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Training Patient Families in Layperson CPR

Preparing Patients for Discharge

Hospital discharge can be one of the highest risk steps in a patient's care. As Alicia Arbaje, an assistant professor at Johns Hopkins School of Medicine puts it, "The most risky transition is from hospital to home."1

This is especially true for two categories of patients, both of which at first blush would seem to have nothing in common—infants and victims of cardiac arrest. The common thread - and common threat - is that on discharge, they are handed over to the care of others who may be poorly equipped to deal with a cardiac emergency if one should arise.

Each year in the United States...

16,000

pediatric patients suffer from cardiac arrest, many of whom are younger than 1 year old.2

90%

of these cases will occur in the home.3

12%

will likely survive. 4

62%

of infants that survive will have properly neurological function.5

For adults, the statistics are...

347,322

out-of-hospital cardiac arrests (OHCA).6

15%

survive to hospital discharge.7

48,000

survive to discharge after an in-hospital cardiac arrest.8

Regardless of where the cardiac arrest occurs, discharge is where that patient is typically being handed over from skilled professional to a novice layperson. A recent survey by Cleveland Clinic showed that slightly more than half of Americans (54%) say they know how to perform CPR; however, only one in six know that the recommended technique for bystander CPR consists of just chest compressions (and no breaths) on an adult.9 Even fewer, 11%, know the correct pace for performing these compressions (100 to 120 beats per minute).10

Efforts are certainly being made to reduce risk when a patient is discharged. Justifiably, the focus is typically on avoiding medication errors. Medication errors may affect as many as half of all patients within their first two weeks of discharge.11 But, what about training for risks beyond medication errors. "For the person who suffers cardiac arrest in the hospital, the odds of being among the one-year survivors works out to about 12 percent, or one in eight," according Paul Chan, a cardiologist at Mid-America Heart Institute in Kansas City, Mo., tells National Public Radio’s Shots.12 

What if we regarded CPR training for a patient’s family and friends the same way we look at the need for medication vigilance? We would now consider CPR training as preventative medicine. That’s just what some hospitals are starting to do.

Parents of Newborns and High-Risk Infants Should Know CPR

Cardiac arrest in children is the result of asphyxia in a majority of the cases. Children have increased cerebral blood flow and higher metabolic needs as compared with adults and lack of oxygen, therefore, can easily spawn a cardiac arrest.13 Premature infants and infants with congenital heart disease (CHD) are at especially high-risk for respiratory or cardiac arrest in their first year.14

For parents going home from the hospital, the idea of something that could lead to a sudden unexplained death is one of the most common fears. Fortunately, there are available methods to prepare parents to face an emergency.

Some organizations, such as Lucile Packard Children’s Hospital, Union Hospital, and Bluewater Health (to name a few), have implemented programs that offer parents of high-risk infants cardiopulmonary resuscitation (CPR) training. The Infant CPR Anytime kits that they are distributing are designed to train nonprofessionals in the lifesaving skills of CPR. This is done with a bilingual, interactive DVD and a manikin that clicks when compressions are performed accurately.

One study about the use of the Infant CPR Anytime program found that parents who trained with the kit actually rose to the challenge and performed CPR on their child.15 Five subjects reported performing CPR after discharge, and four of the five victims survived and remained neurologically intact.16

Parents love it because they can review and practice at their own pace, and nurses love it because it's a more efficient way to teach important skills when a patient leaves the hospital...Parents can show the kits to the babysitter, grandparents, and anyone else caring for their child; the more people know CPR, the better for everyone in the community.

Lynda Knight, RN, Life Support and Resuscitation Educator, Lucile Packard Children's Hospital

The "practice-while-watching" technique allows any lay person to easily learn basic infant CPR, choking relief, and calling for help – all within 20 minutes. Because of the ease of use, some hospitals are evolving from giving these kits to families with high-risk infants to giving them to all families with a newborn child.17

In terms of preventative medicine, this type of training can equate to precious time added to an infants life in the event of a cardiac arrest, while parents wait for EMS to arrive.

Families of Cardiac Arrest Victims Should Know CPR, Too!

Patients who have coronary disease complications or experience cardiac issues have an increased risk of SCA.18 The prompt delivery of CPR can double or triple a victim’s chance of survival, especially if it is performed within the first few minutes of cardiac arrest.19Because loved ones and caregivers are most likely to be present in an emergency, they should be prepared to intervene and provide basic CPR.

In the hospital setting, when a patient is being discharged, there is a unique opportunity to provide CPR instruction to an untrained population of people. This is especially important for the population of people who are most likely to witness an event.

Often, this window of opportunity at the hospital is not wide enough to coordinate a certified instructor to provide a comprehensive training in CPR.20 But, it is long enough to explain the importance of learning CPR and to provide self-directed training materials.

What this calls for is remembering that family and friends of a discharged cardiac arrest patient are in fact bystanders, and we know that immediate CPR given to a cardiac arrest victim by a bystander can double or triple a victim’s chances of survival.21

By preventing the degradation of ventricular fibrillation (VF) - a shockable cardiac arrest rhythm—to a non-shockable cardiac arrest rhythm, CPR increases the number of patients who can be successfully resuscitated through defibrillation. Bystander CPR is also associated with improved health outcomes for individuals who survive cardiac arrest. A number of studies have also found increased quality of life following cardiac arrest for individuals who receive bystander CPR compared to individuals who do not receive bystander CPR.22

So, Why Not Enable Family and Friends To Learn CPR During a Loved One's Discharge? 

