Results Summary

What was the research about?

Patients who have been in the hospital for heart problems have a high risk of sudden cardiac arrest after they go home. Sudden cardiac arrest occurs when a person’s heart stops beating properly without warning. If a person having cardiac arrest gets cardiopulmonary resuscitation, or CPR, they are two to four times more likely to live. CPR involves pressing on the chest and doing mouth-to-mouth breathing.

Since cardiac arrest may happen at home, it’s important for family members or caregivers to know how to give CPR. In this study, the research team compared two ways to teach CPR to caregivers of patients with heart problems leaving the hospital:

  • mApp is an interactive, free mobile app with a 22-minute instructional video, a refresher video, a practice guide, and links to more CPR resources.
  • Video self-instruction, or VSI, kit is a standard CPR training kit with the same instructional video on DVD plus a practice manikin.

The research team wanted to show that mApp wasn’t worse than the VSI kit at teaching CPR skills to caregivers.

What were the results?

Six months after patients left the hospital, caregivers who learned CPR with mApp or the VSI kit didn’t differ, on average, in the number of times and how deeply they pushed down on the chest. But some data suggested that caregivers who used mApp may not have done CPR as well as those who used the VSI kit. The research team can’t say for sure. Neither approach met the CPR goal for this study of pushing on the chest at least 90 times per minute or pressing two inches deep.

Who was in the study?

The study included 541 adult family members or other caregivers of patients who had been in the hospital for a heart attack or with serious heart problems. Of these, 56 percent were White and 33 percent were Black. The average age was 52, and 68 percent were women. Patients received care at one of eight hospitals in Pennsylvania.

What did the research team do?

The research team assigned each hospital by chance to one of two groups: mApp or the VSI kit. Caregivers were offered the approach assigned to their hospital. The team compared the groups by testing how well caregivers performed CPR six months after the patient went home from the hospital. The team collected data about CPR skills using manikins that measure the rate and depth of pushing down on the chest.

People who survived sudden cardiac arrest, caregivers of survivors, and nurses who teach CPR gave input during the study.

What were the limits of the study?

Results may differ for other mobile apps with other layouts or ease of use.

Future research could look at other ways to improve how CPR is taught.

How can people use the results?

Hospitals can use the results when considering how to teach CPR.

Final Research Report

View this project's final research report.

Peer-Review Summary

Peer review of PCORI-funded research helps make sure the report presents complete, balanced, and useful information about the research. It also assesses how the project addressed PCORI’s Methodology Standards. During peer review, experts read a draft report of the research and provide comments about the report. These experts may include a scientist focused on the research topic, a specialist in research methods, a patient or caregiver, and a healthcare professional. These reviewers cannot have conflicts of interest with the study.

The peer reviewers point out where the draft report may need revision. For example, they may suggest ways to improve descriptions of the conduct of the study or to clarify the connection between results and conclusions. Sometimes, awardees revise their draft reports twice or more to address all of the reviewers’ comments. 

Peer reviewers commented and the researchers made changes or provided responses. Those comments and responses included the following:

  • The reviewers pointed out that one of the aims of the project was to assess the patient perspective on family training for cardiopulmonary resuscitation, but patients were not consented directly and did not answer questions directly. Instead, the researchers asked the family members how the patients felt. The researchers acknowledged that the study was missing direct patient feedback, and this was a weakness of the study.
  • The reviewers asked the researchers to explain why the number of skills check visits was different from the number of skills checks recorded. The researchers explained that participants would come to the visit, but some declined to perform the skills check, most likely because they were not prepared at the time.
  • The reviewers noted that year of study (year 1 or year 2) was included in the analyses and asked the researchers to explain what was different between years 1 and 2 of the study. The researchers indicated that there were no substantive differences in study approach or study sample between these two years, but they had included year of study as a covariate just to make sure that they accounted for any unmeasured changes between year 1 and year 2 that might have affected participant willingness to enroll in or complete the study.

Conflict of Interest Disclosures

Project Information

Benjamin Abella, MD, MPhil
University of Pennsylvania
CPR Education for Families of Cardiac Patients before Hospital Discharge: Comparing Methods for Real-World Dissemination

Key Dates

April 2015
December 2021

Study Registration Information


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Last updated: December 9, 2022