Training adult laypeople in basic life support. A systematic review

Extended reality technologies in adult basic life support education: A scoping review

Aim

In recent years, virtual and augmented reality (VR/AR) technologies have gained increasing attention as innovative tools for education, including in the field of adult Basic Life Support (BLS). While existing reviews on this topic primarily focus on comparing VR/AR with other educational approaches, our research aimed to identify the VR/AR hardware and software applications assessed in published studies and their alignment with learning objectives in adult BLS education.

Methods

We conducted a scoping literature review using the Population, Exposure, and Outcome (PEO) framework to analyse publications from 2018 to 2024. The review focused on the impact of VR/AR (exposure) on affective, behavioral, and cognitive learning outcomes (outcome) in adult BLS education among laypersons, healthcare professionals, pre-licensure students, and duty-to-respond laypersons (population).

Results

From 1,282 database records and 54 alternative sources, 31 articles were selected for comprehensive analysis. Many of the studies (11/31; 36%) targeted pre-licensure students, such as nursing students, and laypersons (9/31; 20%), primarily high school students. Only one study focused on duty-to-respond laypersons (1/31; 3%). VR studies (24/31; 77%) were more common than AR studies (6/31; 19%), featuring a broad spectrum of ten VR headsets compared to just two types of AR headsets. Among the assessed software applications, twenty-one commercial programs were examined-sixteen designed for VR and five for AR. Most studies investigated affective outcomes (25/31; 81%), while behavioural outcomes were also commonly examined (22/31; 71%). In contrast, cognitive outcomes were explored in fewer studies (9/31; 29%).

Conclusion

Our review identified several challenges in existing studies, including variability in software and hardware, diverse learning outcomes, and accessibility issues with extended reality (XR) technology. To maximize its effectiveness, XR should be aligned with specific learning objectives rather than adopted for its novelty. Prioritizing educational efficacy ensures that XR enhances learning by addressing precise gaps, ultimately improving the understanding and retention of resuscitation skills among both laypersons and healthcare professionals.

Knowledge and Awareness About the Basics of Cardiopulmonary Resuscitation in the Saudi Population

Introduction According to the World Health Organization (WHO), cardiovascular diseases are the leading cause of death globally, accounting for approximately 17 million deaths annually, with sudden cardiac arrest (SCA) as a significant contributor to this alarming statistic. SCA, the abrupt loss of heart function, is a critical medical emergency that requires early recognition and immediate cardiopulmonary resuscitation (CPR) for the effective resuscitation of victims. Various studies have shown a low level of knowledge regarding CPR in the community. This study aims to evaluate the knowledge and awareness of CPR among the Saudi population, identify gaps, and propose targeted health interventions, including education campaigns and training programs, to enhance community preparedness in emergencies and improve survival rates for SCA victims. Methods A cross-sectional observational study was conducted from May 2023 to November 2023. The study population included citizens and residents aged 18 years and older from the Central, Eastern, and Western regions of Saudi Arabia to ensure a diverse range of cultural and social backgrounds, with a sample size of 4,932 participants. Data were collected using an online, validated, closed-ended, structured questionnaire distributed via social media platforms, specifically WhatsApp and Telegram. Statistical analysis was performed using R version 4.3 (R Foundation for Statistical Computing, Vienna, Austria). Counts and percentages were used to summarize categorical variables. The chi-square test of independence was used to assess associations between categorical variables. The unpaired t-test and Mann-Whitney test were used to compare continuous normal and non-normal variables. Results A total of 4932 respondents completed the questionnaire. The gender distribution was predominantly female (76.5%, n = 3775), compared to 23.5% (n = 1157) males. The age distribution was skewed toward the younger population, with 59.1% (n = 2914) aged between 18 and 30 years. The educational level was predominantly university-level (68.8%, n = 3391). The academic specialization was diverse, with the largest group being healthcare practitioners (47.1%, n = 1615). The study found that 44.7% (n = 2203) of respondents had received basic life support (BLS) or first aid training, while 55.3% (n = 2729) had not. Results suggest a trend toward higher knowledge levels. The average knowledge score among the respondents was 7.17 ± 2.37, indicating that respondents answered slightly more than half of the questions correctly. The minimum score in the dataset was 1, suggesting that nearly all respondents had some level of correct answers. The maximum score achieved is 13, indicating the presence of individuals with a comprehensive understanding of the assessed topic. However, there is still room for improvement in knowledge and emergency preparedness among the surveyed group. Conclusion The study found a relatively high level of knowledge and awareness regarding CPR effectiveness, with higher levels observed among individuals with advanced education and health-related academic backgrounds. Additionally, completion of BLS or first aid training was positively correlated with increased CPR knowledge. These findings highlight the importance of incorporating CPR training into educational curricula and public health programs to enhance awareness and improve bystander response and survival rates in out-of-hospital cardiac arrests.

