Family Members Of Cardiac Patients Research Articles

A pragmatic randomized trial of cardiopulmonary resuscitation training for families of cardiac patients before hospital discharge using a mobile application

Aim of the studySince over 80% of sudden cardiac arrests occur in the home, 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 approach, but evidence regarding its efficacy is lacking. MethodsWe conducted a multicenter, pragmatic, cluster-randomized trial assessing CPR training for family members of cardiac patients. The interventions were mApp (video, no manikin) and VSI (video + manikin). CPR skills were evaluated 6-months post-training. We hypothesized that chest compression (CC) rate from training with an mApp would be no worse than 5 compressions per minute (CPM) lower compared to VSI. ResultsFrom 01/2016 to 01/2018, we enrolled 1325 eligible participants (mean age 51.6 years, 68.2% female and 59.4% white). CPR skills were evaluated 6-months post-training in 541 participants (275 VSI, 266 mApp). Mean rate was 84.6 CPM (95% CI: 80.4, 88.6) in VSI, compared to 82.7 CPM (95% CI: 76.2, 89.1) in the mApp, and mean depth was 42.1 mm (95% CI: 40.3, 43.8) in VSI, compared to 38.9 mm (95% CI: 36.2, 41.6) in the mApp. After adjustment, the mean difference in CC rate was −2.3 CPM (95% CI −9.4, 4.8, p = 0.25, non-inferiority) and CC depth was −3.2 mm (95% CI −5.9, 0.1, p = 0.056). ConclusionIn this large prospective trial of CPR skill retention for family members of cardiac patients, mApp training was associated with lower CC quality. Future work is required to understand additional approaches to improve CPR skill retention. Clinical Trial RegistrationURL: ClinicalTrials.gov, Identifier: NCT02548793.

Abstract 445: Cardiopulmonary Resuscitation Training for Families of Cardiac Patients Before Hospital Discharge Using a Mobile Application

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.

Perceived Stressors of Hospitalized Patients’ Family in Cardiac Care Unites: A Qualitative Content Analysis

The present study attempts to justify the factors inducing stress in the families of patients hospitalized in cardiac intensive care units in the east of Guilan province in Iran. The study aims at gaining an accurate understanding on these stressors for appropriate planning directed at removing or decreasing these tension-inducing components. The present study is a qualitative study based upon a conventional content analysis approach. The study population was selected through purposive sampling (28 family members of cardiac patients), and the data were gathered through semi-structured interviews. Data analysis was performed as per the stages recommended by Graneheim and Lundman (2004). The strength and scientific accuracy of the study was also established. The study yielded three main themes and seven sub-themes: Heavy shadow of illness (fear of loneliness on the caring path, fear of disease, poor personal knowledge); Hesitation in the treatment (doubting the efficiency of technology, ungenial healthcare providers); and Economic storm (high cost of treatment, potential economic problems). The study results indicated that patients’ families underwent stress in various areas, pointing to the need for providing adequate training and information on the disease to family members and caregivers, as well as the sympathy of healthcare providers on the treatment path for reducing the disease-associated tensions suffered by hospitalized patients’ families.

Incorporating cardiopulmonary resuscitation training into a cardiac rehabilitation programme: A feasibility study.

Patients with a cardiac history are at future risk of cardiac events, including out-of-hospital cardiac arrest. Targeting cardiopulmonary resuscitation (CPR) training to family members of cardiac patients has long been advocated, but is an area in need of contemporary research evidence. An environment yet to be investigated for targeted training is cardiac rehabilitation. To evaluate the feasibility of providing CPR training in a cardiac rehabilitation programme among patients, their family members and staff. A prospective before and after study design was used. CPR training was delivered using video self-instruction CPR training kits, facilitated by a cardiac nurse. Data was collected pre-training, post-training and at one month. Cardiac patient participation rates in CPR classes were high ( n = 56, 72.7% of eligible patients) with a further 27 family members attending training. Patients were predominantly male (60.2%), family members were predominantly female (81.5%), both with a mean age of 65 years. Confidence to perform CPR and willingness to use skills significantly increased post-training (both p<0.001). Post training participants demonstrated a mean compression rate of 112 beats/min and a mean depth of 48 mm. Training reach was doubled as participants shared the video self-instruction kit with a further 87 people. Patients, family members and cardiac rehabilitation staff had positive feedback about the training. We demonstrated that cardiac rehabilitation is an effective and feasible environment to provide CPR training. Using video self-instruction CPR training kits enabled further training reach to the target population.

