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.
Professional Abstract
Objective
To compare a mobile app (mApp) versus a video self-instruction (VSI) kit in teaching cardiopulmonary resuscitation (CPR) to caregivers of patients with cardiac problems discharged from the hospital
Study Design
| Design Element | Description |
|---|---|
| Design | Cluster randomized controlled trial |
| Population | 541 adult family members or primary caregivers (including non-family) of patients with a risk of cardiac arrest due to hospitalization with myocardial infarction or possible acute coronary syndrome and known history of coronary disease |
| Interventions/ Comparators |
|
| Outcomes |
CPR skill performance quality, as measured by chest compression rate and chest compression depth |
| Timeline | 6-month follow-up for study outcomes |
This cluster randomized non-inferiority trial compared the effectiveness of two CPR training methods for caregivers of patients with a risk of cardiac arrest in improving CPR skills six months after hospital discharge.
Researchers randomly assigned hospitals to one of two CPR training methods: mApp or VSI kit. While patients were still in the hospital, caregivers were offered the CPR training method assigned to their hospital. Participants in the mApp group watched a 22-minute training video on a tablet or smartphone. They also received a refresher video and practice module to watch during the next six months and links to CPR training resources. Participants in the VSI kit group watched the same training video on a DVD and received a small, inflatable practice manikin.
The study included 541 adult family or non-family primary caregivers of patients who had received care for a myocardial infarction or possible acute coronary syndrome at one of eight hospitals in Pennsylvania. Of the participants, 56% were White and 33% were Black. The average age was 52, and 68% were female.
Six months after patients’ hospital discharge, caregivers took a CPR skills assessment. Adequacy of CPR chest compression rates (for this study, at least 90 per minute) and depth (at least two inches) were assessed using recording manikins. Researchers did not notify caregivers before the assessment to prevent confounding from caregivers practicing for the test. Researchers defined the non-inferiority statistical threshold as a difference of five compressions per minute between the two training methods.
Survivors of sudden cardiac arrest, family members of survivors, and nurses who teach CPR participated in the development and conduct of the study.
Results
Six months after hospital discharge, the average chest compression rate (mean difference: -2.3; 95% confidence interval [CI]: -9.4, 4.8) and depth (mean difference: -3.2; 95% CI: -5.9, 0.1) did not differ significantly between the VSI kit and mApp groups. However, because the range of the difference in average chest compression rate did not meet non-inferiority criteria, it is not clear that mApp was non-inferior to the VSI kit. Although not statistically significant, analyses also revealed a lower compression depth in the mApp group.
Neither of these groups reached the adequate measure of average chest compression rate of 90 per minute or chest compression depth of at least two inches.
Limitations
The study used a single mobile app. The results may differ for mobile apps with other interfaces and ease of use.
Conclusions and Relevance
In this study, neither approach helped caregivers achieve the adequate CPR measures of chest compression rate and depth. Although mApp was possibly not inferior to the VSI kit on a statistical basis, results indicate that mApp may yield modestly lower quality CPR skills than the VSI kit.
Future Research Needs
Future research could focus on how to improve CPR training to reach adequate chest compression rate and depth.
Final Research Report
View this project's final research report.
Journal Citations
Results of This Project
Related Journal Citations
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.