Kids Save Lives - ERC position statement on school children education in CPR.: "Hands that help - Training children is training for life"

Hands-Only Cardiopulmonary Resuscitation Education for Elementary School Students in Korea: Tracking by School Grade, Physical Characteristics, and Physical Strength

Objectives: This study aimed to assess variations in chest compression depth among Korean elementary school students based on grade, physical characteristics, and strength. Methods: The study involved 140 children in the third to sixth grades from elementary schools. Before providing cardiopulmonary resuscitation (CPR) education, we assessed height, weight, BMI, grip strength, and back strength. Subsequently, CPR education was administered, followed by individual measurements of compression depth. The factors related to compression depths was analyzed using t-test, ANOVA and multivariable regression. Results: The mean compression depth was consistently lower than the guideline standard across all grades, indicating grade-dependent differences (p = 0.000). Moreover, height, weight, BMI, grip strength and back strength increased, exhibited significant increases with grade (p = 0.000). In multivariable regression analysis, it was observed that as grade increased, chest compression depth increased by 0.701 cm (p = 0.000). Conclusion: School grade significantly influenced achieving the proper chest compressions depth, no notable correlation found for physical factors. Thus, a strategy emphasizing the importance of sufficient chest compressions during CPR education, particularly targeting elementary school students, seems necessary to encourage greater effort.

Empowering the next Generation: An innovative "Kids Save Lives" blended learning programme for schoolchildren training

INTRODUCTION

Guidelines recommend teaching resuscitation from school age; however, little is known about the best methods to provide it. We devised a blended learning program for primary and secondary students (Kids Save Lives - KSL) consisting of brief lectures, practical training with mannequins, and virtual reality. We aimed to evaluate its impact on students' attitudes towards intervening during cardiac arrest and their knowledge about basic life support.

METHODS

This observational, prospective, before-and-after study assessed attitudes and basic life support knowledge in primary and secondary school children exposed to the KSL program. 20 events were conducted in the metropolitan area of Bologna, Italy. A multiple-choice test (before and after the course) explored attitude, knowledge and perceptions of realism, engagement, and agreement with the virtual reality method.

RESULTS

A total of 1,179 students (response rate 81.4%) were included in the final analysis, with 12.89% from primary schools, 5.94% from middle schools, and 81.17% from high schools. Students' willingness to intervene during a cardiac arrest rose from 56.9% to 93.1% (p < 0.001) post-course. The course's realism, engagement, and future prospects received positive feedback, with median scores notably higher in primary schools compared to secondary schools.

CONCLUSION

The blended learning method improved students' understanding of basic life support techniques and their attitude to act during cardiac arrest situations. The positive reception of the virtual reality component underscores technology's potential to bolster engagement and should be further explored for basic life support teaching in schoolchildren.

Learning of Basic Life Support through the Flipped Classroom in Secondary Schoolchildren: A Quasi-Experimental Study with 12-Month Follow-Up

Background and Objectives: International institutions together with the World Health Organisation recommend the teaching of BLS in schools. Therefore, the objective of this research was to study the feasibility of teaching CPR and AED through the flipped classroom, exploring the medium- and long-term retention of knowledge and practical skills among high school students. Materials and Methods: The sample consisted of 260 secondary schoolchildren (137 in the experimental group (EG) and 123 in the control group (CG)) between 12 and 14 years old (M = 12.75 ± 1.02). Results: The data revealed that the EG obtained better post-course results in the correct position of the hands (p = 0.011), the depth of external cardiac compression (p > 0.001), and the mean time to apply an effective shock with the AED (p = 0.013). The CG obtained better results in compressions with complete chest re-expansion (p = 0.025). These differences disappeared at 6 months (p > 0.05) and 12 months (p > 0.05). Conclusions: A training program based on the flipped classroom is as effective and viable as traditional training, although more efficient since it is applied in less time, in the sequence of action in BLS, CPR skills, and the application of an effective shock with an AED.

