12/30/2011
CPR Anytime Anyschool:
A Randomized Trial of Strategies to Teach CPR
and Use of AED to High School Students
Dr. Laurie J. Morrison
NAEMSP 2012
Medicine
UNIVERSITY OF TORONTO
CPR Anytime Anyschool
Investigators
Principal Investigator
Laurie J. Morrison
Co-Investigators
Katie Dainty
Joanne Cote
Joel Kirsch
Sheldon Cheskes
Research Coordinator
Blake Hurst
Graduate Student
Jason Buick
Summer Student
Monica Yu
Medicine
UNIVERSITY OF TORONTO
CPR Anytime Anyschool
Conflicts of Interest
No conflicts of interest to declare.
This project was funded by the American Heart Association and Laerdal
Medical Foundation.
Medicine
UNIVERSITY OF TORONTO
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12/30/2011
CPR Anytime Anyschool
CPR and AED: The Basics
What is it?
•
•
•
•
CardioPulmonary Resuscitation
Manual chest compression to maintain circulation for cardiac arrest victims
Automated External Defibrillator
Delivers an electronic shock to restore normal heart rhythm
Why is it so important?
•
•
•
•
Brain and other vital organs need oxygen
Without bystander CPR: 6% survival rate
With bystander CPR: 24% survival
With bystander CPR and AED use: 38% survival
Medicine
UNIVERSITY OF TORONTO
CPR Anytime Anyschool
The Problem
In Toronto,
• bystander CPR rate: 27%
• bystander AED rate: 2%
Knowledge
Actual Practice
Medicine
UNIVERSITY OF TORONTO
CPR Anytime Anyschool
The Question
How can we increase bystander
CPR rates and AED use?
Medicine
UNIVERSITY OF TORONTO
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CPR Anytime Anyschool
Ontario’s Current Strategy
Target: high school population
1999 Ontario Legislation
CPR Training
Ontario Curriculum
Medicine
UNIVERSITY OF TORONTO
CPR Anytime Anyschool
Does the strategy work?
Barriers to School CPR
1) Limited Time
2) High Cost
Medicine
UNIVERSITY OF TORONTO
CPR Anytime Anyschool
Our Proposal
CPR Anytime™
–
–
–
–
Only 22 minutes
$35 per kit
DVD based self-instruction
Multiplier effect
Medicine
UNIVERSITY OF TORONTO
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12/30/2011
CPR Anytime Anyschool
Multiplier Effect 1 Facilitator
4-hour traditional class
Eight CPR Anytime™ sessions
TOTAL = 768
24 students / facilitator
= 192 students over 8 sessions
TOTAL = 10
10 students / instructor
576 more trainees / facilitator
~3 more users / kit
at home
Medicine
UNIVERSITY OF TORONTO
CPR Anytime Anyschool
Supporting Evidence
Expedited CPR training works!
Medicine
UNIVERSITY OF TORONTO
CPR Anytime Anyschool
The Research Question
Is expedited CPR training in high
school students effective?
Medicine
UNIVERSITY OF TORONTO
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12/30/2011
CPR Anytime Anyschool
Study Design
Objectives:
• To enhance CPR and AED training in schools,
• To improve secondary school students’ skills,
willingness and confidence in providing CPR
and applying an AED during a cardiac arrest.