Systematic versus opportunistic risk assessment for the primary prevention of cardiovascular disease.

Screening programmes can potentially identify people at high cardiovascular risk and reduce cardiovascular disease (CVD) morbidity and mortality. However, there is currently not enough evidence showing clear clinical or economic benefits of systematic screening-like programmes over the widely practised opportunistic risk assessment of CVD in primary care settings. The primary objective of this review was to assess the effectiveness, costs and adverse effects of systematic risk assessment compared to opportunistic risk assessment for the primary prevention of CVD. We searched the Cochrane Central Register of Controlled Trials (CENTRAL) on the Cochrane Library, MEDLINE, EMBASE on 30 January 2015, and Web of Science Core Collection and additional databases on the Cochrane Library on 4 December 2014. We also searched two clinical trial registers and checked reference lists of relevant articles. We applied no language restrictions. We selected randomised controlled trials (RCTs) that assessed the effects of systematic risk assessment, defined as a screening-like programme involving a predetermined selection process of people, compared with opportunistic risk assessment which ranged from no risk assessment at all to incentivised case finding of CVD and related risk factors. Participants included healthy adults from the general population, including those who are at risk of CVD. Two review authors independently selected studies. One review author extracted data and assessed them for risk of bias and a second checked them. We assessed evidence quality using the GRADE approach and present this in a 'Summary of findings' table. Nine completed RCTs met the inclusion criteria, of which four were cluster-randomised. We also identified five ongoing trials. The included studies had a high or unclear risk of bias, and the GRADE ratings of overall quality were low or very low. The length of follow-up varied from one year in four studies, three years in one study, five or six years in two studies, and ten years in two studies. Eight studies recruited participants from the general population, although there were differences in the age ranges targeted. One study recruited family members of cardiac patients (high risk assessment). There were considerable differences between the studies in the interventions received by the intervention and control groups. There was insufficient evidence to stratify by the types of risk assessment approaches.Limited data were available on all-cause mortality (risk ratio (RR) 0.97, 95% confidence interval (CI) 0.92 to 1.02; 3 studies,103,571 participants, I² = 0%; low-quality evidence) and cardiovascular mortality (RR 1.00, 95% CI 0.90 to 1.11; 2 studies, 43,955 participants, I² = 0%), and suggest that screening has no effect on these outcomes. Data were also limited for combined non-fatal endpoints; overall, evidence indicates no difference in total coronary heart disease (RR 1.01, 95% CI 0.95 to 1.07; 4 studies, 5 comparisons, 110,168 participants, I² = 0%; low-quality evidence), non-fatal coronary heart disease (RR 0.98, 95% CI 0.89 to 1.09; 2 studies, 43,955 participants, I² = 39%), total stroke (RR 0.99, 95% CI 0.90 to 1.10; 2 studies, 79,631 participants, I² = 0%, low-quality evidence), and non-fatal stroke (RR 1.17, 95% CI 0.94 to 1.47; 1 study, 20,015 participants).Overall, systematic risk assessment appears to result in lower total cholesterol levels (mean difference (MD) -0.11 mmol/l, 95% CI -0.17 to -0.04, 6 studies, 7 comparisons, 12,591 participants, I² = 57%; very low-quality evidence), lower systolic blood pressure (MD -3.05 mmHg, 95% CI -4.84 to -1.25, 6 studies, 7 comparisons, 12,591 participants, I² = 82%; very low-quality evidence) and lower diastolic blood pressure (MD -1.34 mmHg, 95% CI -1.76 to -0.93, 6 studies, 7 comparisons, 12,591 participants, I² = 0%; low-quality evidence). One study assessed adverse effects and found no difference in psychological distress at five years (1126 participants). The results are limited by the heterogeneity between trials in terms of participants recruited, interventions and duration of follow-up. Limited data suggest that systematic risk assessment for CVD has no statistically significant effects on clinical endpoints. There is limited evidence to suggest that CVD systematic risk assessment may have some favourable effects on cardiovascular risk factors. The completion of the five ongoing trials will add to the evidence base.