Knowledge and willingness of schoolteachers in Jordan to perform CPR: a cross-sectional study

OBJECTIVES

This study aimed to assess the cardiopulmonary resuscitation (CPR) knowledge and willingness of schoolteachers in Jordan.

DESIGN

This was a cross-sectional study conducted using an online questionnaire.

SETTING

For inclusion in this study, schoolteachers must be currently teaching at any level in schools across the country. Responses were collected from 1 April 2021 to 30 April 2021.

PARTICIPANTS

All schoolteachers actively working in public or private schools were included in our study.

PRIMARY AND SECONDARY OUTCOME MEASURES

Continuous variables were summarised as means and SD, whereas categorical variables were reported as frequencies and percentages (%). A χ2 test for independence, independent sample t-tests and analysis of variance were used appropriately. A p-value less than 0.05 was used to determine statistical significance.

RESULTS

A total of 385 questionnaires were eligible for analyses. Only 14.5% of the participants received CPR training and overall correct knowledge answers were 18.8% of the total score. Those participants with previous CPR training had higher mean knowledge scores (2.34 vs 1.15, p<0.001). Trained participants were also more likely to provide hands-only CPR to various patient groups than untrained participants (p<0.05). Participants were more willing to provide standard CPR to family members than hands-only CPR (p<0.001), but more willing to provide hands-only CPR to friends (p<0.001), students (75.1% vs 58.2%, p<0.001), neighbour (p<0.001), stranger (p=0.001) and patient from the opposite gender (p<0.001).

CONCLUSIONS

Schoolteachers in Jordan possess limited knowledge of CPR. However, the study participants showed a positive attitude towards performing CPR. The study revealed that they were more inclined to provide hands-only CPR than standard CPR. Policymakers and public health officials can take advantage of these findings to incorporate CPR training programmes for schoolteachers, either as a part of their undergraduate studies or as continuing education programmes with an emphasis on hands-only CPR.

More than 302 million people reached and over 2,200,000 trained in cardiopulmonary resuscitation worldwide: The 2021 ILCOR World Restart a Heart initiative

Immediate bystander CPR after an out-of-hospital-cardiac arrest is likely to save hundreds of thousands of lives worldwide each year. International Liaison Committee on Resuscitation launched the World Restart a Heart initiative on October 16, 2018. In 2021 more than 2,200,000 persons were trained and at least 302,000,000 people were reached by WRAH global collaboration through print and digital media making it the highest-impact year since its inception. We strive for real success when CPR training and awareness become a year-round activity in all countries and all the citizens of the world realize that "Two Hands Can Save a Life!"

Global prevalence of basic life support training: A systematic review and meta-analysis

BACKGROUND AND AIMS

Out-of-hospital cardiac arrest exerts a large disease burden, which may be mitigated by bystander cardiopulmonary resuscitation and automated external defibrillation. We aimed to estimate the global prevalence and distribution of bystander training among laypersons, which are poorly understood, and to identify their determinants.

METHODS

We searched electronic databases for cross-sectional studies reporting the prevalence of bystander training from representative population samples. Pooled prevalence was calculated using random-effects models. Key outcome was cardiopulmonary resuscitation training (training within two-years and those who were ever trained). We explored determinants of interest using subgroup analysis and meta-regression.

RESULTS

28 studies were included, representing 53,397 laypersons. Among national studies, the prevalence of cardiopulmonary resuscitation training within two-years and among those who were ever trained, and automated external defibrillator training was 10.02% (95% CI 6.60-14.05) and 39.64% (95%CI 29.11-50.67), and 15.70% (95% CI 10.17-22.18) respectively. Subgroup analyses by continent revealed pooled prevalence estimates of 31.58% (95%CI 18.70-46.09), 52.62% (95%CI 38.40-66.63), 18.93 (95%CI 0.00-62.94), 64.97% (95%CI 64.00-65.93), and 50.56% (95%CI 47.57-53.54) in Asia, Europe, Middle East, North America, and Oceania respectively, with significant subgroup differences (p<0.01). A country's income and cardiopulmonary resuscitation training (ever trained) (p=0.033) were positively correlated. Similarly, this prevalence was higher among the employed (p<0.00001) and highly educated (p<0.00001).

