In the current work, we demonstrated the feasibility of using the hospital environment as a “point of capture” for training family members of at-risk patients in CPR skills. Given that most SCA events occur in the home setting, family member training may hold greater potential for CPR delivery during actual events than training a similar number of younger laypersons at large. Other investigators have identified the focused identification and CPR training of populations at risk of SCA as an important and potentially efficient step to improve survival.10, 12, 18–19
CPR education of family members before hospital discharge represents a logical extension of other cardiac risk factor-focused health care education and services before patients are discharged home, including delivery of dietary counseling, diabetic teaching, and education regarding cardiac symptoms. To our knowledge, our work represents the first hospital-based, adult, layperson, CPR training program using VSI as an instructional approach. CPR training via a 25 minute VSI program has been shown to yield CPR performance quality in trainees that is similar to that generated from formal CPR classes that require 3–4 hours.14–16
While VSI training does not provide CPR certification, it is unlikely that the lack of testing and certification is a barrier to participation for the lay public. Indeed, the removal of the pressures of a formal class and testing may increase interest in CPR training through the VSI method.13, 20–21
Several prior investigations have exploited VSI methodology as an outreach tool to teach CPR in various settings. A recent study in Norway used VSI CPR kits as refresher tools for hospital employees.22
Other work has focused on use of VSI implementation in schools. 20–21, 23
An example of this latter approach was a Danish initiative in which 35,000 VSI kits were distributed to 7th
Over 15,000 laypersons received “secondary training” at home by the initially trained students, highlighting a key advantage of the VSI kit approach. It has been argued that this secondary training phenomenon is among the reasons the VSI educational approach may offer a cost effective means for targeted family training.13, 20–21
While participants in our program were able to adequately perform CPR skills and expressed self-reported motivation and empowerment, it must be acknowledged that many trained laypersons still do not act when confronted with an actual arrest event. 8
In addition, CPR quality at the time of actual performance may be variable, attenuating the survival benefit.24–26
However, several population-based observational studies have supported the notion that training more laypersons in CPR translates into improved overall survival rates from cardiac arrest.25, 27–28
Further work will be required to follow newly trained, at-risk family members over time to determine if SCA events occur, and if so, whether CPR was initiated.
Willingness to undergo CPR training is likely to be confounded by cultural, regional and educational factors. Therefore, the general applicability of this three-hospital program to other practice environments remains an open question. In our program, the majority of screened family members still refused participation; however, we did not discern a simple relationship between willingness to participate and age, gender or race. Furthermore, we utilized paid research assistants as subject recruiters and proctors to the VSI training; from a broader implementation perspective, it would be important to determine whether hospital volunteers or staff could perform the training. In addition, while a VSI training kit currently costs $35 and a conventional CPR course could cost from $150–$300, a formal cost-effectiveness analysis of VSI training has yet to be performed. Another key limitation is that the secondary training effect was measured by participant self-report, which may be prone to recall bias; however, no specific incentives or penalties were used to encourage over-reporting of secondary training. Finally, in this short-term feasibility study, no direct patient outcomes nor instances of CPR performance were measured.
In this prospective study of hospital-based CPR training, we have shown that targeted training of families before hospital discharge is feasible, well received by trainees, and has the benefits of secondary training in the home environment, where most SCA events take place. This program could be easily implemented in other hospital or practice settings. Through targeted CPR training programs such as the one described in this investigation, at risk populations that are underrepresented in conventional CPR training classes can be equipped with important life-saving skills. Further work on a larger scale will be required to measure the impact of such programs on patient outcomes.