Dissemination of CPR video self-instruction materials to secondary trainees: Results from a hospital-based CPR education trial

BackgroundCardiopulmonary resuscitation (CPR) video self-instruction (VSI) materials have been promoted as a scalable approach to increase the prevalence of CPR skills among the lay public, in part due to the opportunity for secondary training (i.e., sharing of training materials). However, the motivations for, and barriers to, disseminating VSI materials to secondary trainees is poorly understood. MethodsThis work represents an ancillary investigation of a prospective hospital-based CPR education trial in which family members of cardiac patients were trained using VSI. Mixed-methods surveys were administered to primary trainees six months after initial enrollment. Surveys were designed to capture motivations for, and barriers to, sharing VSI materials, the number of secondary trainees with whom materials were shared, and the settings, timing, and recipients of trainings. ResultsBetween 07/2012 and 05/2015, 653 study participants completed a six-month follow-up interview. Of those, 345 reported sharing VSI materials with 1455 secondary trainees. Materials were shared most commonly with family members. In a logistic regression analysis, participants in the oldest quartile (age >63 years) were less likely to share materials compared to those in the youngest quartile (age ≤44 years, OR 0.58, CI 0.37–0.90, p=0.02). Among the 308 participants who did not share their materials, time constraints was the most commonly cited barrier for not sharing. ConclusionsVSI materials represent a strategy for secondary dissemination of CPR training, yet older individuals have a lower likelihood of sharing relative to younger individuals. Further work is warranted to remedy perceived barriers to CPR dissemination among the lay public using VSI approaches.

Abstract 15569: Video-Only Cardiopulmonary Resuscitation Education for Families Before Hospital Discharge: A Multicenter Pragmatic Clinical Trial

Background: The need for improved dissemination of public cardiopulmonary resuscitation (CPR) education is highlighted by the fact that bystander CPR is delivered in less than 40% of cardiac arrests in the US. Studies have suggested that simplified methods for CPR training can promote broader dissemination. The minimum CPR training curriculum to encourage broad implementation but ensure long-term retention remains poorly characterized. Objectives: To compare video-only CPR training without a manikin to training with a video self-instruction (VSI) kit including a practice manikin. We hypothesized that laypersons who receive video-only training will perform comparable chest compressions (CC) as those taught with a VSI kit six months after initial training. Methods: We performed a pragmatic, randomized trial of CPR training for family members of cardiac patients on inpatient wards at eight hospitals. Hospitals were block randomized to offer either video-only training or the VSI kit to high-risk families before patient discharge. At six months post-training, CPR skills were assessed quantitatively. We analyzed the mean difference in chest compression rate and depth between cohorts and used multivariate regression modeling to control for confounding. Results: From 2/2012 to 5/2015, 1610 subjects were enrolled and 571 subjects consented to a 6-month skills check. Enrollees’ mean age was 52±15 years, 73% were female and 81% were immediate patient’s family. The unadjusted mean CC rate in the video-only cohort was 88 (95% CI: 85, 90) compressions per min (cpm) and 89 (95% CI: 87, 91) cpm in the VSI cohort (p=0.56), while the mean CC depth was 40 (95% CI: 39, 42) mm in the video-only cohort and 45 (95% CI: 44, 47) mm in the VSI cohort (p&lt;0.01). The statistical relationship remained the same after adjustment for confounding. Conclusions: To our knowledge, this represents the largest prospective trial of CPR training and long-term retention among lay providers. Video-only training yielded a statistically indistinguishable difference in CC rate compared to VSI training. While the CC depth was statistically different, the clinical impact of these differences may be small given recent clinical research suggesting maximum survival benefit at depths between 40-55 mm.

Understanding and improving low bystander CPR rates: a systematic review of the literature

Cardiopulmonary resuscitation (CPR) is a crucial yet weak link in the chain of survival for out-of-hospital cardiac arrest. We sought to understand the determinants of bystander CPR and the factors associated with successful training. For this systematic review, we searched 11 electronic databases, 1 trial registry and 9 scientific websites. We performed hand searches and contacted 6 content experts. We reviewed without restriction all communications pertaining to who should learn CPR, what should be taught, when to repeat training, where to give CPR instructions and why people lack the motivation to learn and perform CPR. We used standardized forms to review papers for inclusion, quality and data extraction. We grouped publications by category and classified recommendations using a standardized classification system that was based on level of evidence. We reviewed 2409 articles and selected 411 for complete evaluation. We included 252 of the 411 papers in this systematic review. Differences in their study design precluded a meta-analysis. We classified 22 recommendations; those with the highest scores were 1) 9-1-1 dispatch- assisted CPR instructions, 2) teaching CPR to family members of cardiac patients, 3) Braslow's self-training video, 4) maximizing time spent using manikins and 5) teaching the concepts of ambiguity and diffusion of responsibility. Recommendations not supported by evidence include mass training events, pulse taking prior to CPR by laymen and CPR using chest compressions alone. We evaluated and classified the potential impact of interventions that have been proposed to improve bystander CPR rates. Our results may help communities design interventions to improve their bystander CPR rates.

