Crash Course: Shorter Is Better in CPR Training

March 9, 2011— -- The days of the hours-long office CPR training session may be numbered if the findings of a new study hold true.

A 60-second training video may be all it takes to save a life, researchers found in a new study funded by the American Heart Association. Study participants who viewed a one-minute CPR instructional video were more likely to attempt CPR and perform a higher quality of CPR than those who did not watch the video.

More surprising was that the group who watched the one-minute training video performed better and made better decisions than those who watched a five- or eight-minute version, suggesting that less may be more when it comes to teaching CPR basics.

Dr. Gabe Wilson, associate medical director in the department of emergency medicine at St. Luke's-Roosevelt Hospital Center in New York, said that when information is boiled down to a few clear points, people have much better recall and interest.

"When you know you are going to be provided with important information, and only need to pay attention for 60 seconds, the chances of engaging attention is much greater," said Wilson.

Wilson, who was not involved in the study, said that 60 seconds is enough time to cover the basic fundamentals of CPR.

"CPR is just not that difficult," he said.

"We're really excited about this," said Dr. Bentley J. Bobrow, lead author of the study, published in Circulation: Cardiovascular Qualities and Outcomes, and clinical associate professor in the department of emergency medicine at the Maricopa Medical Center in Phoenix.

"Survival is really low for sudden cardiac arrest, and it's not drugs or fancy expensive devices or hospital care that helps save the most lives. It's CPR.

"But so few people receive CPR. It's really a tragedy and lost opportunity."

According to the American Heart Association, sudden cardiac arrest is a leading cause of death in the United States. About 300,000 people experience an out-of-hospital cardiac arrest in the United States each year, and their chance of survival declines 7 percent to 10 percent with each minute that passes without CPR and defibrillation.

"Only one-quarter of cardiac arrest is treated with CPR," said Dr. Benjamin Abella, clinical research director for the Center for Resuscitation Science at University of Pennsylvania and co-author of the study. "So you have people waiting for the paramedics, which can take five, six or seven minutes. And every minute is making a huge difference on the outcome. With every minute waiting, mortality skyrockets.

"If we can get people to do CPR, it will open up a whole new vista," he said.

Clear Points Mean Better Success

Researchers divided 336 study participants into four groups. People in the assigned groups either watched a 60-second CPR training video, a longer video or no video at all.

When the groups were put into identical two-minute scenarios in which researchers asked the study participants to demonstrate what they would do if a person suddenly went into cardiac arrest in front of them, those in the one-minute video group performed the best.

Mouth-to-Mouth Hesitation

Two years ago, the American Heart Association announced that hands-only CPR worked just as well in adults as the standard CPR that includes mouth-to-mouth resuscitation.

And in October 2010, Bobrow and colleagues published a study that found hands-only CPR by bystanders was associated with even better survival rates than conventional CPR.

Doctors said that people are often hesitant to perform mouth-to-mouth on strangers. Hands-only is a simpler regimen. By lifting that barrier, experts hoped that more people would jump in to perform CPR when necessary.

"One of the key reasons that we have arrived at this juncture is that it was recognized that mouth-to-mouth breathing lent a great deal of complexity and discomfort to CPR, but did not provide much benefit," said Wilson. "Once we were able to remove mouth-to-mouth from the equation, CPR became a much more simple procedure."

Besides the germ factor, doctors said there are several reasons why people do not perform CPR as bystanders.

"People are often afraid that they're going to hurt the person and don't fully appreciate that all you can do is help someone who has gone into sudden cardiac arrest," said Abella.

Shorter CPR Video May Quell Performance Anxiety

Dr. Michael Sayre, associate professor in the department of emergency medicine at the Ohio State University Medical Center, offered three more reasons: People panic. They don't feel competent or that they can help. And they fear legal consequences.

"I doubt that a short video is going to overcome the panic factor, but it might help," said Sayre. "The study shows that the short video can help rescuers perform CPR more competently. Video can also address the unfounded fear of legal consequences from attempting to save a life."

Sayre said that all 50 states have Good Samaritan laws that protect rescuers from any legal backlash or situations after CPR attempts.

More Americans die each year from sudden cardiac arrest than from breast cancer, prostate cancer, lung cancer and AIDS combined, Sayre said.

"You are more likely to survive a plane crash than a sudden cardiac arrest," he said.

High rates of CPR success may be able to counter those low rates of survival. Because the CPR video lasts only one minute, the study authors are currently seeking ways to get this quick and easy information to the public for free.

Disseminating Information Through Media Platforms

"With all the different media platforms, we could get this information to the public in a lot of different venues," said Bobrow. "That's what really gets us excited. We're on the brink of finally changing survival rates."

Bobrow and Abella said they hoped to distribute the training video in a way that made it easy for people to get the information. Making it available on smart phones, in doctors' offices or in PSA announcements would help get the CPR message out.

"It is not unthinkable that after a sudden cardiac event, like the death of Tim Russert, one of the networks might donate 60 seconds of prime airtime as a public service, potentially having an immediate impact," said Wilson.

The authors believe that a simple video could literally mean the difference between life or death.

"We need more attention on this disease," said Abella. "Up until 20 years ago, cardiac arrest was synonymous with death, but we are seeing more survivals. This is no longer a disease without hope."