Barriers and Willingness to Undertake Cardiopulmonary Resuscitation Reported by Medical Students Dependent on Their Place of Residence-A Single-Center Study

Background

Bystander-administered cardiopulmonary resuscitation (CPR) is crucial for the survival of out-of-hospital cardiac arrests. However, only roughly 58% of bystanders would provide CPR, with wide variations across different regions. Identifying each factor affecting the barrier or readiness to perform resuscitation is a significant challenge for researchers. This study aimed to evaluate the obstacles preventing first-year medical students from initiating CPR, focusing on the size of domestic residential environments and the time and methodology of practical training.

Methods

The original online questionnaire surveyed first-year medical students at the Medical University of Łódź from February 1 to March 2, 2024. The questionnaire development involved a literature review, expert evaluation, and pilot testing. Participation was voluntary and anonymous, with strict inclusion and exclusion criteria. The data were analyzed using PQStat software, employing descriptive statistics.

Results

The study revealed that 271 medical students reported a similar median of barriers regardless of the place of residence (median (Me) = 5, interquartile range (IQR) 2-6.25 vs. Me = 4, IQR 3-6 vs. Me = 4, IQR 3-6, p = 0.620). Out of 18 analyzed barriers, the only significant difference was found for crowded places. Medical students living in cities most frequently reported a willingness to perform CPR with rescue breaths for all victims. Those who grew up in towns <100,000 residents were less willing to start CPR if an unknown adult were the victim (rural area: 39.2% vs. town: 17.6% vs. city: 45.1%, p < 0.01). The number of reported barriers was similar regardless of training type and the time since training; however, the nature of these barriers varied after a year passed.

Conclusions

Respondents across various locations reported similar number and types of barriers to performing CPR, including the most commonly declared fear of harm, uncertainty about recognizing cardiac arrest, and concerns about disease transmission. Although differences connected to the type of victims were observed, its low or moderate practical significance needs more comprehensive research on the impact of the size of the place of residence on the willingness to perform resuscitation and the related barriers.

Ventilation efficacy during paediatric cardiopulmonary resuscitation (PEDIVENT): simulation-based comparative study

Introduction

This simulation-based study aimed to evaluate the efficacy of ventilation during paediatric cardiopulmonary resuscitation (CPR) provided by healthcare professionals (HCPs) and lay rescuers (LRs). The objective was to assess the number of effective breaths delivered during the initial sequence of CPR. Effective ventilation plays a critical role during paediatric CPR as most cardiac arrests are secondary to hypoxia in origin. The recommendations on initial resuscitation in unresponsive, non-breathing children differ worldwide. The European Resuscitation Council (ERC) guidelines recommend five breaths before starting the chest compressions. Yet, this recommendation was based on the expert consensus historically and has not changed since 2000 because of the lack of evidence. This research addresses the identified knowledge gap, with potential implications for improving resuscitation practices and ultimately enhancing patient outcomes.

Methods

HCPs and LRs performed 90 s of CPR involving two mannequins: 5-kg Baby and 20-kg Junior. Both groups (HCPs and LRs) performed the task before and after structured CPR training, and the efficacy of ventilation before and after the training was compared. The HCPs provided bag-mask ventilation; LR performed dispatcher-assisted CPR with mouth-to-mouth ventilation.

