Elsevier

Resuscitation

Volume 85, Issue 1, January 2014, Pages 131-137
Resuscitation

Simulation and education
Availability and quality of cardiopulmonary resuscitation information for Spanish-speaking population on the Internet,☆☆,☆☆☆

https://doi.org/10.1016/j.resuscitation.2013.08.274Get rights and content

Abstract

Background

Bystander cardiopulmonary resuscitation (CPR) is a vital link in the chain of survival for out-of-hospital cardiac arrest (OHCA); however, there are racial/ethnic disparities in the provision of bystander CPR. Approximately 32% of Hispanics perform CPR when confronted with cardiac arrest, whereas approximately 41% of non-Hispanics perform CPR. Public education, via the Internet, may be critical in improving the performance of bystander CPR among Hispanics. The objective of this study was to evaluate the availability and quality of CPR-related literature for primary Spanish-speaking individuals on the Internet.

Methods

Two search engines (Google and Yahoo!) and a video-site (YouTube) were searched using the following terms: “resucitacion cardiopulmonar” and “reanimacion cardiopulmonar.” Inclusion criteria were: education of CPR technique. Exclusion criteria were: instruction on pediatric CPR technique, failure to provide any instruction on CPR technique, or duplicated website. Data elements were collected on the content and quality of the websites and videos, such as assessing scene safety, verifying responsiveness, activating EMS, properly positioning hands on chest, performing accurate rate and depth of compressions.

Results

Of the 515 websites or videos screened, 116 met criteria for inclusion. The majority of websites (86%; 95% Confidence Interval [CI] 79–92%) educated viewers on traditional bystander CPR (primarily, 30:2 CPR), while only 14% (95% CI 9–21%) taught hands-only CPR. Of websites that used video (N = 62), 84% were conducted in Spanish and 16% in English. The quality of CPR education was generally poor (median score of 3/6, IQR of 3.0). Only half of websites properly educated on how to check responsiveness, activate EMS and position hands on chest. Eighty-eight percent of websites failed to educate viewers on assessing scene safety. The majority of websites had improper or no education on both rate and depth of compressions (59% and 63%, respectively). Only 16% of websites included 5 or more quality markers for proper bystander CPR.

Conclusions

A small proportion of internet resources have high quality CPR education for a Spanish-speaking population. More emphasis should be placed on improving the quality of educational resources available on the Internet for Spanish-speaking populations, and with particular emphasis on current basic life support recommendations.

Introduction

More than 290,000 cases of out-of-hospital cardiac arrests (OHCAs) are reported each year in the United States, with only 1 of 10 victims surviving to hospital discharge.1 A crucial link in the American Heart Association's (AHA) chain of survival is the provision of high-quality cardiopulmonary resuscitation (CPR), either by trained personnel or by lay persons. Without CPR, chances of survival decline by approximately 10% each minute.1

Although recommendations to perform CPR have been in place for over 30 years, only about 33% of OHCA victims nationwide actually receive CPR.1 In 2008, the AHA changed its guidelines to recommend lay person performance of hands-only CPR for adult with OHCA of presumed cardiac etiology. Hands-only CPR is performed by “pushing hard and fast in the middle of the victim's chest” and not stopping for ventilations.2 A study comparing bystander-initiated hands-only CPR to conventional CPR and no CPR showed an increase in survival for OHCA victims who received hands-only CPR.3 Despite the increasing evidence of the importance of both conventional and hands-only CPR in increasing survival, major health disparities currently exist, especially in Hispanic communities. A recent study in Arizona demonstrated that Hispanics perform bystander CPR 10% less than non-Hispanics (32% versus 42%, respectively).4 It is postulated that this may be linked to the lack of awareness about CPR and a relative paucity of Spanish language CPR resources. This disparity in the provision of bystander CPR in Hispanics is an important public health concern as Hispanics account for approximately 5% of the U.S. population, representing a total of 44.3 million Americans, and are the fastest growing population in the United States.5

The promulgation of CPR education through the Internet may be a way to increase access to CPR education. The Internet is an easily accessible source for health-related information.6 Self-education through internet resources is widespread in the United States7, 8 and is being used to teach bystander CPR.9 Only one prior study has examined the quality of CPR education by video-based self-instruction (VSI) using YouTube videos available in English.10 However, no studies have been conducted to examine the quantity and quality of resources for CPR education for a primarily Spanish-speaking population. As a result, the goal of this study was to evaluate the availability and quality of CPR-related literature for Spanish-speaking-only individuals on the Internet. We hypothesized that there would be a lack of quality educational resources available for this unique population.

Section snippets

Study design and search strategy

We performed a cross-sectional study using the two most widely utilized search engines (Google and Yahoo!) and the most widely utilized online video-site (YouTube). Each was queried using the following terms: “resucitacion cardiopulmonar” and “reanimacion cardiopulmonary” (both served as Spanish translation for CPR). Given the abundance of CPR-related websites on both Google and Yahoo!, the search was restricted to the following: Spanish language only, matched to exact wording of the search,

Results

The initial search resulted in >352,230 websites or videos from Google, Yahoo!, and YouTube. Based on our a priori search strategy, 515 websites were found for initial review. Of these, 399 were excluded based on a priori exclusion criteria, leaving 116 websites included in this study (Fig. 1). The final search was undertaken on April 1, 2011.

Baseline characteristics of websites are shown in Table 1. The majority of websites (86%; 95% Confidence Interval [CI] 79–92%) taught viewers traditional

Discussion

Cardiac arrest is an important public health issue, with known disparities by racial/ethnic groups.4 Studies have shown that survival from cardiac arrest is highly dependent on immediate resuscitation efforts, beginning with high-quality CPR.11 In 2008, the AHA recommended hands-only CPR for lay persons as an acceptable alternative to traditional CPR for untrained bystander.3 Efforts to disseminate this information on hands-only CPR to the public have included traditional classroom education,

Conclusions

The majority of websites for Spanish-speaking persons do not teach hands-only bystander CPR, despite 2008 AHA recommendations. Only 1 in 7 websites found on the Internet has quality CPR education for this population. Given the growing Hispanic population in the United States and in an effort to improve the dismal rates of bystander CPR in this community, more emphasis should be placed on (1) improving the quality of educational resources available on the Internet to teach CPR, (2) creating

Conflict of interest statement

None declared.

References (18)

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    Citation Excerpt :

    These data are consistent with the findings of previous studies which have shown that minority groups and Latinos in particular may be less likely to be given and receive appropriate bystander assistance in the setting of OHCA [13,14,18,19]. Language may play an important role, as previous work has suggested that limited knowledge of CPR among Latinos may be the result of a lack of educational resources in Spanish [26]. While we did not find an association between language of survey and AED training, this does not imply that providing AED training in Spanish is not needed, as the selection of English for a survey may not coincide with comfort level of receiving health information in English as well.

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A Spanish translated version of the abstract of this article appears as Appendix in the final online version at http://dx.doi.org/10.1016/j.resuscitation.2013.08.274.

☆☆

Presented, in part, at the American College of Emergency Physicians Annual Conference, San Francisco, 2011 (Liu).

☆☆☆

Supported, in part, by an Independent Scientist Award (K02 HS017526) from the Agency for Healthcare Research and Quality (AHRQ) (Haukoos) and an American Heart Association Scientist Development Grant (Sasson) and Emergency Medicine Foundation Career Development Award (Sasson).

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