A novel scoring system and correlative analysis of the strength and effectiveness of nationwide high school cardiopulmonary resuscitation mandates: Insights from a high school CPR study

Aashish Katapadi; Avani Lakkireddy; Sneha Korlakunta; Lasya Maganti; Rachad Ghazal; Aditya Mansabdar Mudr; Nicholas Pham; Danish Bawa; Adnan Ahmed; Anjali Baratham; Nikhila Chelikam; Douglas Darden; Ehtesham Shan; Jalaj Garg; Rajesh Kabra; Rakesh Gopinathannair; Donita Atkins; Cathie Biga; Kenneth A Ellenbogen; Mina K Chung; Richard Kovacs; Dhanunjaya Lakkireddy

doi:10.1016/j.hrthm.2024.07.033

A novel scoring system and correlative analysis of the strength and effectiveness of nationwide high school cardiopulmonary resuscitation mandates: Insights from a high school CPR study

Heart Rhythm. 2024 Jul 20:S1547-5271(24)02916-3. doi: 10.1016/j.hrthm.2024.07.033. Online ahead of print.

Authors

Aashish Katapadi¹, Avani Lakkireddy², Sneha Korlakunta³, Lasya Maganti², Rachad Ghazal¹, Aditya Mansabdar Mudr¹, Nicholas Pham¹, Danish Bawa⁴, Adnan Ahmed⁴, Anjali Baratham², Nikhila Chelikam¹, Douglas Darden¹, Ehtesham Shan¹, Jalaj Garg⁵, Rajesh Kabra¹, Rakesh Gopinathannair¹, Donita Atkins¹, Cathie Biga⁶, Kenneth A Ellenbogen⁷, Mina K Chung⁸, Richard Kovacs⁹, Dhanunjaya Lakkireddy¹⁰

Affiliations

¹ Kansas City Heart Rhythm Institute, Overland Park, Kansas.
² Barston School, Kansas City, Missouri.
³ Boston University, Boston, Massachusetts.
⁴ Division of Cardiology, HCA Midwest Health, Overland Park, Kansas.
⁵ Loma Linda University Health, Loma Linda, California.
⁶ Cardiovascular Management of Illinois, Darien, Illinois.
⁷ Virginia Commonwealth University, Richmond, Virginia.
⁸ Cleveland Clinic Foundation, Cleveland, Ohio.
⁹ Indiana University, Indianapolis, Indiana.
¹⁰ Kansas City Heart Rhythm Institute, Overland Park, Kansas. Electronic address: dhanunjaya.lakkireddy@hcahealthcare.com.

PMID: 39034017
DOI: 10.1016/j.hrthm.2024.07.033

Abstract

Background: Numerous states have introduced cardiopulmonary resuscitation (CPR) training mandates for high school students and staff to prevent sudden cardiac death (SCD). However, the content and implementation of these mandates vary substantially. Furthermore, a comprehensive and objective assessment of these mandates and their impact is lacking.

Objective: We aimed to conduct a thorough evaluation of CPR training mandates across the United States.

Methods: We developed a novel scoring system based on proposed CPR standards, training and certification requirements, and legislative action to assess current mandates. This was used to rate the CPR mandates across all 50 states and the District of Columbia. Mandate scores were then compared with available real-world registry data as a surrogate for efficacy from 2018 to 2021.

Results: State CPR mandate scores ranged from 0 to 47, with a higher score indicating more robust mandates. The median and mean scores were 24 (interquartile range, 19.5-27) and 21.52 ± 8.61, respectively, with 35 being the highest score. Intraobserver variability was 0.986 (95% CI, 0.944-1.028; P < .001). The year of implementation did not influence the strength of the score (R² = -0.173; 95% CI, -0.447 to 0.131; P = .262). Correlation with SCD rate (R² = -0.76; 95% CI, -0.492 to 0.367; P = .742), bystander-initiated CPR (R² = -0.006; 95% CI, -0.437 to 0.427; P = .978), automated external defibrillator use (R² = -0.125; 95% CI, -0.528 to 0.324; P = .590), and cardiovascular death rate (R² = -0.13; 95% CI, -0.379 to 0.21; P = .355) failed to reach statistical significance.

Conclusion: Modest scoring consistency highlights the need for robust, standardized CPR requirements to potentially mitigate SCD. This study lays the groundwork for evidence-informed policy development in this area.

Keywords: Automated external defibrillator; Cardiopulmonary resuscitation; High school; Legislation; Out-of-hospital cardiac arrest; Scoring; Students; Sudden cardiac death.