CONCLUSIONS

Large regional variation exists in data availability and bystander training prevalence. Socioeconomic status correlated with prevalence of bystander training, and regional disparities were apparent between continents. Bystander training should be promoted, particularly in Asia, Middle East, and low-income regions. Data availability should be encouraged from under-represented regions.

RCParvulari training: A basic life support training methodology applied to 5-year-old students: Effectiveness in a cluster-randomized clinical trail

INTRODUCTION

Basic life support training in school age is a topical issue because, with adequate training, any person can help save a life.

METHODS

Cluster clinical trial with data collection through an ad hoc self-administered, semi-structured questionnaire. The target population encompassed the students aged 4-6 years enrolled in 49 educational centres. The centres were randomly allocated to the intervention or control group. The intervention group was trained with the RCParvulari® methodology, consisting of theoretical and practical training on the first link of the chain of survival. The control group only received theoretical training. We evaluated participants before and immediately after the intervention and between 3 and 12 months post intervention by means of the questionnaire. We assessed the acquisition and retention over time of the knowledge and skills covered in the training compared to previous trainings in both groups.

RESULTS

A total of 1327 schoolchildren (79% of the target population) participated. The level of knowledge acquired immediately after training and after 3-12 months compared to baseline was significantly better (P < .001) in the intervention group than in the control group, both in early recognition and contacting of emergency services (112) and in remembering the "mouth-nose-eyes" mnemonic.

CONCLUSIONS

The RCParvulari® methodology significantly contributed to an improved ability to recognize a possible medical emergency, start the chain of survival by alerting an adult and call the 112 emergency number in students in the last year of preschool education.

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.

Outcomes of audio-instructed and video-instructed dispatcher-assisted cardiopulmonary resuscitation: a systematic review and meta-analysis

BACKGROUND

The present meta-analysis of clinical and simulation trials aimed to compare video-instructed dispatcher-assisted bystander cardiopulmonary resuscitation (V-DACPR) with conventional audio-instructed dispatcher-assisted bystander cardiopulmonary resuscitation (C-DACPR).

METHODS

We searched PubMed, Embase, Web of Science, Cochrane Collaboration databases and Scopus from inception until June 10, 2021. The primary outcomes were the prehospital return of spontaneous circulation (ROSC), survival to hospital discharge, and survival to hospital discharge with a good neurological outcome for clinical trials, and chest compression quality for simulation trials. Odds ratios (ORs) and mean differences (MDs) with 95% confidence intervals (CIs) indicated the pooled effect. The analyses were performed with the RevMan 5.4 and STATA 14 software.

RESULTS

Overall, 2 clinical and 8 simulation trials were included in this meta-analysis. In clinical trials, C-DACPR and V-DACPR were characterised by, respectively, 11.8% vs. 24.3% of prehospital ROSC (OR = 0.46; 95% CI: 0.30, 0.69; I² = 66%; p < .001), 10.7% vs. 22.3% of survival to hospital discharge (OR = 0.46; 95% CI: 0.30, 0.70; I² = 69%; p < .001), and 6.3% vs. 16.0% of survival to hospital discharge with a good neurological outcome (OR = 0.39; 95% CI: 0.23, 0.67; I² = 73%; p < .001). In simulation trials, chest compression rate per minute equalled 91.3 ± 22.6 for C-DACPR and 107.8 ± 12.6 for V-DACPR (MD = -13.40; 95% CI: -21.86, -4.95; I² = 97%; p = .002). The respective values for chest compression depth were 38.7 ± 14.3 and 41.8 ± 12.5 mm (MD = -2.67; 95% CI: -8.35, 3.01; I² = 98%; p = .36).

