A controlled trial of cardiopulmonary resuscitation training for ethnically diverse parents of infants at high risk for cardiopulmonary arrest.

OBJECTIVE: Parents of infants hospitalized in the neonatal intensive care unit are routinely taught cardiopulmonary resuscitation (CPR) as part of the preparation for transition to home. A variety of methods are used to teach CPR knowledge and skills. The purpose of this study was to compare the psychosocial consequences of three different methods of CPR training for parents of infants at high risk for cardiopulmonary arrest. DESIGN, SETTING, AND SUBJECTS: In this prospective, multisite clinical trial, 335 parents and other caretakers of infants hospitalized in the neonatal intensive care unit were followed for 1 yr. Participants were 69% female, 49% Latino/Latina, with a mean age of 30 +/- 8 yrs. INTERVENTION: Subjects initially were randomized to one of four CPR training protocols: a video-only class, an instructor-taught class, an instructor-taught class combined with a social support intervention, and a control group. The social support intervention involved a group discussion after CPR training with regular telephone follow-up over the next 6 months by a nurse. MEASUREMENTS AND MAIN RESULTS: Data on psychosocial adjustment to illness, anxiety, and depression were collected at baseline, 2 wks, and 3 and 6 months. There were significant differences among the groups over time in anxiety (p = .007) and psychosocial adjustment to illness (p = .001). Parents in the CPR-video protocol had significantly less early anxiety and better postdischarge psychosocial adjustment compared with parents in the social support intervention at 2 wks after hospital discharge. Patterns of change over time, however, supported the efficacy of the CPR-social support intervention or the CPR-instructor protocols when compared with the CPR-video protocol. CONCLUSION: The results confirm that parents have difficulty adjusting after an infant's discharge from the neonatal intensive care unit and support the positive psychosocial effects of helping parents prepare for a home emergency by teaching CPR. The additional staff resources required to provide parents with social support along with CPR training are not justified based on the findings of the current study.

Comparison of cardiopulmonary resuscitation training methods for parents of infants at high risk for cardiopulmonary arrest.

STUDY OBJECTIVES: To compare three different methods of teaching CPR to parents of infants at high risk for sudden cardiopulmonary arrest and to identify characteristics that predict difficulty in learning CPR. METHODS: We conducted a prospective, multicenter clinical trial of 480 parents and other infant caretakers. Subjects were randomly assigned to 1 of 3 CPR training protocols: an instructor-taught CPR class, an instructor-taught CPR class followed by a social support intervention, or a self-training video module. CPR proficiency was evaluated with the use of a CPR skills checklist. RESULTS: Of 480 subjects, 301 (63%) were able to demonstrate successful CPR after training. Univariate analysis revealed that unsuccessful learners were likely to be less educated, to have lower incomes, to never have attended a previous CPR class, and to have better psychosocial adjustment to their infant's illness, compared with successful learners. The proportion of successful learners was significantly higher in the 2 instructor-taught classes than in the self-training video class. Multiple logistic regression analysis was used to develop a predictive profile to describe unsuccessful learners. The following characteristics independently predicted unsuccessful learners: CPR learned in the self-training video group, fewer years of education, and better psychosocial adjustment. CONCLUSION: Most parents of infants at high risk for sudden death can demonstrate successful CPR skills at the completion of 1 class. However, a significant minority will require extra attention to be successful. Self-training video instruction may not be an adequate substitute for instructor-taught CPR.

The psychological consequences of cardiopulmonary resuscitation training for family members of patients at risk for sudden death.

OBJECTIVES: The purpose of this study was to determine psychological consequences of teaching cardiopulmonary resuscitation (CPR) to family members of patients at risk for sudden death. METHODS: Patient-family pairs (n = 337) were randomized into one of four groups: control, CPR only, CPR with cardiac risk factor education, and CPR with a social support intervention. Only family members received CPR training. Data on emotional state and psychosocial adjustment to illness were collected at baseline, 2 weeks, and 3 and 6 months following CPR training. RESULTS: There were no significant differences in the emotional states of family members across the four groups. However, significant differences in psychosocial adjustment and emotional states occurred in patients across treatment groups following CPR training. Patients whose family members learned CPR with the social support intervention reported better psychosocial adjustment and less anxiety and hostility than patients in the other groups. Control patients reported better psychosocial adjustment and less emotional distress than patients in the CPR-only and CPR-education groups. CONCLUSIONS: These findings support tailoring family CPR training so that instruction does not result in negative psychological states in patients. The findings also illustrate the efficacy of a simple intervention that combines CPR training with social support.

