
authors.affiliation: From the Department of Emergency Medicine and Center for Resuscitation Science (A.L.B., L.B.B., M.L., B.S.A.), Department of Biostatistics and Epidemiology (A.L.B., M.E.P., J.L.), School of Nursing (B.J.R., M.L.), New Courtland Center for Transitions and Healthy (B.J.R.), Department of Medicine (J.A.S., J.N.K., P.W.G.), Department of Anesthesiology and Critical Care (R.A.B.), University of Pennsylvania, Philadelphia; The Children's Hospital of Philadelphia, Pennsylvania (R.A.B., V.M.N.); and Philadelphia Veterans Affairs Medical Center, Pennsylvania (P.W.G.). benjamin.abella@uphs.upenn.edu.
authors.forename: Benjamin S
authors.initials: BS
authors.lastname: Abella
mesh_terms: D000328:Adult; D000368:Aged; D016887:Cardiopulmonary Resuscitation / Q000193:education*; D016757:Death, Sudden, Cardiac / Q000209:etiology / Q000517:prevention & control*; D004522:Educational Status; D005190:Family; D005260:Female; D006266:Health Education / Q000379:methods*; D007722:Health Knowledge, Attitudes, Practice; D006323:Heart Arrest / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D006801:Humans; D008297:Male; D008348:Manikins; D008875:Middle Aged; D010414:Pennsylvania; D011446:Prospective Studies; D012153:Retention, Psychology; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D014741:Video Recording
keywords: cardiopulmonary resuscitation; cardiovascular diseases; heart arrest; randomized controlled trial; resuscitation