The knowledge and perceptions of medical personnel relating to outcome after cardiac arrest

We sought to evaluate the knowledge of probable outcome by medical personnel for in-hospital and out-of-hospital cardiac arrests, and self-reported history of CPR training referrals for family members of cardiac patients. One hundred people from each of three population lists were randomly selected at a large, urban school of medicine and affiliated medical center: (1) year III and IV medical students; (2) residents in family medicine, emergency medicine, internal medicine, anesthesia, and surgery; (3) attending physicians in the same departments. A questionnaire was distributed that elicited estimates of in-hospital and out-of-hospital cardiac arrest (IHCA and OHCA, respectively) survival rates, and CPR training referral history. Estimates were compared against published data for accuracy (IHCA: 5-20%; OHCA 1-10%) The overall response rate was 63%. Accurate in-hospital cardiac arrest estimates [% (95% CI)] of survival were provided by 51.1% (36.8-63.4%), 47.3% (35.9-58.7%), and 36.7% (23.2-50.2%) of students, residents, and attending physicians, respectively. Accurate out-of-hospital estimates of survival were provided by 51.1% (36.8-63.4%), 52.1% (40.6-63.5%), and 70.8% (57.9-83.7%), respectively. Most thought that family members of cardiac patients ought to be CPR trained (92.6%). However, few had referred any for training in the past year (16.5%). There was strong support across respondent groups for including death notification information in the ACLS training program, with 80.4% of all respondents in favor. This study demonstrates that medical experience is not associated with accurate estimates of cardiac arrest survival. Overwhelmingly, medical personnel believe family members should be trained to perform CPR, however, few refer family members for CPR training.

Attitudes towards CPR training and performance in family members of patients with heart disease

Considering that heart patients may be at higher risk for cardiac arrest, this study was conducted to evaluate the preparedness and willingness of cardiac patient family members to perform cardiopulmonary resuscitation (CPR). A cross-sectional survey of 100 family members of cardiac patients was conducted at a tertiary care emergency department over a 1.5-month period. Response rate was 95%. While 49% reported prior CPR training, only 7% trained within the past year. The majority received training (59%) because of a school or job requirement with only 8% trained because of ‘concern for a family member.’ The most frequent reasons for not being trained were ‘never thought about it’ or ‘not interested’ (57%). However, 49% of the untrained group did report an interest in future training. While 2% of respondents recalled a healthcare professional suggesting such training, 58% stated they would be influenced positively by such a recommendation. The most frequently reported barriers to performing CPR included fear of harming the patient or a lack of knowledge and skill to help. Despite a presumed higher risk for sudden cardiac death, most family members of cardiac patients do not maintain skills in basic CPR. Healthcare professionals may have the ability to significantly alter this concerning statistic through education and routine recommendations to patients’ families.

Attitudes of health professionals towards cardiopulmonary resuscitation training for family members of cardiac patients

Summary Family members of cardiac patients are the most common witnesses of a cardiac arrest but are least likely to attempt cardiopulmonary resuscitation (CPR). Training within cardiac rehabilitation programmes for relatives has been recommended by the Scottish Health Service Advisory Council (1993) but little information exists on the attitudes of the health professionals who coordinate such programmes. Their attitudes would be a source of influence on training provision. Hence a postal questionnaire survey was carried out on all of the 45 Scottish cardiac rehabilitation programmes on the register of the British Heart Foundation. The response rate was 93%. All respondents agreed that the public should be trained in CPR. The majority though that relatives of cardiac patients should be trained (93%), within rehabilitation programmes (81%), and were happy to recommend such training to families (86%). However, only 48% felt that families should be informed of the training benefits by hospital staff before discharge and 53% disagreed or were undecided. The majority believed that CPR training decreases (63%) or does not increase patient and family anxiety (68–76%), but a sizeable minority (22–34%) were undecided on both directions. Issues and implications arising from consonance and dissonance between beliefs and behavioural intent are discussed.