Is cardiopulmonary resuscitation training deleterious for family members of cardiac patients?

The purpose of the study was to determine the attitudes toward cardiopulmonary resuscitation (CPR) training and subsequent CPR use of 172 CPR-trained family members of cardiac patients. The majority (88.9%) reported positive attitudes. Only 14 (8.1%) reported feeling too responsible for their family member. One hundred and forty-one (81.9%) said that they would perform CPR if required to do so. Family members do not feel unduly burdened by learning CPR, and CPR training should be recommended to families of patients at risk for sudden cardiac death.

Effects of a multidimensional cardiopulmonary rehabilitation program on psychosocial function.

The effects of participation in a structured, outpatient cardiac rehabilitation program on psychosocial function after acute myocardial infarction or coronary artery bypass surgery, or both, were evaluated prospectively in 141 patients who were married or living with "a significant other" (89% men, mean [+/- standard deviation] age 63 +/- 9 years old). Forty-one patients who were participants in a 3-month cardiac rehabilitation program were compared with 100 patients who did not participate in a formal program. On average, patients in both groups were well educated, older Caucasians who had minimal cardiac dysfunction (New York Heart Association class I or II). Patients in the 2 groups were not different at baseline in sociodemographic or clinical characteristics or in any of the dependent measures of anxiety, depression, psychosocial adjustment to illness or marital adjustment. Six months after initial testing, patients who attended cardiac rehabilitation were significantly less anxious (F[1,139] = 5.09, p = 0.03), less depressed (F[1,139] = 8.39, p = 0.004), had better psychosocial adjustment (F[1,139] = 5.87, p = 0.02), and were more satisfied with their marriages (F[1,139] = 8.6, p = 0.004) than nonparticipants. The findings support the effectiveness of group cardiac rehabilitation for this subgroup of patients in facilitating their psychosocial recovery after an acute cardiac event.

Cardiopulmonary resuscitation skills retention in family members of cardiac patients.

The purpose of this study was to determine if the use of a retention strategy would maintain cardiopulmonary resuscitation (CPR) skills in family members of cardiac patients. Thirty-one subjects trained in CPR received retention packets 3 and 6 months after CPR training. Sixteen subjects were tested for CPR retention at 7 months after initial training, and 15 at 12 months. Likelihood chi 2 was used to compare the 7- and 12-month groups. There were no differences between the 7- and 12-month groups, because CPR retention overall was poor. Only 19.4% of subjects reported using the retention packet; therefore, subjects were regrouped into practice and no practice groups for purposes of further statistical analysis. There were significant differences in retention in subjects who practiced compared with subjects who did not. These findings underscore the importance of promoting practice/review after initial CPR training for family members of cardiac patients.

Can family members of high-risk cardiac patients learn cardiopulmonary resuscitation?

The immediate delivery of bystander-administered cardiopulmonary resuscitation (CPR), coupled with the rapid delivery of advanced cardiac life support, can significantly reduce mortality from out-of-hospital cardiac arrest. Because the majority of sudden cardiac deaths occur in the victim's home with family members present, family members of cardiac patients at high risk for sudden death are the logical focus of CPR training. However, previous research has shown that only a small minority of family members of cardiac patients actually learn CPR and that health care professionals have failed to recommend CPR training in this population, in part due to concerns about their ability to learn CPR. The purpose of this study was to describe learning capabilities in this population and to identify characteristics of unsuccessful learners. To this end, we taught CPR to 83 family members of cardiac patients who were at risk for sudden cardiac death. Subjects had no CPR training within the past two years. Eighty-one percent of the subjects successfully learned CPR. Of the demographic and psychological characteristics examined, only gender, age, and depression were significant in explaining differences in CPR skills attainment ability. The elderly, the depressed, and males were more likely to be unsuccessful in demonstrating adequate CPR skills. Our results suggest that the majority of family members of cardiac patients can learn CPR successfully. Specific training strategies may need to be developed and tested to enhance CPR training in those family members of cardiac patients predicted to have difficulty learning CPR.

Emergency cardiac pacing.

This discussion reviews and critiques the available emergency pacing methods for the control of symptomatic bradycardias and the management of tachyarrhythmias. In addition, attention is addressed to the emergency care of patients with permanent pacemakers.

