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Monday, December 9, 2013

¿Se puede aprender CPR en el internet?

(UPDATE 3/24/14: Dr Sasson's work has helped drive the production of a quality, up-to-date CPR video for hispanohablantes. Skip to the bottom for the video!)

Say you want to learn CPR, but you only speak Spanish. What would you do? 

It looks like some organizations in the area offer CPR classes in Spanish (good outreach Stamford!), but not everyone can make it to these, and they may not be offered often. 

On the other hand, you can learn about anything on the internet these days, so why should CPR be any different? After all, going to a class is so 1980's. These days, you should be able to Google a few good websites for CPR, or even better, some videos on YouTube!

Or just watch some 80's videos on YouTube. Whichever.
We have a lot of people in this country who speak mostly or only Spanish. Heck, we're the second-largest Spanish-speaking country in the world! We should be able to choose from a plethora of on-line resources to learn CPR. 

Unfortunately, it turns out that the information available to Spanish speakers is usually out-dated, incomplete, or confusing. 

The study design
The authors of Availability and quality of cardiopulmonary resuscitation information for Spanish-speaking population on the Internet looked through Google, Yahoo, and YouTube for instruction on " resucitacion cardiopulmonar," and similar terms. They analyzed the websites and videos, and assigned quality ratings for 6 key elements.

After sifting through > 300,000 websites, they came up with 116 results that fit with the study's focus.

The results
They found that most websites, 86%, didn't teach hands-only CPR. That's cool - it's only been in the AHA guidelines for laypersons for 5 years...  Only half of the websites described activating 911. Other aspects, like scene safety or depth of compressions, were also missing in many, if not most, internet resources. 

The importance
Stop the presses - some health-related websites are wrong?!

Lots of internet information is iffy - Why is this a big deal?

* Chain of survival
Well, while researcher are busy wondering if we can eek out a higher survival rate by using hypothermia, or steroids, or vasopressin, or "leg-compression" CPR, none of this matters if bystanders don't do CPR in the first place. While it's fun to hash out the evidence regarding the ResQPOD, the first link in the chain for survival will always be bystander CPR.

* Bystander CPR
This is why it so concerning that at least one study has found that Hispanics are far less likely to get bystander CPR, and the reasons why aren't clear. If 10% fewer Hispanic patients are getting CPR, a bolus of prednisone isn't going to save their brains! Part of the reason the AHA switched to "hands-only" CPR was to encourage bystander CPR, and this study suggests that website quality may affect this effort. (Strangely enough, 3 out of the 5 bilingual websites taught hands-only CPR.)

  * Barriers to accessing 911
The Latino community does not need any further obstacles in dealing with medical emergencies. It's  been shown that many people in the Spanish-speaking community have doubts and fears when considering calling 911. (And no, it doesn't just have to do with a fear of "la migra," or the cost of the ambulance. Given that many people had experience with EMS in countries with far different systems than ours, they are confused about when it would be appropriate to call 911 versus drive to the hospital.)

The bottom line
In the last month we've seen good evidence that the LUCAS device doesn't save lives, and that prehospital therapeutic hypothermia probably doesn't help either. Early and effective CPR still remains our most important tool. 

Keep in mind that successful prehospital resuscitation programs don't just involve "pit-crews" or regional cardiac-arrest centers. The best programs also put a lot of work into the true first responders, the bystanders. Bobrow et al. showed that intensive public outreach in Arizona was associated with a doubling in cardiac arrest survival.

If your EMS catchment area includes many Spanish speakers, you have to figure out how to communicate with them, and enlist them in your efforts to improve cardiac arrest management. Sure, it's easy to do CPR classes in English, down at the high-school or community college like we've always done. But how are we going to reach the non-English speakers, and those that can't make it to a class? 

These days, this outreach is probably going to involve the internet - make sure it's a quality effort!

The AHA has a new, up-to-date, and complete video on performing CPR in Spanish. Check it out!



  1. Thanks for highlighting our study regarding the lack of CPR resources for Spanish-speakers. I am happy to say, as a direct result of this work, that the American Heart Association now has a Spanish-website with free Hands-Only CPR resources for our community members.

    There are resources that people can print out and post in their community centers, hospitals etc. There is also a Hands-Only CPR You-Tube demonstration (2 minutes in length).

    Thanks for bringing awareness to this issue, as well as getting the word out about how important it is for us to make sure we are multi-lingual and culturally-appropriate.

    Comilla Sasson, MD, MS
    Associate Clinical Professor Dept. of EM
    University of Colorado

    Director of Program Development and Innovation
    American Heart Association, Emergency Cardiovascular Care Group

    1. Thanks for pointing out the new site! That's indeed a great resource, and I'll be directing folks to it.

      I have one nagging thought, however. I realize that "Stayin' Alive" has a nice 104 beats-per-minute pace, which is perfect for CPR. But how well does the song translate across cultures? E.g.; will Guatemalan and Ecuadorean immigrants immediately recognize this song, and more importantly, recall the pace?

      If this song is, as I fear it may be, too grounded in US/UK 70s pop culture to be useful across the cultural spectrum, then we ought to consider other songs with which to deliver the message of "RCP usando sólo las manos."

      I was hoping that "Vamos a la Playa" (Righeira 1983) would work out, but it's a little too fast, at 129 bpm!