Out-of-hospital cardiac arrest constitutes a major public health challenge responsible for hundreds of thousands of deaths annually in the U.S. A family responder program, where family members of a person at high risk of cardiac arrest are equipped and trained with an automated external defibrillator (AED), is an innovative method to reduce mortality. Although lifesaving, the successful operation of the AED requires achievement of technical skill. Moreover given the extreme circumstances of cardiac arrest, the AED may serve to enhance or erode the psychological well-being of the patient and/or family. Behavioral theory and empirical evidence from studies of lifesaving skills training of laypersons suggest that an AED training approach that incorporates tenets of self-efficacy and perceived control may favorably impact skills retention and psychological status. To test this hypothesis, 300 (sets of) patients at high-risk of cardiac arrest and their family members will be will be randomized to one of four AED training programs: 1) instructional video, 2) video with self-efficacy, 3) face-to-face instruction with self efficacy, 4) face-to-face instruction with self-efficacy and perceived control.
The specific aims are to determine which AED training program achieves optimal skills retention and psychological adjustment among heart disease patients and their family members. Patients and family members will be enrolled shortly after hospital discharge for an acute coronary syndrome. AED skills of family members will be assessed in a simulated """"""""surprise"""""""" cardiac arrest 9 months following enrollment using a validated skills measure. Psychological adjustment of family members and patients will be assessed at baseline (prior to randomization) and 3 and 9 months later using validated survey instruments for psychological and functional health. During the initial 6 months, the investigators will gain review board approval, finalize assessment and training resources, and hire staff. For the subsequent 3 years, subjects will be enrolled and baseline and outcome measures will be assessed. Data will be analyzed and reports written during the final 12 months of the study. The study has greater than 80 percent power to detect clinically important differences between training groups. Although the programs span the spectrum from streamlined to personalized and intensive, each approach constitutes a potential real-word, generalizable AED training method. If training that is enhanced in self-efficacy and perceived control is superior, more training resources may be required to maximize the health benefits of a family responder AED program. Alternatively, if nominal video-based approaches achieve comparable outcomes, training efforts can be streamlined at considerable cost savings with fewer impediments for distribution and dissemination. ? ?
|Seymour, Christopher W; Rea, Thomas D; Kahn, Jeremy M et al. (2012) Severe sepsis in pre-hospital emergency care: analysis of incidence, care, and outcome. Am J Respir Crit Care Med 186:1264-71|
|Meischke, Hendrika; Diehr, Paula; Phelps, Randi et al. (2011) Psychologic effects of automated external defibrillator training: a randomized trial. Heart Lung 40:502-10|
|Seymour, Christopher W; Kahn, Jeremy M; Cooke, Colin R et al. (2010) Prediction of critical illness during out-of-hospital emergency care. JAMA 304:747-54|