Cardiopulmonary resuscitation (CPR) training. Consequences for family members of high-risk cardiac patients.

A prospective, controlled trial was conducted to document the psychological risks and benefits of teaching cardiopulmonary resuscitation (CPR) techniques to family members of patients at high risk for a sudden death event. Clinical outcomes for the high-risk patients were also measured. Cardiac patients (n = 65) and their family members (n = 69) were randomized to one of three groups: CPR training, risk factor education, and control. Patients did not attend either intervention group. No adverse psychological effects for family members were documented. The patients in the CPR group, however, were more anxious at three months' follow-up than patients in either the educational or control groups. Patients in both CPR and risk factor education groups reported poorer adjustment to illness at six months' follow-up than did control patients. These results suggest that CPR training for family members may have an adverse psychological effect on high-risk cardiac patients.

Identification of impaired metabolic reserve by atrial pacing in patients with significant coronary artery stenosis.

We investigated myocardial 11C-palmitate clearance kinetics at a resting heart rate (control) and during pacing using positron-emission tomography in 10 patients with significant coronary artery stenosis (greater than 70%) and evidence of exercise-induced ischemia. Serial 11C-palmitate images acquired at control and during pacing revealed biexponential myocardial 11C clearance both in myocardium supplied by a stenotic coronary artery (myocardium "at risk") and in myocardium supplied by a normal coronary artery (normal myocardium). At control, the average rate of myocardial 11C clearance from the early rapid curve component (the clearance half-time) was similar in normal myocardium and in that at risk (22.2 +/- 5.2 vs 21.0 +/- 5.4 min, NS), as was the amount of myocardial 11C activity at the end of the early rapid phase (residual fraction 56.3 +/- 7.2% vs 54.7 +/- 7.3%, NS). Thus, myocardial clearance was homogeneous at control, suggesting a similar rate and amount of 11C-palmitate oxidation in normal myocardium and in that at risk. Pacing shortened clearance half-times and decreased residual fraction in both normal myocardium and that at risk compared with control. However, clearance half-times were 17% longer and residual fractions 14% higher in myocardium at risk compared with normal myocardium (p less than .005 and p less than .01, respectively). Therefore, during pacing myocardial 11C clearance became heterogeneous, suggesting impaired 11C-palmitate oxidation in myocardium at risk compared with normal myocardium. Increased substrate utilization in response to increased workload can be thought of as a measure of metabolic reserve. Our data suggest metabolic reserve for free fatty acid oxidation is impaired in myocardium supplied by a significantly stenosed coronary artery and that this impairment can be detected by analysis of myocardial 11C-palmitate clearance.

The survival benefit of bystander cardiopulmonary resuscitation in a paramedic served metropolitan area.

We investigated the survival benefit bystander cardiopulmonary resuscitation (CPR) for out-of-hospital emergencies in a paramedic served area of metropolitan Los Angeles. Clinical information for all events occurring between January 1 and December 31, 1978 was obtained from paramedic report forms and hospital medical records. Bystander CPR was performed for 93 cases and, of these, 20 (22 per cent) survived to hospital discharge, as compared to 7 (5 per cent) of the 150 patients not receiving bystander CPR (p less than 0.001). Twelve (27 per cent) of the 45 patients in ventricular fibrillation (VF) who had bystander CPR survived, as compared to 4 (6 per cent) of 70 VF patients without bystander CPR (p less than 0.01). We conclude that bystander CPR, initiated prior to arrival of paramedics, produced a fourfold improvement in survival. Overall there was a 10 per cent survival rate at hospital discharge. Survival rates reported from Seattle may not necessarily be generalized to larger cities.

Creatine phosphokinase-MB (CPK-MB) and the diagnosis of myocardial infarction.

Creatine phosphokinase-MB (CPK-MB) is the most sensitive and the most specific indicator available for the diagnosis of an acute myocardial infarction. With the exception of after-cardiac surgical procedures, the degree and the duration of CPK-MB elevation in serum approximates the extent of an acute myocardial infarction, although a variety of factors may affect the reliability of such an index. Differences in the fractionation and assay methods for the creatine phosphokinase isoenzymes have produced conflicting documentation as to the presence of CPK-MB in tissues other than myocardium and the release of CPK-MB under conditions other than an acute myocardial infarction. The embryological development of the CPK-MB isoenzymes, as well as the various conditions involving increased CPK-BB serum activity, also deserve attention.