Emergency medical services/brief research reportCell Phone Cardiopulmonary Resuscitation: Audio Instructions When Needed by Lay Rescuers: A Randomized, Controlled Trial
Introduction
Bystander cardiopulmonary resuscitation (CPR) represents one of the few interventions that can improve survival from cardiac arrest, but only about 30% of CPR-trained bystanders will perform CPR.1, 2 Low rates of bystander CPR have been attributed to attitudinal/altruistic differences and fear of disease transmission, as well as training-related factors: poor skill retention after conventional CPR training and bystanders' self-perceived inability to perform CPR correctly.2 These latter factors suggest that the current didactic approach to CPR training needs revision.
Real-time CPR instruction aids—those immediately accessible to assist with resuscitation—might help bystanders perform CPR, and several have been studied. Dispatcher-assisted CPR instructions can increase bystander initiation of CPR and survival outcomes,3, 4 but not all emergency medical services (EMS) call centers have CPR instruction protocols or use them when available.5
Cellular telephones have been studied as CPR instruction aids because most people have them handy at home and in public. Several studies have evaluated the efficacy of using cell telephone video/text software, but participants had difficulty interpreting small screen images.6, 7
We sought to study the applicability of using a simple audio cell telephone program with CPR instructions. In a randomized controlled trial, we tested the differences in quality of CPR performed by CPR-trained and CPR-untrained participants with and without cell telephone audio instructions. We hypothesized that CPR quality (chest compression rate, depth, hand placement, and pauses) would be better for trained participants with the telephone versus trained participants without the telephone and untrained participants with the telephone compared with untrained participants without the telephone.
Section snippets
Study Design
We conducted a prospective study of CPR-trained and -untrained veterans and family members/caregivers, randomized to simulate resuscitating a manikin for 3 minutes with or without assistance from a cell telephone equipped with CPR instructions.
Setting
We recruited subjects (November 2008 to March 2009) by posting a flyer in a large urban Veterans Affairs Medical Center advertising a CPR study with a $20 voucher for study completion.
Selection of Participants
Veterans have high rates of cardiovascular disease and are at risk for
Results
Of the 178 participants who responded to the flyer, 94% (168/178) met eligibility criteria and were scheduled for a study appointment (Figure). Eight did not return for the appointment. Ninety percent (160/178) completed the entire study. Of the 160 participants, 94% were men, 78% were black, and 74% reported an average annual income of less than $25,000 per year (Table 1). The average participant age was 52 (7) years (mean [SD]). Randomization generated 4 groups: CPR trained, receiving a
Limitations
We evaluated CPR performance in a manikin simulation, so our findings may not be applicable in an actual arrest in which fear or stress and other factors may limit performance. Our cohort consisted of volunteers (several of whom had previously performed CPR in a real situation), which also limits generalizability to the overall population. Additionally, coin flip may not have allowed for true randomization. Our simulation occurred for 3 minutes, whereas in practice the time until EMS arrival
Discussion
We demonstrated that CPR quality was better when participants used the cell telephone CPR instruction aid, regardless of CPR training history. Several elements of the intervention appear to be most responsible for its overall success.
First, the cell telephone approach provided an appropriate cadence for chest compressions (100/minute). Participants without the telephone (in both the trained and untrained groups) on average provided chest compressions at half the recommended rate (approximately
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Supervising editor: Robert A. De Lorenzo, MD, MSM
Author contributions: RMM, LBB, and DAA conceived and designed the study. RMM and DAA obtained research funding. RMM, BSA, and DAA supervised the conduct of the study and data collection. RMM, EJA, and TMS undertook recruitment of the patients and managed data, including quality control. RMM, JAL, PWG, and DAA provided statistical advice on study design. RMM, BSA, EJA, TMS, LBB, and DAA analyzed the data. RMM drafted the article and all authors contributed substantially to its revision. RMM takes responsibility for the paper as a whole.
Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article that might create any potential conflict of interest. See the Manuscript Submission Agreement in this issue for examples of specific conflicts covered by this statement. This research was supported by funding from the Philadelphia Veterans Affairs Medical Center for Health Equity Research and Promotion pilot grant and the Robert Wood Johnson Foundation Clinical Scholars program at the University of Pennsylvania. The contents do not reflect the views of the Department of Veterans Affairs or the United States Government.
Please see page 539 for the Editor's Capsule Summary of this article.
Reprints not available from the authors.
Publication date: Available online March 4, 2010.