BACKGROUND:Bystander cardiopulmonary resuscitation (CPR) rates are low. Our study objective was to encourage Philadelphia high school students to develop CPR/AED (automated external defibrillator) training programs and to assess their efficacy. The focus was on developing innovative ways to learn the skills of CPR/AED use, increasing willingness to respond in an emergency, and retention of effective psychomotor resuscitation skills. METHODS AND RESULTS:Health education classes in 15 Philadelphia School District high schools were selected, with one Control and one Study Class per school. Both completed CPR/AED pre- and post-tests to assess cognitive knowledge and psychomotor skills. After pre-tests, both were taught CPR skills and AED use by their health teacher. Study Classes developed innovative programs to learn, teach, and retain CPR/AED skills. The study culminated with Study Classes competing in multiple CPR/AED skills events at the CPR/AED Olympic event. Outcomes included post-tests, Mock Code, and presentation scores. All students' cognitive and psychomotor skills improved with standard classroom education (p<0.001). Competition with other schools at the CPR/AED Olympics and the development of their own student-directed education programs resulted in remarkable retention of psychomotor skill scores in the Study Class (88%) vs the Control Class (79%) (p<0.001). Olympic participants averaged 93.1% on the Mock Code with 10 of 12 schools ≥94%. CONCLUSION:Students who developed creative and novel methods of teaching and learning resuscitation skills showed outstanding application of these skills in a Mock Code with remarkable psychomotor skill retention, potentially empowering a new generation of effectively trained CPR bystanders.

Background: Conditions associated with sudden cardiac arrest/death (SCA/D) in youth often have a genetic etiology. While SCA/D is uncommon, a pro-active family screening approach may identify these inherited structural and electrical abnormalities prior to symptomatic events and allow appropriate surveillance and treatment. This study investigated the diagnostic utility of exome sequencing (ES) by evaluating the capture and coverage of genes related to SCA/D.Methods: Samples from 102 individuals (13 with known molecular etiologies for SCA/D, 30 individuals without known molecular etiologies for SCA/D and 59 with other conditions) were analyzed following exome capture and sequencing at an average read depth of 100X. Reads were mapped to human genome GRCh37 using Novoalign, and post-processing and analysis was done using Picard and GATK. A total of 103 genes (2,190 exons) related to SCA/D were used as a primary filter. An additional 100 random variants within the targeted genes associated with SCA/D were also selected and evaluated for depth of sequencing and coverage. Although the primary objective was to evaluate the adequacy of depth of sequencing and coverage of targeted SCA/D genes and not for primary diagnosis, all patients who had SCA/D (known or unknown molecular etiologies) were evaluated with the project's variant analysis pipeline to determine if the molecular etiologies could be successfully identified.Results: The majority of exons (97.6 %) were captured and fully covered on average at minimum of 20x sequencing depth. The proportion of unique genomic positions reported within poorly covered exons remained small (4 %). Exonic regions with less coverage reflect the need to enrich these areas to improve coverage. Despite limitations in coverage, we identified 100 % of cases with a prior known molecular etiology for SCA/D, and analysis of an additional 30 individuals with SCA/D but no known molecular etiology revealed a diagnostic answer in 5/30 (17 %). We also demonstrated 95 % of 100 randomly selected reported variants within our targeted genes would have been picked up on ES based on our coverage analysis.Conclusions: ES is a helpful clinical diagnostic tool for SCA/D given its potential to successfully identify a molecular diagnosis, but clinicians should be aware of limitations of available platforms from technical and diagnostic perspectives.

Purpose of reviewOver half of young sudden cardiac arrest victims show no prior warning signs or symptoms and survival depends on secondary prevention, notably prompt initiation of cardiopulmonary resuscitation (CPR) and the use of an automated external defibrillator (AED), for out-of-hospital arrests. There is increasing public interest in and uptake of public access defibrillation programs in communities and schools. Our purpose was to review recent data on sudden cardiac arrest in children and its outcome to identify ways to improve the current low survival rate of youth who experience sudden cardiac arrest.Recent findingsIncreases in bystander cardiopulmonary resuscitation in Norway to 73% have occurred alongside increasing survival from sudden cardiac arrest from shockable rhythms to 52%. Studies in Denmark and the US show that survival of 69-74% is possible when a shockable rhythm is present and an automated external defibrillator is immediately applied. Up to 70-80% of US schools have automated external defibrillators, but not all have effective emergency action plans to maximize the impact of the presence of the AED.SummaryStudies suggest that education to increase bystander CPR and implementation of school AEDs and other public access defibrillation programs improve the survival of youth experiencing sudden cardiac arrest to 74% when optimal programs are in place. Methods to enhance such programs are presented. All involved with the health and education of youth are urged to implement best practices to protect youth and improve survival from sudden cardiac arrest.

Specific triggers for sudden cardiac arrest (SCA) in youth are unclear. Parent Heart Watch members with children who had SCA were surveyed. Questions included 1) occurrence 2) prior symptoms: evaluation, diagnoses 3) family history 4) medications, other triggers 5) activity 6) circumstances.