Like the addition of Infant CPR Anytime kits in newborn discharge protocols, Adult CPR Anytime kits can be beneficial in the discharge of high-risk cardiac patients. One study supporting the use of hospital-based CPR training showed that targeted training of families is feasible, well-received by trainees, and can increase the chance of survival from a SCA in the home.23

For those who have recently suffered a serious cardiac event, they can leave the hospital with the trust that those around them are trained in basic lifesaving skills. Knowing CPR in this context is as important to the course of care for the patient as understanding his or her medication regimen. The two, many would argue, are inextricably linked.

Extend the Reach of Bystander CPR

The American Heart Association (AHA) estimates that for every Infant CPR Anytime® Kit distributed, 1.5 additional people are trained. And, for every Adult CPR Anytime® Kit distributed, 2.5 additional people are trained. By providing vulnerable patients with a kit upon discharge, there is an extended opportunity to train family, friends, caregivers, and coworkers in CPR. Each additional person trained with a CPR Anytime Kit is more likely to intervene as a bystander of SCA.

Are you interested in CPR Anytime Kits for your organization?

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CPR Anytime is a registered trademark of the American Heart Association.

References

*Stanford Children’s Health. (2012). Bringing home baby – and a CPR toolkit. Retrieved from https://healthier.stanfordchildrens.org/en/bringing-home-baby-and-a-cpr-toolkit/

  1. Rau, J. (2016). Hospital discharge: It’s one of the most dangerous periods for patients. Kaiser Health News. Retrieved from https://khn.org/news/home-health-agencies-often-miss-medication-errors-endangering-patients/
  2. Tress, E.E., Kochanek, P.M., Saladino, R.A., & Manole, M.D. (2010). Cardiac arrest in children. Journal of Emergencies, Trauma, and Shock, 3(3), 267-272. DOI: 10.4103/0974-2700.66528
  3. CPR Blog. (2018). CPR Statistics. Retrieved from https://cprblog.heart.org/cpr-statistics/
  4. Tress, E.E., Kochanek, P.M., Saladino, R.A., & Manole, M.D. (2010). See reference #2.
  5. Ibid
  6. Benjamin, E.J., Virani, S.S., Callaway, C.W., Chamberlain, A.M., Chang, A.R., Cheng, S., et al. (2018). Heart disease and stroke statistics – 2018 update: A report from the American Heart Association. Circulation, 137, e67-e494. DOI: https://doi.org/10.1161/CIR.0000000000000558
  7. Lurie, K., Levy, M., Swor, R., & Moore, J. (2017). Cardiac costs: The economic impact of out-of-hospital cardiac arrest care. The Insider. Retrieved from http://takeheartamerica.org/wp-content/uploads/2017/12/Economic-Impact.pdf
  8. Ibid
  9. Cleveland Clinic. (2018). New Cleveland Clinic survey: Only half of Americans say they know CPR. Retrieved from https://newsroom.clevelandclinic.org/2018/02/01/new-cleveland-clinic-survey-only-half-of-americans-say-they-know-cpr/
  10. Ibid
  11. Godman, H. (2012). Medication errors a big problem after hospital discharge. Harvard Health Publishing. Retrieved from https://www.health.harvard.edu/blog/medication-errors-a-big-problem-after-hospital-discharge-201207095012
  12. Knox, R. (2013). Cardiac arrest survivors have better outlook than doctors think. NPR. Retrieved from https://www.npr.org/sections/health-shots/2013/03/14/174291275/cardiac-arrest-survivors-have-better-outlook-than-doctors-think
  13. Tress, E.E., Kochanek, P.M., Saladino, R.A., & Manole, M.D. (2010). See reference #2.
  14. Pierick, T.A., Van Waning, N., Patel, S.S., & Atkins, D.L. (2012). Self-instructional CPR training for parents of high risk infants. Resuscitation, 83(9), 1140-1144. DOI: 10.1016/j.resuscitation.2012.02.007
  15. Knight, L.J., Wintch, S., Nichols, A., Arnolde, V., & Schroeder, A.R. (2013). Saving a life after discharge: CPR training for parents of high-risk children. Journal for Healthcare Quality. DOI: https://doi.org/10.1111/j.1945-1474.2012.00221.x
  16. Ibid
  17. Trigg, L. (2017). Union hospital distributes ‘Infant CPR Anytime’ kits. Tribune Star. Retrieved from https://www.tribstar.com/news/local_news/union-hospital-distributes-infant-cpr-anytime-kits/article_295b49c3-5a5d-536e-bc83-b9752f08d3f5.html
  18. Blewer, A.L., Leary, M., Decker, C.S., Andersen, J.C., Fredericks, A.C., Bobrow, B.J., et al. (2011). Cardiopulmonary resuscitation training of family members before hospital discharge using video self-instruction: A feasibility trial. Journal of Hospital Medicine, 6(7), 428-432. DOI: 10.1002/jhm.847
  19. HANDS-ONLY CPR fact sheet. 2016, American Heart Association. DS10261 5/16
  20. Blewer, A.L., Leary, M., Decker, C.S., Andersen, J.C., Fredericks, A.C., Bobrow, B.J., et al. (2011). See reference #18.
  21. CPR Blog. (2018). See reference #3.
  22. Graham, R., McCoy, M.A., & Schultz, A.M. (2015). Strategies to improve cardiac arrest survival: A time to act. National Academies Press (US). Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK321502/
  23. Blewer, A.L., Leary, M., Decker, C.S., Andersen, J.C., Fredericks, A.C., Bobrow, B.J., et al. (2011). See reference #18.