Cardiopulmonary resuscitation training for family members of patients on cardiac rehabilitation programmes in Scotland

Existing cardiopulmonary resuscitation (CPR) training programmes have failed to reach those most likely to witness a cardiac arrest, such as families of cardiac patients. In 1993, the Scottish Health Service Advisory Committee suggested that CPR training could be offered as part of cardiac rehabilitation programmes. A survey was carried out to identify the current extent and nature of such training and factors influencing its provision. Questionnaires were mailed to all the 45 Scottish cardiac rehabilitation programmes on the British Heart Foundation’s register. A 93% response rate was achieved. Only 37% of programmes provided information to families about attending a CPR course and 37% actually provided CPR training The numbers trained by these programmes were very small. Hospital programmes were significantly more likely than community programmes to provide CPR training (χ2=6.65, P<0.01) as were those which included an exercise component (χ2=7.63, P<0.01). Reasons for not providing training ranged from lack of resources and lack of staff training, to not having considered it. CPR training is provided as part of cardiac rehabilitation programmes to a limited extent. Ways of recruiting and increasing the number of family members of cardiac patients who are trained in CPR need to be found.

Are we training the right people yet?: A survey of participants in public cardiopulmonary resuscitation classes

It has long been argued that cardiopulmonary resuscitation (CPR) training should be targeted at those most likely to be on the scene when a cardiac arrest occurs. Since cardiac arrest occurs in the home about three-quarters of the time, the persons most likely to be on hand are family members. We surveyed 244 participants in public (i.e. not offered in a workplace) CPR classes to determine the make up of the population. In contrast to the family members of cardiac patients, who average 55 years of age, CPR class participants are young (mean 30.8 years). The majority (66.8%) of participants are in their twenties and thirties; only 6.6% are aged 50 or older. A minority (18.5%) indicate living with someone at high risk for a heart attack. In at least one respect, CPR class participants do resemble family members of cardiac patients, they are overwhelmingly (69.4%) female. Even in public classes, the majority (78.5%) of persons taking CPR are fulfilling a job requirement. Most (62.0%) have had prior CPR training; about half (49.2%) have had recent (i.e. within three years) training. Targeting of CPR training to the individuals most likely to be at the scene of a cardiac arrest has long been advocated, but the reality is that training does not reach the right people. More research is needed to determine how better to reach these persons.

American Heart Association Report on the Public Access Defibrillation Conference December 8-10, 1994

During the past 20 years, morbidity and mortality rates for nearly all types of cardiovascular disease have declined. Progress in these areas is in stark contrast to that for sudden cardiac death, which continues unabated at a rate of approximately 1000 times per day in the United States, with little decline in incidence or improved outcome. Clearly, the problem of sudden cardiac death is best approached through prevention, but horizons in that area seem no more promising and in some respects less promising and substantially more costly than 2 decades ago. The means necessary for successful resuscitation of a patient in cardiac arrest were known by the early 1960s. Externally performed cardiopulmonary resuscitation (CPR) could maintain an “oxygen plateau” and delay permanent brain damage long enough to allow external defibrillation using direct current (DC). The possibility of long-term survival was increasingly recognized, as early anecdotal experiences accumulated into published series.1 2 3 Given the hindsight of 3 decades, the obstacles to be overcome before significant progress could be made in out-of-hospital resuscitation were formidable. First, cardiac arrest was perceived as an event that typically occurred in the hospital. In-hospital cardiac arrests are now recognized to represent only a small proportion of sudden deaths based in the community. Second, the CPR technique was known to only a limited number of hospital-based physicians. CPR is no longer restricted to hospitals or physicians; it is routinely taught to the lay public. Third, only line-powered, bulky, and awkward defibrillators were available. The first out-of-hospital defibrillation device weighed 110 lb. Contemporary external defibrillators are available that weigh less than 10 lb. The present report details progress made in achieving the goal of facilitating out-of-hospital resuscitation and specifies those areas in which further headway is needed. This effort began in 1990 with an American Heart …

Is cardiopulmonary resuscitation training deleterious for family members of cardiac patients?

The purpose of the study was to determine the attitudes toward cardiopulmonary resuscitation (CPR) training and subsequent CPR use of 172 CPR-trained family members of cardiac patients. The majority (88.9%) reported positive attitudes. Only 14 (8.1%) reported feeling too responsible for their family member. One hundred and forty-one (81.9%) said that they would perform CPR if required to do so. Family members do not feel unduly burdened by learning CPR, and CPR training should be recommended to families of patients at risk for sudden cardiac death.