CONCLUSIONS

As compared with C-DACPR, V-DACPR significantly increased prehospital ROSC and survival to hospital discharge. Under simulated resuscitation conditions, V-DACPR exhibited a higher rate of adequate chest compressions than C-DACPR.Key messagesBystander cardiopulmonary resuscitation parameters significantly depend on the dispatcher's support and the manner of the support provided.Video-instructed dispatcher-assisted bystander cardiopulmonary resuscitation can increase the rate of prehospital return of spontaneous circulation and survival to hospital discharge.Video-instructed dispatcher-assisted bystander cardiopulmonary resuscitation improves the quality of chest compressions compared with dispatcher-assisted resuscitation without video instruction.

Teaching cards as low-cost and brief materials for teaching basic life support to 6–10-year-old primary school children – a quasi-experimental combination design study

Aim

Teaching Basic Life Support (BLS) in schools is a key initiative to improve the survival rates after out-of-hospital cardiac arrest. Low-cost training materials can reach a wider population. Our aim was to compare the effectiveness of using teaching cards with the traditional instructor-led and combined methods on BLS skills and attitude and to evaluate the long-term effects after two months.

Methods

A quasi-experimental combination design study. Two hundred sixty-three schoolchildren aged 6 to 10 years were assigned to three groups with different methods to teach BLS: teaching card group (n = 100), traditional instructor-led teaching group (n = 91), combined teaching group (n = 72). BLS skills and attitude were measured and compared before the training (T0), after the training (T1), and two months later (T2).

Results

BLS skills improved in every group at T1 compared to T0 (p < 0.001) and remained higher at T2 than at T0 in almost all cases (p < 0.001). Skill performance was similar in most of the skills between the three groups at T1. The best skill scores acquired were calling the ambulance and the correct hand position by chest compression. Positioning the head during check the breathing was more effective in the traditional group (48.4%) and combined group (61.1%) than in the teaching card group (19.0%) (p < 0.001) at T1. However, some skills improved significantly in the teaching card group at T2: check breathing for 10 s (p = 0.016); positioning the head by check breathing (p < 0.001); and positioning the head by ventilation (p = 0.011). Attitude did not change significantly in any of the groups (p > 0.05). Furthermore, the level of attitude was inferior in the teaching card group compared with the traditional (p = 0.005), and the combined groups (p = 0.049).

Conclusion

Using low-cost materials for teaching BLS for young schoolchildren can improve their skills, however, could not improve attitudes. Teaching cards were not inferior compared to traditional and combined methods in some skills but inferior in others. Therefore, hands-on training opportunity is still important. Teaching cards are useful for long-term learning. To learn correctly the whole sequence of BLS is difficult for 6 to 10 years-old children, however, they are able to learn more BLS-related skills separately.

[The new 2021 resuscitation guidelines and the importance of lay resuscitation]

Lay resuscitation is one of the most important measures to increase the survival rate of patients after out-of-hospital cardiac arrest. While European countries, and especially Scandinavian countries, achieve lay resuscitation rates of over 80%, the rate in Germany is only around 40%. The 2021 Resuscitation Guidelines updated by the European Resuscitation Council give special weight to Systems Saving Lives and focus on resuscitation by laypersons. The Systems Saving Lives emphasize the interplay between all actors involved in the chain of survival and thereby specify the link between the emergency service and the general population.Based on the BIG FIVE survival strategies after cardiac arrest, five key strategies are outlined that can achieve the greatest improvement in survival. These are (1) increasing lay resuscitation rates through campaigns and KIDS SAVE LIVES school-based resuscitation training, (2) implementing telephone resuscitation in dispatch centers, (3) first responder systems, (4) advanced life support, and (5) specialized cardiac arrest centers.

