Implementation of cardiopulmonary resuscitation training for at-risk families

描述（由申请人提供）：及时实施心肺复苏术（CPR）可使心脏骤停（SCA）患者的存活率提高2-3倍，但大多数旁观者目睹的受害者仍然在没有最初心肺复苏术的情况下死亡。我们对如何向高危人群传播心肺复苏术培训的理解存在一个关键的知识缺口。这一点很重要，因为心肺复苏术是为数不多的可以提高SCA患者存活率的工具之一，在美国，每年有超过20万人患有SCA。冠心病患者发生SCA的风险显著增加，超过75%的SCA事件发生在家庭环境中。综上所述，这两个观察结果强调了通过针对因冠心病并发症住院患者的家庭成员（尤其是配偶）进行心肺复苏术培训来影响心血管健康的机会。目前的心肺复苏术培训在很大程度上未能达到这一高危人群。简化心肺复苏术教育的尝试，从而扩大和增加培训，导致了“仅手”心肺复苏术的发展，省去了口对口通气的需要。然而，广泛实施的首选策略尚不清楚。我们工作的长期目标是建立“现实世界”CPR传播的最佳实践，使培训场所与高危人群相匹配，最大限度地保留复苏技能，并促进采取行动的意愿。为此，本应用程序的目标是在医院实施程序中使用最近验证的视频自我指导（VSI） CPR程序来测试两种CPR教育策略。我们的中心假设是，在这一高度积极的高危人群中，与标准CPR相比，徒手CPR培训将提高技能保留，并解决重要的培训障碍。作为一个传播项目，将给予每家医院的当地利益攸关方高度的自主权，以定制每个医院的工作人员和招生方法，一个重要目标将是学习他们的执行经验。为了验证我们的中心假设，我们将在八家医院的队列中追求以下具体目标：(1)评估随机分配到纯手动VSI CPR训练与标准VSI CPR训练的受试者在三个月时复苏技能保留的客观指标。(2)使用混合定量和定性调查方法，衡量我们基于医院的模型中参加心肺复苏术培训的感知障碍和动机。(3)分析我们的VSI心肺复苏术教育计划的成本，并对具体目标1中的两种心肺复苏术策略进行预算影响分析，比较员工机会成本和每个受试者的成本，并将充分保留的技能作为成本模型输入。我们的调查团队以其长期专注于临床心肺复苏研究和心肺复苏教育合作的记录，为完成这项工作做好了独特的准备。这种创新的方法，通过医院平台和VSI的使用，将心肺复苏术培训与公众需求相匹配，可以作为向高度积极的人群传播心肺复苏术救生技能的国家模式。

DESCRIPTION (provided by applicant): Prompt delivery of cardiopulmonary resuscitation (CPR) increases survival from sudden cardiac arrest (SCA) by 2-3 fold, yet most bystander-witnessed victims still die without an initial CPR attempt. There is a critical knowledge gap in our understanding of how to disseminate CPR training to at-risk populations. This is important as CPR delivery represents one of very few tools available to improve survival from SCA, which afflicts over 200,000 people in the United States each year. Individuals with coronary disease are at significantly increased risk of SCA, and greater than 75% of SCA events occur in the home environment. Taken together, these two observations highlight the opportunity to impact cardiovascular health by targeting CPR training to family members (and especially spouses) of patients hospitalized for complications of coronary disease. Current CPR training implementation largely fails to reach this at-risk demographic. Attempts to simplify CPR education and thereby broaden and increase training have led to the development of "hands- only" CPR, omitting the need for mouth-to-mouth ventilation. However, the preferred strategy for broad implementation is unknown. The long term goal of our work is to establish best practices for "real world" CPR dissemination that match training venues with at-risk populations, maximize resuscitation skill retention, and promote willingness to act. Towards this end, the goal of this application is to test two CPR educational strategies using a recently validated video-self instruction (VSI) CPR program in a hospital-based implementation program. Our central hypothesis is that hands-only CPR training will yield improved skills retention and address important training barriers when compared to standard CPR in this highly motivated at- risk population. As a dissemination project, a high degree of autonomy will be given to local stakeholders at each hospital to tailor the staff and enrollment approach at each site, and an important objective will be to learn from their implementation experiences. To test our central hypothesis, we will pursue the following Specific Aims in an eight hospital cohort: (1) Assess objective metrics of resuscitation skill retention at three months in subjects randomized to hands-only VSI CPR training versus standard VSI CPR. (2) Measure the perceived barriers and motivations to enrollment for CPR training in our hospital-based model using mixed quantitative and qualitative survey methods, and (3) Analyze the costs of our VSI CPR educational program, and perform a budget impact analysis comparing the two CPR strategies in Specific Aim 1 with regard to the staff opportunity costs and cost per subject with adequately retained skills as cost modeling inputs. Our investigative team is uniquely poised to accomplish this work, with its longstanding focus on clinical CPR research and track record of collaboration in CPR education. This innovative approach, to match CPR training with public need via the hospital platform and the use of VSI, may serve as a national model for dissemination of lifesaving CPR skills to a highly motivated population. PUBLIC HEALTH RELEVANCE: The prompt delivery of cardiopulmonary resuscitation (CPR) by laypersons dramatically improves survival from sudden cardiac arrest, yet less than 25% of arrest victims receive CPR by the public. Methods to train the population at risk of witnessing cardiac arrest, primarily 50-70 year old spouses of coronary disease patients, and characterization of the "real world" barriers to CPR implementation, are lacking. We propose an implementation project testing different strategies for CPR education in a novel hospital-based model of community CPR education, targeted to families of hospitalized patients with coronary disease.