Cardiopulmonary resuscitation skills retention in family members of cardiac patients

Abstract The purpose of this study was to determine if the use of a retention strategy would maintain cardiopulmonary resuscitation (CPR) skills in family members of cardiac patients. Thirty-one subjects trained in CPR recelved retention packets 3 and 6 months after CPR training. Sixteen subjects were tested for CPR retention at 7 months after initial training, and 15 at 12 months. Likelihood χ 2 was used to compare the 7- and 12-month groups. There were no differences between the 7- and 12-month groups, because CPR retention overall was poor. Only 19.4% of subjects reported using the retention packet; therefore, subjects were regrouped into practice and no practice groups for purposes of further statistical analysis. There were significant differences in retention in subjects who practiced compared with subjects who did not. These findings underscore the importance of promoting practice/review after initial CPR training for family members of cardiac patients.

Sudden cardiac death, a worldwide problem

Sudden death is an internationally recognized problem in the industrialized world. In Maastricht, research is performed to determine the characteristics and circumstances of persons who die suddenly outside the hospital. It appeared that sudden death usually occurs at rest (in 80% of the cases), and often at home. Cardiac complaints preceded sudden death in only 60% of the cases. Patients with a cardiac history and admitted to the Cardiology department are often not recognized before discharge to be at high risk for sudden death outside the hospital. The conclusion is, if one wants to decrease the number of sudden deaths outside the hospital, more attention has to be paid to optimalization of resuscitation efforts outside the hospital. A group who needs special attention are family members of cardiac patients, because sudden death usually occurs at home.

Cardiopulmonary resuscitation skills retention in family members of cardiac patients

The purpose of this study was to determine if the use of a retention strategy would maintain cardiopulmonary resuscitation (CPR) skills in family members of cardiac patients. Thirty-one subjects trained in CPR recelved retention packets 3 and 6 months after CPR training. Sixteen subjects were tested for CPR retention at 7 months after initial training, and 15 at 12 months. Likelihood χ 2 was used to compare the 7- and 12-month groups. There were no differences between the 7- and 12-month groups, because CPR retention overall was poor. Only 19.4% of subjects reported using the retention packet; therefore, subjects were regrouped into practice and no practice groups for purposes of further statistical analysis. There were significant differences in retention in subjects who practiced compared with subjects who did not. These findings underscore the importance of promoting practice/review after initial CPR training for family members of cardiac patients.

Targeted recruitment of senior citizens and cardiac patients to a mass CPR training course.

CPR courses attract a predominance of young, healthy adults. Targeted recruitment of senior citizens and family members of cardiac patients has been suggested but inadequately studied. We used a targeted recruitment strategy for our annual mass CPR training course to determine if such an approach would be effective in attracting the target group. Targeting significantly increased the percentage of senior citizen participants and participants who took the course because they or a close friend or relative had cardiac disease (P less than .00001). These data have important implications regarding potential future CPR training course recruitment methods compared with nontargeted recruitment approaches.

Can Family Members of High-Risk Cardiac Patients Learn Cardiopulmonary Resuscitation?

The immediate delivery of bystander-administered cardiopulmonary resuscitation (CPR), coupled with the rapid delivery of advanced cardiac life support, can significantly reduce mortality from out-of-hospital cardiac arrest. Because the majority of sudden cardiac deaths occur in the victim's home with family members present, family members of cardiac patients at high risk for sudden death are the logical focus of CPR training. However, previous research has shown that only a small minority of family members of cardiac patients actually learn CPR and that health care professionals have failed to recommend CPR training in this population, in part due to concerns about their ability to learn CPR. The purpose of this study was to describe learning capabilities in this population and to identify characteristics of unsuccessful learners. To this end, we taught CPR to 83 family members of cardiac patients who were at risk for sudden cardiac death. Subjects had no CPR training within the past two years. Eighty-one percent of the subjects successfully learned CPR. Of the demographic and psychological characteristics examined, only gender, age, and depression were significant in explaining differences in CPR skills attainment ability. The elderly, the depressed, and males were more likely to be unsuccessful in demonstrating adequate CPR skills. Our results suggest that the majority of family members of cardiac patients can learn CPR successfully. Specific training strategies may need to be developed and tested to enhance CPR training in those family members of cardiac patients predicted to have difficulty learning CPR.