The Effects of an Intervention Based on the Flipped Classroom on the Learning of Basic Life Support in Schoolchildren Aged 10–13 Years: A Quasi-Experimental Study

Most out-of-hospital cardiac arrests are attended first by bystanders who are usually friends and/or relatives of the victim. Therefore, the objective of this research was to analyse the impact of a training process based on the flipped classroom on basic life support skills in primary education students. The sample consisted of 308 children (148 experimental group (EG) and 160 control group (CG)) between 10 and 13 years old (M = 10.68 ± 0.64) from 2 schools in Galicia, Spain. The data reveal that the quality parameters are obtained in the number of total compressions in 2 min (CG = 213 and EG = 217; p = 0.024) and in the percentage of correct compressions (CG = 87.23% and EG = 91.6%; p = 0.013) except for the mean depth and the percentage of correct compressions, which were not reached in any case. Regarding the application of an effective discharge with the Automated external defibrillator (AED), there were no significant differences in the time used by schoolchildren between both methods (p = 0.795), but 97.5% (n = 156) of the CG and 100% (n = 148) of the EG are able to do it in just over 1 min. Based on the results obtained, we can conclude that a training program based on the flipped classroom is as effective and viable as traditional training in psychomotricity on CPR techniques and the application of an effective discharge using an AED.

Addressing the Helper's and Victim's Gender Is Crucial in Schoolchildren Resuscitation Training-A Prospective, Educative Interventional Trial

Background: A victim’s gender is a known factor that influences the willingness of adult bystanders to perform cardiopulmonary resuscitation (CPR) if an out-of-hospital cardiac arrest (OHCA) occurs. This study aims to identify whether gender characteristics of OHCA victims are also relevant to schoolchildren, who are the key target group of CPR trainings worldwide. Methods: A prospective, educative intervention study was performed in schoolchildren (5th−7th grade). Schoolchildren’s willingness to perform CPR was assessed by means of questionnaires before (t0) and after (t1) standardized CPR training. Participants were asked how determined they were to perform CPR in male and female OHCA victims on a 5-point Likert scale (not being determined to being very determined). A data analysis was performed according to the gender characteristics of schoolchildren. Results: Overall, 342 schoolchildren aged 10−15 years were included, and 166 male (MG) and 176 female (FG) schoolchildren served as a comparison group. Before (t0) and after (t1) the intervention, females showed a significantly higher general willingness to perform CPR than males (t0: 97.1% vs. 89.0%; p < 0.003 and t1: 95.7% vs. 98.9%; p = 0.038). The general willingness to perform CPR after training had a stronger increase in males (8.0% vs. 2.3%; p = 0.017). In the case that the OHCA victim was female, male schoolchildren were less willing to perform CPR than females at baseline (MG: n = 101;60.8% vs. FG: n = 147;84.5%; p < 0.001) and after training (MG: n = 97;58.4% vs. FG: n = 138;79.3%; p < 0.001). At t1, CPR willingness for female victims was improved in males (MG: n = 36;21.7% vs. FG: n = 19;10.9%; p = 0.006). Conclusions: The gender characteristics of OHCA victims, as well as schoolchildren themselves, have a relevant impact on the willingness to perform CPR. Training concepts should effectively motivate male schoolchildren to reduce preexisting inhibitions, especially towards female OHCA patients. Trial registration: This study was registered at the German Clinical Trials Register (Registration number: DRKS00017707) on 2 August 2019.

Retention of Knowledge and Skills After a Basic Life Support Course for Schoolchildren: A Prospective Study

Courses on basic life support (BLS) and automated external defibrillator (AED) in schools lead to increase in knowledge but its retention is less well explored. We aimed to explore the long-term retention of knowledge and practical skills among schoolchildren after a BLS and AED course to be able to tailor future courses accordingly. Study was conducted in 3 parts and included 823 seventh and ninth graders from different elementary schools in Maribor, Slovenia. In Study 1 (n=611) we assessed students' baseline knowledge and immediate knowledge gain after our BLS and AED course with a validated questionnaire; in Study 2 (n=116) we assessed retention of gained knowledge and skills after 5 months with a modified Cardiff test and Little Anne QCPR manikin; in Study 3 (n=96) we assessed retention of knowledge 2 years after the course. Mean differences in knowledge before and after the course in Study 1 and between studies were analyzed using paired t-tests and independent t-tests. Differences between individual question scores at different time points were compared using Mann – Whitney U test. A two-sided P<0,05 was considered significant. Practical skills retention was presented with descriptive statistics. Knowledge gain was significant immediately after the course with 83% correct answers compared to 60% at baseline. Scores dropped significantly after 5 months (73%) and after 2 years (75%), but remained significantly better than at baseline (P<0.001). Practical skills perfomance score as per Cardiff test after 5 months was 63%. Overall BLS performance score as per QCPR app was 59%, with an overall cardio score of 77% (average compression rate: 124/min and depth: 52 mm) and ventilation score of 44%. This study showed that long term retention of theoretical knowledge was satisfying whereas poor practical skills performance after 5 months calls for a more intense practical training on repeat courses.