• To improve bystander CPR and AED application
rates
Medicine
UNIVERSITY OF TORONTO
CPR Anytime Anyschool
Study Design
Design:
• Randomized controlled trial
- Control: Traditional CPR plus AED class (4 hours)
- Intervention: CPR Anytime plus AED training (45 minutes)
Population and Setting:
• Grade 9 students in Halton and Toronto region schools
Medicine
UNIVERSITY OF TORONTO
CPR Anytime Anyschool
Study Design
Control
4 hour
CPR plus AED
Class
Prequestionnaire
R
45 minute
CPR Anytime
plus AED
Postquestionnaire
CPR Skills Test
Intervention
6 month break
Retention
questionnaire
Retention CPR
Skills Test
R = Randomization
Medicine
UNIVERSITY OF TORONTO
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12/30/2011
CPR Anytime Anyschool
Data Collection
- Student questionnaire
- Standardized Skills Checklist
- Resusci®Anne Skillreporter manikin™
Skill
Characteristics of Satisfactory Demonstration
of Skill
Satisfactory
(Yes or No)
Recognition of the
need for CPR
1. Verified that patient “appeared lifeless”
• Tap n’ Talk
2. Recognized need for CPR
EMS Activation
3. Called 911 (or local number for EMS) as soon
as adult victim was found unresponsive
Ventilation
4. Assessed for absence of breathing
5. Achieved Chest Rise after breaths
•
1 second / breath
/2
Medicine
UNIVERSITY OF TORONTO
CPR Anytime Anyschool
Results
Randomized and Scheduled (n=334)
Failed to appear
for or did not
complete session
(n=27)
Completed CPR training and skills testing (n=307)
Failed to appear
for retention
session (n=23)
Failed to fully
complete
retention session
(n=20)
Completed ALL sessions (n=264)
Medicine
UNIVERSITY OF TORONTO
CPR Anytime Anyschool
Survey Results
Pre-training
Domains
Mean
Posttraining
Mean
2.90
4.05 *
Randomization
Retention
Mean
Confidence
Control
3.31 *
CPR Anytime
2.88
4.12 *
3.19 a
Competence
Control
2.24
4.23 *
3.13 *
CPR Anytime
2.41
4.40 *
3.14 *
Willingness
Control
3.44
4.18 *
3.61 **
CPR Anytime
3.34
4.07 *
3.36**
* Wilcoxon Signed-Rank test found the mean scores are statistically higher than the pre-training survey score in these domains (p<0.0001)
** Wilcoxon singed-rank test does not found statistically different between retention and pre-training survey
a --- p = 0.0018 from Wilcoxon Signed-Rank test
Medicine
UNIVERSITY OF TORONTO
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12/30/2011
CPR Anytime Anyschool
Quantitative Results
Red = p-value indicates no significant difference between Control and CPR Anytime
Medicine
UNIVERSITY OF TORONTO
CPR Anytime Anyschool
Electronic Quantitative Results
Guidelines
Depth: >38mm
Rate: >100/min
Red = p-value indicates no significant difference between Control and CPR Anytime
Medicine
UNIVERSITY OF TORONTO
CPR Anytime Anyschool
Limitations
• Self-reporting has inherent bias
• Cannot control for activities during 6 month period
– Potential for cross-over bias
– Potential for outside training
• Generalizability of selected schools to entire school population
Medicine
UNIVERSITY OF TORONTO
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CPR Anytime Anyschool
Conclusions and Implications
•
•
Both programs resulted in improved confidence, competence, and
willingness to perform CPR
Students in either program had similar performance on the skills tests
•
CPR AnytimeTM is a cheaper and quicker way to teach CPR in schools
In the Future
• Improved bystander CPR rates
• Improved cardiac arrest survival
Medicine
UNIVERSITY OF TORONTO
CPR Anytime Anyschool
ANYONE can learn to save a life!
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UNIVERSITY OF TORONTO
CPR Anytime Anyschool
Questions
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UNIVERSITY OF TORONTO
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CPR Anytime Anyschool
Appendix
Medicine
UNIVERSITY OF TORONTO
CPR Anytime Anyschool
Student Demographic
Previous CPR Training
Randomization
Yes
No
Control
60
97
CPR Anytime
78
91
Percentage of students with previous CPR training per randomization group:
Control: [60/(60+97)]*100%= 43.2%
CPR Anytime: [78/(78+91)]*100% = 40.2%
Medicine
UNIVERSITY OF TORONTO
CPR Anytime Anyschool
Participating Schools
School
Control*
CPR Anytime*
Excluded
Total
A
25
33
19
77
B
7
8
3
18
C
25
26
20
71
D
21
23
8
52
E
28
23
3
54
F
19
26
17
62
TOTAL
125
139
70
334
*Control = Heartsaver CPR plus AED class
CPR Anytime = CPR Anytime plus AED training
Medicine
UNIVERSITY OF TORONTO
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12/30/2011
CPR Anytime Anyschool
Does the strategy work?
Medicine
UNIVERSITY OF TORONTO
CPR Anytime Anyschool
Multiplier Effect 1 Facilitator
4-hour traditional class
TOTAL = 10
10 students / instructor
Eight CPR Anytime™ sessions
TOTAL = 768
24 students / facilitator
= 192 students over 8 sessions
576 more trainees / facilitator
~3 more users / kit
at home
Medicine
UNIVERSITY OF TORONTO
10