Results

The number of participants that reached the primary outcome before and after the training in Baby was 26 (65%) vs. 40 (100%) in HCPs and 28 (60.9%) vs. 45 (97.8%) in LRs (improvement in both p < 0.001), respectively. The number of participants that reached the primary outcome before and after the training in the Junior mannequin was 31 (77.5%) vs. 32 (82.1%) in HCPs (p = 0.77) and 32 (82.1%) vs. 37 (94.9%) in LRs (p = 0.005), respectively.

Discussion

This simulation-based study is the first to investigate ventilation efficacy during paediatric CPR provided by HCPs and LRs. Ventilation represents an important aspect of good-quality CPR in children. The concept of initiating paediatric CPR with initial breaths, as stated in ERC guidelines 2021, is justifiable. Trained HCPs and LRs providing dispatcher-assisted CPR could deliver effective ventilation to paediatric mannequins. These findings can contribute to future research in this area and address identified knowledge gaps concerning resuscitation guidelines, given the unique practical application of simulation as a research tool.

Augmented reality training in basic life support with the help of smart glasses. A pilot study

Introduction

Laypeople should be trained in basic life support and traditional and innovative methodologies may help to obtain this goal. However, there is a knowledge gap about the ideal basic life support training methods. Smart glasses could have a role facilitating laypeople learning of basic life support.

Aim

To analyze the potential impact on basic life support learning of a very brief training supported by smart glasses video communication.

Methods

Twelve laypeople were basic life support tele-trained by means of smart glasses by an instructor in this pilot study. During training (assisted trough smart glasses) and after the training (unassisted) participants' performance and quality of basic life support and automated external defibrillation procedure were assessed on a standardized simulated scenario.

Results

After the training all participants were able to deliver good quality basic life support, with results comparable to those obtained when real time remotely guided by the instructor through the smart glasses. Mean chest compression rate was significantly higher when not guided (113 /min vs. 103 /min, p = 0.001). When not assisted, the participants spent less time delivering the sequential basic life support steps than when assisted while training.

Conclusions

A very brief remote training supported by instructor and smart glasses seems to be an effective educational method that could facilitate basic life support learning by laypeople. This technology could be considered in cases where instructors are not locally available or in general in remote areas, providing basic internet connection is available. Smart glasses could also be useful for laypeople rolling-refreshers.

Would anti-choking devices be correctly and quickly managed by health science students? A manikin crossover trial

BACKGROUND

The brand-new anti-choking devices (LifeVac® and DeCHOKER®) have been recently developed to treat Foreign Body Airway Obstruction (FBAO). However, the scientific evidence around these devices that are available to the public is limited. Therefore, this study aimed to assess the ability to use the LifeVac® and DeCHOKER® devices in an adult FBAO simulated scenario, by untrained health science students.

METHODS

Forty-three health science students were asked to solve an FBAO event in three simulated scenarios: 1) using the LifeVac®, 2) using the DeCHOKER®, and 3) following the recommendations of the current FBAO protocol. A simulation-based assessment was used to analyze the correct compliance rate in the three scenarios based on the correct execution of the required steps, and the time it took to complete each one.

RESULTS

Participants achieved correct compliance rates between 80-100%, similar in both devices (p = 0.192). Overall test times were significantly shorter with LifeVac® than DeCHOKER® device (36.6 sec. [31.9-44.4] vs. 50.4 s [36.7-66.9], p < 0.001). Regarding the recommended protocol, a 50% correct compliance rate was obtained in those with prior training vs. 31.3% without training, (p = 0.002).

CONCLUSIONS

Untrained health science students are able to quickly and adequately use the brand-new anti-choking devices but have more difficulties in applying the current recommended FBAO protocol.

The Effectiveness of Technology-Based Cardiopulmonary Resuscitation Training on the Skills and Knowledge of Adolescents: Systematic Review and Meta-analysis

BACKGROUND

Cardiopulmonary resuscitation (CPR) training for adolescents is a prominent strategy to increase the number of community first responders who can recognize cardiac arrest and initiate CPR. More schools are adopting technology-based CPR training modalities to reduce class time and reliance on instructor availability and increase their capacity for wider training dissemination. However, it remains unclear whether these technology-based modalities are comparable with standard training.

