Research Magazine 2006
CPR Anytime kit
CPR Anytime kits include a DVD that lets users learn lifesaving skills from their homes.

Get personal, save lives

Nursing researchers advocate self-directed CPR kits to teach rescue skills

Beth Mancini knows what it’s like to watch a loved one die. Sudden cardiac arrest took her father’s life when she was 16. The tragedy still motivates her.

“We couldn’t save him,” she said, “and I have spent much of my life trying to do the things necessary that would change that for the next person.”

Dr. Mancini, associate dean in the UT Arlington School of Nursing and an internationally recognized expert in resuscitation education, is spearheading a project to boost the number of people trained in cardiopulmonary resuscitation.

In an age where bystanders provide CPR and/or early defibrillation with automatic external defibrillators (AEDs), she thinks her work can make a difference. “We believe we can increase the rate of survival, which right now is in the single digits in out-of-hospital cardiac arrests.”

The key, she says, is to make CPR training easier and more available.

Survival kits

Mancini and Carolyn Cason, associate dean for research and director of UT Arlington’s Center for Nursing Research, are examining an initiative called the Family & Friends CPR Anytime Personal Learning Program. The self-directed, personal CPR kit includes an inflatable manikin, a 22-minute practice DVD and informational materials. The kit teaches rescue skills to those who cannot attend the customary four- to eight-hour classes.

Mancini sees benefits in the classes, but at a cost-effective $30 the CPR Anytime kit can reach more people.

“Now, instead of just training one individual, our research has shown that between three and four individuals are trained using the same kit. It’s like a domino effect. We can train more people with fewer resources in a shorter time, and they get to keep the kit, which in itself promotes additional re-training.”

CPR practice kit

Nursing researchers have found that three to four people typically use the same kit for training.

In the past year, the research has targeted the kit’s application in four areas. One involved training lay personnel—anyone who is not a health care provider. Another focused on training only health care providers.

“We wanted to see if doctors and nurses could learn adult, child and infant CPR along with the additional lifesaving skills they need as health care providers, such as using breathing bags and barrier devices, without being away from work for four to eight hours,” Mancini said. “We demonstrated that they were able to learn the required skills using a self-directed program.”

A third area of study looked at teaching lay people how to use the “shock box,” or AED, in addition to teaching CPR. A fourth aspect taught non-health care providers in groups using the same self-directed approach.

Unlike a traditional CPR course, the CPR Anytime kit is not set up for certification. But Mancini says most people don’t need certification—they need basic lifesaving skills.

“The studies we have done indicate that the self-directed video is comparable to the traditional course in its ability to teach CPR skills,” she said, adding that those who do need certification can go to a training center and be evaluated.

Laerdal Medical, a leading supplier of emergency medical products, produces the kits with the American Heart Association, which wants to teach 20 million people CPR a year.

It’s an ambitious goal.

“We are actively committed to helping the AHA identify the most effective and efficient ways of doing that,” Mancini said.

Streamline, simplify, expand

In her more than two decades of CPR research, Mancini has seen technology play a major role in the way individuals learn.

“Twenty-five years ago, we were trying to figure out how to give eight-hour, large-group training sessions using very big and bulky equipment. But getting people in for a full eight hours was very difficult.”

Still, she said it was possible to effectively teach CPR—but only through a complex series of skills. “We used to teach a lot more in the program. That’s why it took eight hours.”

But training focused so much on healthy heart living and first aid that individuals weren’t learning the most important hands-on techniques like calling 911 in an emergency, starting CPR and basically keeping a person alive until paramedics arrive.

“So we did a lot of work with the notion that we need to streamline and simplify the approach and that we needed better tools to teach. And over 25 years, we’ve seen it move from big bulky pieces of equipment that could only be used in the classroom, to where people can actually learn the lifesaving skills of CPR at home, in 22 minutes, using a personal learning system.”

Mancini added that having effective training tools is good, but not good enough. There’s still a need for large-scale community training.

Her involvement with the AHA and the National Registry of Cardiopulmonary Resuscitation has helped CPaRlington succeed. This nationally recognized initiative is aimed at training 10 percent of Arlington’s population in basic CPR skills using the CPR Anytime kits. Spearheaded by Mayor Robert Cluck, a physician, it earned an honorable mention at the 2007 U.S. Conference of Mayors.

The AHA is using CPaRlington as a national model, and it is the largest single heart-health project in any community in the country. Since the initiative was launched in 2006, more than 8,500 Arlington residents have learned the lifesaving techniques.

As one of the largest employers in the city, UT Arlington is taking a leading role.

“We are fully committed to this initiative,” President James D. Spaniolo said. “I have encouraged everyone on campus to embrace this lifesaving opportunity.”

