After the starting signal, instead of immediately bolting into a sprint, the runner crouched to the ground. So did all the other runners in the other lanes. With intense focus, the competitors attached their specially designed race batons to the simulated victims resting at the starting line, and they performed 30 chest compressions. Only then did each runner dash at top speed and hand off the baton (which resembled an automated external defibrillator, or AED), to a teammate who stood ready to revive the next simulated manikin victim 100 yards down the track.
You did not see this AED Relay race during the Olympic Games in Rio, nor in any future elite international athletic competition. But a great deal of training went into these so-called CPR/AED Olympics, which were held at the historic Franklin Field at the University of Pennsylvania.
New research from The Children’s Hospital of Philadelphia suggests that training for and competing in this event gave the participants a lasting edge in improvement in their ability and readiness to resuscitate a victim of sudden cardiac arrest. The researchers believe that further study and expansion of such successful educational elements could support a broader effort to improve cardiac arrest survival throughout the community.
In Philadelphia, sudden cardiac arrest occurs about four times every day, with 80 percent of arrests occurring at home. Often, a friend or family member is a bystander who could potentially perform lifesaving cardiopulmonary resuscitation (CPR) while waiting for an emergency medical responder to arrive — but, in reality, bystander CPR occurs too rarely. Expanding access to and the effectiveness of educational interventions could better equip more bystanders with the right skills and attitudes to act.
A Competition in a Class of its Own
The CPR/AED Olympics challenged students to put their learning about CPR and the use of AEDs into practice in a fun, competitive environment. In addition to the AED Relay, other competitions during the day-long event challenged students to perform CPR on manikins during a mock emergency scenario and to do so at the correct depth and rate during a two-minute compression challenge.
All of these competitions called for at least as much brains as brawn. And one competition in particular asked for the most: Each team was scored on the planning and creativity of its own new educational program designed to teach other students the CPR and AED skills they had learned.
Planning for the CPR/AED Olympics and the study of its outcomes were led by Victoria Vetter, MD, MPH, a pediatric cardiologist and medical director of the Youth Heart Watch Program at CHOP and professor of Pediatrics at the Perelman School of Medicine at the University of Pennsylvania. The project overall is called the SPORTS study.
Dr. Vetter and colleagues from CHOP and Penn devised the SPORTS study as a unique partnership with the Philadelphia School District to improve existing CPR/AED education in high schools’ health class curriculum. The one-year program in 2011 was funded by a grant from the American Heart Association and the Laerdal Medical Foundation, a provider of training, educational, and therapy products for lifesaving and emergency medical care. The CHOP Youth Heart Watch Program had previously partnered with the schools to help them secure AEDs for all Philadelphia public high schools and middle schools.
Fifteen schools enrolled in the study. In two health classes in each school, members of the CHOP research team tested students’ cognitive and psychomotor skills in performing CPR and using AEDs, as well as their attitudes and willingness to perform CPR, before and after they learned these skills. One health class in each participating school was a control class receiving standard teaching, while one intervention class was asked to develop an original, creative CPR education program and invited to train to compete against other schools in the CPR Olympics at the end of the school year. Retention testing was performed a year later.
“We asked the kids to figure out what type of lesson would be good for their own community, in their own school, so they could take it and run with it,” said Noreen Dugan, RN, BSN, CCRC, clinical research project manager for the Youth Heart Watch Program at CHOP and a co-author of the study.
The students not only ran, but leapt at the creative educational challenge. They wrote and performed original music in genres from rap to ballad. They shot music videos with ballet and CPR dramatizations. They even considered low-cost solutions to help more students practice CPR skills in budget-strained schools. In particular, students in one school proposed using a field hockey ball to practice compressions because the ball has a similar resistance to a human chest and is already widely available in many schools, unlike expensive CPR training manikins. The Youth Heart Watch Program subsequently adapted that idea by creating a simple heart-shaped ball as an inexpensive training tool.
“We didn’t know what to expect from these kids,” Dr. Vetter said. “Here was this group at CHOP saying, ‘We want to hear what your thoughts are. We want you to come up with something and tell us what you’ve done.’ And they really stepped up. As pediatricians who invest our careers in watching children develop, that was very rewarding.”
Measuring a Lasting Impact on Skills, Working Toward Increasing Survival
“Participating in this competition and the educational program creation process resulted in a remarkable retention of resuscitation skills in the students who were in the intervention class,” Dr. Vetter said.
These findings were recently published in the journal Resuscitation.
All of the students in the participating schools improved their skills and willingness to perform CPR after learning about it in health class, both in the control classes and in the intervention groups. When the CHOP team returned to six schools a full year later for follow-up testing, they found that students who had participated in the CPR Olympics and developed educational programs a year earlier retained the psychomotor skills for performing CPR exceptionally well, at a rate of 88 percent. That represented a drop of less than one percentage point from their scores immediately after completing the class. In contrast, scores from students in the control classes dropped to 79 percent after a year, despite initially being slightly higher than scores in the intervention classes.
The high level of skill retention as an outcome of the program is a unique finding.
“We are hoping this will develop into a nationwide program that will promote CPR and AED education and awareness,” Dr. Vetter said. “It’s a program that has scientific grounding and also has educational input and impact.”
Representatives from the Youth Heart Watch Program at CHOP, the Center for Resuscitation Science at Penn, and other partners, have joined forces as part of a group called the Philadelphia Regional CPR Awareness Coalition. The group’s CPR Ready campaign aims to triple the rate of bystander CPR in the Philadelphia region while addressing racial and ethnic disparities in cardiac arrest survival. Tripling bystander CPR rates would have an estimated overall impact of doubling survival rates from sudden cardiac arrest. Educational interventions like the CPR Olympics could be a valuable component of that plan.