OBJECTIVE

This study aimed to systematically review and perform meta-analyses to evaluate the effectiveness of technology-based CPR training on adolescents' CPR skills and knowledge.

METHODS

Searches were conducted in PubMed, Embase, Cochrane Library, Ovid MEDLINE, CINAHL, PsycINFO, Education Resources Information Center, ProQuest Dissertations and Theses Global, and Scopus from inception to June 25, 2021. Eligible randomized controlled trials (RCTs) compared technology-based training with standard training for adolescents aged 12 to 18 years. Studies were appraised using the Cochrane risk-of-bias tool. Random-effects meta-analyses were performed using Review Manager (The Cochrane Collaboration). Subgroup analyses were conducted to explore sources of heterogeneity. Overall certainty of evidence was appraised using the Grading of Recommendations Assessment, Development, and Evaluation approach.

RESULTS

Seventeen RCTs involving 5578 adolescents were included. Most of the studies had unclear risks of selection bias (9/17, 53%) and high risks of performance bias (16/17, 94%). Interventions that included instructor guidance increased the likelihood of adolescents checking the responsiveness of the person experiencing cardiac arrest (risk ratio 1.39, 95% CI 1.19-1.63) and calling the emergency medical services (risk ratio 1.11, 95% CI 1.00-1.24). Self-directed technology-based CPR training without instructor guidance was associated with poorer overall skill performance (Cohen d=-0.74, 95% CI -1.02 to -0.45). Training without hands-on practice increased mean compression rates (mean difference 9.38, 95% CI 5.75-13.01), whereas real-time feedback potentially yielded slower compression rates. Instructor-guided training with hands-on practice (Cohen d=0.45, 95% CI 0.13-0.78) and the use of computer programs or mobile apps (Cohen d=0.62, 95% CI 0.37-0.86) improved knowledge scores. However, certainty of evidence was very low.

CONCLUSIONS

Instructor-guided technology-based CPR training that includes hands-on practice and real-time feedback is noninferior to standard training in CPR skills and knowledge among adolescents. Our findings supported the use of technology-based components such as videos, computer programs, or mobile apps for self-directed theoretical instruction. However, instructor guidance, hands-on practice, and real-time feedback are still necessary components of training to achieve better learning outcomes for adolescents. Such a blended learning approach may reduce class time and reliance on instructor availability. Because of the high heterogeneity of the studies reviewed, the findings from this study should be interpreted with caution. More high-quality RCTs with large sample sizes and follow-up data are needed. Finally, technology-based training can be considered a routine refresher training modality in schools for future research.

Early or late booster for basic life support skill for laypeople: a simulation-based randomized controlled trial

PURPOSE

Retention of skills and knowledge has been shown to be poor after resuscitation training. The effect of a "booster" is controversial and may depend on its timing. We compared the effectiveness of an early versus late booster session after Basic Life Support (BLS) training for skill retention at 4 months.

METHODS

We performed a single-blind randomized controlled trial in a simulation environment. Eligible participants were adult laypeople with no BLS training or practice in the 6 months prior to the study. We provided participants with formal BLS training followed by an immediate BLS skills post-test. We then randomized participants to one of three groups: control, early booster, or late booster. Based on their group allocation, participants attended a brief BLS refresher at either 3 weeks after training (early booster), at 2 months after training (late booster), or not at all (control). All participants underwent a BLS skills retention test at 4 months. We measured BLS skill performance according to the Heart and Stroke Foundation's skills testing checklist for adult CPR and the use of an automated external defibrillator.

RESULTS

A total of 80 laypeople were included in the analysis (control group, n = 28; early booster group, n = 23; late booster group, n = 29). The late booster group achieved better skill retention (mean difference in checklist score at retention compared to the immediate post-test = - 0.8 points out of 15, [95% CI - 1.7, 0.2], P = 0.10) compared to the early booster (- 1.3, [- 2.6, 0.0], P = 0.046) and control group (- 3.2, [- 4.7, - 1.8], P < 0.001).

