David G Buckler

Association of Mechanical Cardiopulmonary Resuscitation Device Use With Cardiac Arrest Outcomes: A Population-Based Study Using the CARES Registry (Cardiac Arrest Registry to Enhance Survival)

The use of mechanical cardiopulmonary resuscitation devices (mCPR) to deliver CPR has become more widespread, although a survival advantage has not been demonstrated in randomized, controlled trials.1–3 Little is known about real-world use of mCPR or the association with outcomes. CARES (Cardiac Arrest Registry to Enhance Survival), a US national registry of out-of-hospital cardiac arrest,4 was analyzed for adults with nontraumatic out-of-hospital cardiac arrest from January 2013 to December 2015. Patients treated with mCPR were compared with patients receiving manual CPR only. Time of arrest, time of first CPR, and timing of interventions were not reliably reported. However, patients had information about when return of spontaneous circulation (ROSC) occurred before or after advanced life support (ALS) measures. As part of a subgroup analysis, patients with ROSC before ALS were excluded because of the decreased likelihood of these patients receiving mCPR. The primary outcome of interest was neurologically favorable survival at hospital discharge, defined as a Cerebral Performance Category of 1 or 2. This project was deemed exempt from review by the Children’s Hospital of Philadelphia and University of Pennsylvania Institutional Review boards. Statistical analyses included the Student t test and χ2 test as appropriate. A multivariable logistic regression model was created with the use of stepwise addition to control for Utstein-style arrest characteristics, …

Dissemination of CPR video self-instruction materials to secondary trainees: Results from a hospital-based CPR education trial☆

BACKGROUND Cardiopulmonary resuscitation (CPR) video self-instruction (VSI) materials have been promoted as a scalable approach to increase the prevalence of CPR skills among the lay public, in part due to the opportunity for secondary training (i.e., sharing of training materials). However, the motivations for, and barriers to, disseminating VSI materials to secondary trainees is poorly understood. METHODS This work represents an ancillary investigation of a prospective hospital-based CPR education trial in which family members of cardiac patients were trained using VSI. Mixed-methods surveys were administered to primary trainees six months after initial enrollment. Surveys were designed to capture motivations for, and barriers to, sharing VSI materials, the number of secondary trainees with whom materials were shared, and the settings, timing, and recipients of trainings. RESULTS Between 07/2012 and 05/2015, 653 study participants completed a six-month follow-up interview. Of those, 345 reported sharing VSI materials with 1455 secondary trainees. Materials were shared most commonly with family members. In a logistic regression analysis, participants in the oldest quartile (age >63 years) were less likely to share materials compared to those in the youngest quartile (age ≤ 44 years, OR 0.58, CI 0.37-0.90, p=0.02). Among the 308 participants who did not share their materials, time constraints was the most commonly cited barrier for not sharing. CONCLUSIONS VSI materials represent a strategy for secondary dissemination of CPR training, yet older individuals have a lower likelihood of sharing relative to younger individuals. Further work is warranted to remedy perceived barriers to CPR dissemination among the lay public using VSI approaches.