Carol Sue Marshall, an associate professor in the UT Arlington College of Education, has completed two other CPR training courses but says the kits are as effective as any traditional method.

“They have everything you need,” she said. “The technology is available to us. And as mentors and leaders on this campus, it’s our responsibility to not only make sure we’re trained in these skills, but that we share them.”

Dr. Marshall has shared the kit with her church youth group and others.

“I made it known among my circle of family and friends that it was available. And I would absolutely feel very comfortable using it if, a year from now, I thought I needed to refresh my skills.”

Don’t panic

According to the AHA, cardiovascular disease and sudden cardiac arrest each year kill 325,000 Americans before they reach a hospital. Almost 80 percent of cardiac arrests occur at home and are witnessed by a family member.

Effective bystander CPR, provided immediately after sudden cardiac arrest, can more than double a victim’s survival chances. Yet less than 25 percent of the time do people actually begin CPR. Why? They panic, Mancini says.

“People should not die of sudden cardiac arrest in a large percentage of cases.”

- nursing Professor Beth Mancini

“As a result, another initiative going on right now is something called Just in Time training, which examines how we work with the dispatcher and 911 operators in guiding panicked people through the CPR process.”

Nursing alumna Angela Bazzell works in both inpatient and outpatient health care environments—as a PRN (pro re nata or whenever necessary) nurse in the epilepsy monitoring unit at Medical City Dallas and as a clinic manager for the Nelson-Tebedo Health Resource Center in Dallas. She has observed that same panic in health care professionals who do not regularly use CPR.

“The nurses in high-acuity areas, such as in the intensive care unit, are certainly much more comfortable administering CPR because those units often have more patients who require resuscitative efforts,” she said. “On the other hand, nurses working in low-acuity areas, such as in the epilepsy monitoring unit, do not regularly use CPR other than with their normal required training.”

Bazzell says nurses in those situations might feel more anxious because they re-train only once every two years.

The survival rate of cardiac arrest victims is approximately 5 percent, according to the AHA’s Web site. Mancini says increasing it comes down to translating this lifesaving information to others.

“People should not die of sudden cardiac arrest in a large percentage of cases,” she said. “They’ve experienced a sudden isolated incident, and if we can do CPR, start chest compressions and quickly provide a shock to bring their heart back to a rhythm that will sustain them until more advanced care arrives, they have a better chance of surviving and, ultimately, living a long and effective life.”

To order a CPR Anytime kit, visit www.shopcpranytime.org.

Are we fit enough to do CPR?

School of Nursing and Department of Kinesiology researchers are teaming to examine the amount of energy the body requires to perform cardiopulmonary resuscitation.

Carolyn Cason, nursing associate dean for research, says American Heart Association guidelines on delivering effective CPR don’t consider all facets of human capabilities.

“No one has actually looked at what it takes for an average person to deliver CPR,” said Dr. Cason, who also directs UT Arlington’s Center for Nursing Research. “We know that effective CPR requires chest compressions be delivered to a certain point on the chest, that they be delivered to a certain depth (usually 1.5 to 2 inches) and that the recommended rate is 100 to 130 beats per minute.”

Bouncing up and down on someone’s chest is strenuous. The researchers want to measure how long an individual can perform CPR before fatigue sets in and the compressions no longer deliver oxygen to the brain.

Co-investigators are nursing Professor Beth Mancini, kinesiology Associate Professor Mark Ricard and kinesiology Assistant Professor Cynthia Trowbridge. The project director is kinesiology graduate student Jesal Parekh.

The study targets two groups of women, ages 45 to 60, and 22 to 35.

“If you were to look at our typical graduating class, you would see that the women are petite and on the slim side,” said Cason, the project’s principal investigator. “But most of the training initiatives have targeted middle-aged men. Yet it is this very group who are likely to have a sudden collapse associated with a heart problem. Those left standing to help are usually the wives and daughters of these men, or the typical hospital health care provider, such as a nurse.”

The study uses electromyography to gauge how long the women can deliver effective chest compressions. Sensors at critical muscle bundles in the arms, back, abdomen and upper legs determine what effect compressions have on the body’s electrical activity.

“We know that when the primary muscle being used in a given activity starts to fatigue, it will recruit other muscle groups to help out,” Cason said. “So we’re not only identifying the primary muscles being used, but we’re also looking at what point other muscles are recruited.”

The researchers are also monitoring CPR performance, adding that even with rapid EMT response the average time required to perform effective CPR is eight minutes. Conversely, hospital CPR resuscitation guidelines suggest changing out every two minutes.

Even the manikin being used for the chest compressions has a recording system that measures whether the compressions are being delivered at the right rate, depth and hand position on the chest.

— Susan M. Slupecki