CONCLUSION

A late booster session improves BLS skill retention at 4 months in laypeople.

TRIAL REGISTRATION NUMBER

NCT02998723.

Performing Simulated Basic Life Support without Seeing: Blind vs. Blindfolded People

Previous pilot experience has shown the ability of visually impaired and blind people (BP) to learn basic life support (BLS), but no studies have compared their abilities with blindfolded people (BFP) after participating in the same instructor-led, real-time feedback training. Twenty-nine BP and 30 BFP participated in this quasi-experimental trial. Training consisted of a 1 h theoretical and practical training session with an additional 30 min afterwards, led by nurses with prior experience in BLS training of various collectives. Quantitative quality of chest compressions (CC), AED use and BLS sequence were evaluated by means of a simulation scenario. BP’s median time to start CC was less than 35 s. Global and specific components of CC quality were similar between groups, except for compression rate (BFP: 123.4 + 15.2 vs. BP: 110.8 + 15.3 CC/min; p = 0.002). Mean compression depth was below the recommended target in both groups, and optimal CC depth was achieved by 27.6% of blind and 23.3% of blindfolded people (p = 0.288). Time to discharge was significantly longer in BFP than BP (86.0 + 24.9 vs. 66.0 + 27.0 s; p = 0.004). Thus, after an adapted and short training program, blind people were revealed to have abilities comparable to those of blindfolded people in learning and performing the BLS sequence and CC.

Worldviews on Evidence-Based Cardiopulmonary Resuscitation Using a Novel Method

The evaluation of scientific content by researchers, as well as the knowledge networks and working groups of cardiopulmonary resuscitation, can help to improve and expand new scientific evidence in this field. The aim of this study was to identify the global scientific publications on cardiopulmonary resuscitation research using a novel method. The method used was based on obtaining bibliographic data automatically from scientific publications through the use of the Scopus Database API Interface. A total of 17,917 results were obtained, with a total of 60,226 reports and 53,634 authors. Six categories were detected with 38.56% corresponding to cardiac arrest, 21.8% to cardiopulmonary resuscitation, 17.16% to life-support training and education, 12.45% to ethics and decision-making in cardiac arrest, 4.77% to therapeutic treatment, and 3.72% to life-support techniques. Analyzing and identifying the main scientific contributions to this field of study can make it possible to establish collaboration networks and propose new lines of research, as well as to unify criteria for action. Future research should delve into the analyses of the other elements involved in this area.

Comparison of Long-Term Effects between Chest Compression-Only CPR Training and Conventional CPR Training on CPR Skills among Police Officers

Despite of the changes of out-of-hospital cardiac arrest (OHCA) survival rise when bystander CPR is provided, this was only conducted in about 23% of OHCA patients in Korea in 2018. Police officers acting as first responders have a high chance of witnessing situations requiring CPR. We investigated long-term effects on CPR quality between chest compression-only CPR training and conventional CPR training in police officers to find an efficient CPR training method in a prospective, randomized, controlled trial. Police officers underwent randomization and received different CPR training. With the Brayden Pro application, we compared the accuracy of CPR skills immediately after training and the one after 3 months. Right after training, the conventional CPR group presented the accuracy of the CPR skills (compression rate: 74.6%, compression depth: 66.0%, recoil: 78.0%, compression position: 96.1%) and chest compression-only CPR group presented the accuracy of the CPR skills (compression rate: 74.5%, compression depth: 71.6%, recoil: 79.2%, compression position: 99.0%). Overall, both groups showed the good quality of CPR skills and had no meaningful difference right after the training. However, three months after training, overall accuracy of CPR skills decreased, a significant difference between two groups was observed for compression position (conventional CPR: 80.0%, chest compression only CPR: 95.0%). In multiple linear regression analysis, three months after CPR training, chest compression-only CPR training made CPR skills accuracy 28.5% higher. In conclusion, police officers showed good-quality CPR right after CPR training in both groups. But three months later, chest compression-only CPR training group had better retention of CPR skills. Therefore, chest compression-only CPR training is better to be a standard training method for police officers as first responders.