Background: The National Center for the Review and Prevention of Child Deaths (NCRPCD) maintains a unique multistate database supported by the US Maternal and Child Health Bureau to record circumstances of child deaths with data submitted by state Child Death Review teams. Methods: We aim to describe circumstances of child cardiovascular deaths (CVD) in the NCRPCD database and to identify modifiable risk factors, potential disparities, and their contribution to sudden cardiac death (SCD) and non-sudden CVD. An analytical dataset involving 16 states was developed for analysis of CVD cases occurring in 2005-2009. We developed algorithms to identify SCD and non-sudden CVD cases. Logistic regression was used to identify correlates of SCD among all CVD cases. Results: CVD cases (1099) were 0.6 (0.1, 9.6) yrs median (IQR) with 55% ≤1 yr and 22% ≥12 yrs; Male 58%; White 70%, Black 22%, Asian 2%, Other 5%; Hispanic ethnicity 19%. Prior conditions, present in 47%, included congenital heart defects (CHD), 23%; cardiomyopathy (CM), 4%; arrhythmia (AR), 2%. Most deaths occurred at home/school, 30% or in the hospital, 40%. Common causes of death were CHD 21%; AR 17%; and CM 8%. Reclassification indicated 59.1% (649/1099) of CVD were SCD and 33.8% (371/1099) were non-sudden CVD. Differences in SCD (versus non-sudden death) were noted by race with SCD in 73.2% blacks vs. 60.9% whites (p=0.02). More SCD occurred in the suburban (84.9%) than in urban sites (57.6%) p<0.0005. Among SCD, 911 was called in 92.6% of suburban and 78.6% of urban SCD (p=0.006). In a multivariable logistic regression model (Table) being black, older (>6 months), Hispanic, and living in the suburbs were significantly associated with SCD. Conclusions: The NCRPCD database contains valuable information to help understand and prevent SCD. Evaluation of risk factors for SCD indicated a higher risk by race, age, ethnicity, and location.

Background: Since less than 30% of lay witnesses to cardiac arrest attempt cardiopulmonary resuscitation (CPR), understanding the public's perception of CPR training and performance is essential to inform future CPR training methods. Little is known regarding layperson perspectives on CPR in context of the 2010 resuscitation guidelines and the development of hands-only CPR. Objectives: We hypothesized that bystanders would feel more confident performing CPR when made aware of the new guidelines support for hands-only CPR. Methods: Subjects participated in an hour-long semi-structured qualitative interview. The interview script covered general questions designed to understand subject's perspectives on CPR training and performance. Following transcription, all responses were coded and processed using NVivo 9 qualitative analysis software. Results: Interviews were completed by 19 subjects, of whom 11% were untrained, 47% had completed a training course within the past 5 years and 42% had completed a course in the past 5+ years. Less than 49% of the subjects could describe when to perform CPR, and those who described using CPR incorrectly confused the lifesaving skill with first aid (64%) or clearing of the airway (27%). Subjects described incomplete training, lack of hands-on practice time (38%) and difficulty with skill retention (21%) as top themes surrounding their previous CPR training. Lack of confidence in CPR skills was a commonly reported theme among 79% of interviewees, despite 41% of these respondents having been trained within 5 years. When asked about hands-only CPR, 74% of the subjects had not heard of the new technique and 68% were unaware of the updated 2010 CPR guidelines. When briefly educated about the 2010 guidelines, 89% felt more confident with performing CPR if they had the option of employing “hands-only” CPR (p<0.01). Conclusions: CPR trained individuals lacked confidence and retention of CPR knowledge, and were not aware of hands-only CPR and the 2010 resuscitation guidelines update. When informed about the option for hands-only CPR, individual's self-reported confidence increased significantly. This has implications for future public messaging surrounding layperson CPR and the need to promote hands-only CPR more broadly.

Introduction: Bystander cardiopulmonary resuscitation (CPR) rates are 15-30%. We aimed to help students develop innovative CPR/AED (automated external defibrillator) training programs in Philadelphia high schools and to assess their efficacy. Hypothesis: Harnessing adolescent characteristics of teamwork, competitiveness, and creativity will produce novel and effective methods of learning resuscitation skills. Methods: Health education classes in 15 Philadelphia School District high schools were selected, with 1 control and 1 study intervention group per school. Both groups completed CPR/AED pre- and post-tests to assess cognitive knowledge and psychomotor skills. After pre-tests, both groups were taught CPR skills and AED use by their health teacher. Study groups developed innovative programs to learn, teach, and retain CPR/AED skills. The study culminated with the CPR/AED Olympic event in a sports stadium with study group students from 12 schools competing in multiple CPR/AED skills events including a Mock Code and CPR/AED program presentations. Outcomes included post-tests, Mock Code (17 performance factors), and presentation scores with analysis using paired student's t tests. Results: Students' cognitive and psychomotor skills improved with standard classroom education programs (p<0.0001). Competition with other schools at the CPR/AED Olympics and the development of their own student-directed education programs resulted in further remarkable improvements. Participants averaged 93.1% on the Mock Code with 10 of 12 schools ≥94%. Conclusion: Students who developed creative and novel methods of teaching and learning resuscitation skills showed outstanding application of these skills in a Mock Code. Harnessing adolescent characteristics of teamwork, competitiveness, and creativity produced novel and effective methods of teaching resuscitation skills, potentially empowering a new generation of effectively trained CPR bystanders.