Potential impact of a targeted cardiopulmonary resuscitation program for older adults on survival from private residence cardiac arrest

Abstract

Study objectives: Traditional cardiopulmonary resuscitation (CPR) training programs do not target older adults who are most likely to witness private-residence cardiac arrests nor reliably train a bystander who is likely to perform CPR in the event of an arrest. The objective of this study is to compare targeted CPR training programs for older adults (>50 years) that (1) increase numbers of CPR-trained bystanders; or (2) increase the percentage of trained bystanders who perform CPR. A simultaneous outcome is to estimate the minimal significant survival benefit associated with each of the training programs. Methods: A probabilistic simulation model was developed in Fortran95 that incorporated key out-of-hospital cardiac arrest elements, including witnessed arrests, CPR-trained witness, CPR provision, and impact of CPR on ventricular fibrillation. Input data were derived from published or publicly available data, including a large prospective cohort study of outcomes in Oakland County, MI. Monte Carlo simulation (n=10,000) and sensitivity analyses (n=40) were used to assess median and 95% confidence intervals (CIs) for incremental survival with either intervention. Results: The baseline model, calibrated to the input-data community's characteristics, established that 40.8% of cardiac arrest bystanders were trained in CPR; however, only 25.7% performed CPR, which yielded 4.81% survival (95% CI 4.72% to 4.89%). Modeling the impact on the baseline training level with increased CPR performance among trainees indicated that 75% of trained bystanders would need to perform CPR to reach a minimally significant improvement in survival (5.02%; 95% CI 4.94% to 5.15%). Similarly, targeted CPR training that would result in a significant survival benefit (to 5.01%; 95% CI 4.93% to 5.09%) would require that 70.8% of bystanders be trained. Conclusion: CPR training programs that focus on yielding 75% of trainees who perform CPR in the event of witnessing an arrest would have equivalent results to mass CPR training programs that result in 70% of arrest bystanders being trained in CPR. However, the minimal survival benefit associated with these programs (∼0.2%) may prove neither method cost-ineffective.