Cardiac arrest: An interdisciplinary scoping review of the literature from 2019

OBJECTIVES

The Interdisciplinary Cardiac Arrest Research Review (ICARE) group was formed in 2018 to conduct a systematic annual search of peer-reviewed literature relevant to cardiac arrest. Now in its second year, the goals of the review are to illustrate best practices in research and help reduce compartmentalization of knowledge by disseminating clinically relevant advances in the field of cardiac arrest across disciplines.

METHODS

An electronic search of PubMed using keywords related to cardiac arrest was conducted. Title and abstracts retrieved by these searches were screened for relevance, classified by article type (original research or review), and sorted into 7 categories. Screened manuscripts underwent standardized scoring of overall methodological quality and impact on the categorized fields of study by reviewer teams lead by a subject-matter expert editor. Articles scoring higher than 99 percentiles by category-type were selected for full critique. Systematic differences between editors' and reviewers' scores were assessed using Wilcoxon signed-rank test.

RESULTS

A total of 3348 articles were identified on initial search; of these, 1364 were scored after screening for relevance and deduplication, and forty-five underwent full critique. Epidemiology & Public Health represented 24% of fully reviewed articles with Prehospital Resuscitation, Technology & Care, and In-Hospital Resuscitation & Post-Arrest Care Categories both representing 20% of fully reviewed articles. There were no significant differences between editor and reviewer scoring.

CONCLUSIONS

The sheer number of articles screened is a testament to the need for an accessible source calling attention to high-quality and impactful research and serving as a high-yield reference for clinicians and scientists seeking to follow the ever-growing body of cardiac arrest-related literature. This will promote further development of the unique and interdisciplinary field of cardiac arrest medicine.

Traffic police officers' use of first aid skills at work: a qualitative content analysis of focus group discussions in Dar Es Salaam, Tanzania

Background

The World Health Organisation (WHO) recommends involving lay people in prehospital care. Several training programmes have been implemented to build lay responder first aid skills. Findings show that most programmes significantly improved participants’ first aid skills. However, there is a gap in knowledge of what factors influence the use of these skills in real situations. The current study aimed to describe police officers’ views on and experiences of factors that facilitate or hinder their use of trained first aid skills at work.

Methods

Thirty-four police officers participated in five focus group discussions. A structured interview guide was used to collect data. Interviews were audio-recorded and transcribed verbatim. Data were analysed using qualitative content analysis.

Results

We identified five categories of facilitators or hindrances. Training exposure was considered a facilitator; work situation and hospital atmosphere were considered hindrances; and the physical and social environments and the resources available for providing first aid could be either facilitators or hindrances.

Conclusion

Practical exposure during training is perceived to improve police officers’ confidence in applying their first aid skills at work. However, contextual factors related to the working environment need to be addressed to promote this transfer of skills.

Relief Alternatives during Resuscitation: Instructions to Teach Bystanders. A Randomized Control Trial

To analyze the quality of resuscitation (CPR) performed by individuals without training after receiving a set of instructions (structured and unstructured/intuitive) from an expert in a simulated context, the specific objective was to design a simple and structured CPR learning method on-site. An experimental study was designed, consisting of two random groups with a post-intervention measurement in which the experimental group (EG) received standardized instructions, and the control group (CG) received intuitive or non-standardized instructions, in a public area simulated scenario. Statistically significant differences were found (p < 0.0001) between the EG and the CG for variables: time needed to give orders, pauses between chest compressions and ventilations, depth, overall score, chest compression score, and chest recoil. The average depth of the EG was 51.1 mm (SD 7.94) and 42.2 mm (SD 12.04) for the CG. The chest recoil median was 86.32% (IQR 62.36, 98.87) for the EG, and 58.3% (IQR 27.46, 84.33) in the CG. The use of a sequence of simple, short and specific orders, together with observation-based learning makes possible the execution of chest compression maneuvers that are very similar to those performed by rescuers, and allows the teaching of the basic notions of ventilation. The structured order method was shown to be an on-site learning opportunity when faced with the need to maintain high-quality CPR in the presence of an expert resuscitator until the arrival of emergency services.