Learning to resuscitate at school. Study in 8-12 year-old schoolchildren

OBJECTIVE

To quantitatively assess the learning capacity of school children aged between 8-12 years in basic life support (theory and practice) after a feasible school training programme.

MATERIAL AND METHODS

Quasi-experimental study with a convenience sample of 567 pupils in 3rd and 5th year of Primary Education, and first year of Compulsory Secondary Education, from 3 public schools in Galicia. They received 2h (one theoretical and another practical) of basic life support training by their Physical Education teachers, as part of the school program. The children were evaluated by a theoretical test and a practical skill test that measured the quality of chest compressions, and assessed the performance of the basic life support sequence.

RESULTS

The level of knowledge increased with respect to the baseline, and was higher in the higher grades (P < .001). The complete basic life support sequence was carried out by 16.5% of pupils in the 3rd year of Primary Education, 54.4% of pupils in the 5th year of Primary Education, and 28.5% of pupils in the 1st year of Secondary Education (P = .030). The following compression quality parameters improved significantly with age: continuity of compressions (P < .001), percentage of compressions performed at correct depth (P = .002), and median depth (P < .001), while the percentage of compressions with correct decompression decreased significantly (P < .001).

CONCLUSIONS

Although their anthropometric characteristics may not allow them to achieve the ideal quality of this manoeuvre, a 2h theoretical and practical training programme, taught by Physical Education teachers, helps to improve the ability of children younger than 13 years old to recognise the emergency, start the chain of survival, and initiate chest compressions.

KIDS SAVE LIVES: a narrative review of associated scientific production

PURPOSE OF REVIEW

In sudden out-of-hospital cardiac arrest, bystander cardiopulmonary resuscitation (CPR) is one of the most important elements of the chain of survival. Since 2015, international health societies and associations have recognized KIDS SAVE LIVES (KSL) as an essential initiative on CPR principles dissemination among schoolchildren. Children can be potential multipliers of the CPR competencies by teaching families, relatives, and friends. This review aimed to determine the main CPR issues raised in the KSL-associated publications.

RECENT FINDINGS

We found 12 Editorials, 9 Letters, 2 Special Reports, 4 Reviews, 2 Guidelines, 9 Original Articles and 17 Conference Presentations on KSL history, the schoolchildren CPR education, and KSL program implementation in several countries. In nine original studies, the main issues were instructors' and learners' CPR knowledge, skills, and retention, gender and physical aspects affecting CPR performance, types of KSL programs and new technologies to teach CPR.

SUMMARY

The KSL-associated literature is limited to support KSL benefits. However, the KSL could potentially contribute to improve out-of-hospital CPR performed by lay people at earlier age in different countries. Children are an important target group to diffuse CPR principles ('CHECK-CALL-COMPRESS'), as they are curious, motivated and enjoy teaching others.

Training frequency for educating schoolchildren in basic life support: very brief 4-month rolling-refreshers versus annual retraining-a 2-year prospective longitudinal trial

OBJECTIVE

To compare the effectiveness of 4-month rolling-refreshers and annual retraining in basic life support (BLS) on a sample of schoolchildren.

DESIGN

Prospective longitudinal trial.

SETTING AND PARTICIPANTS

Four hundred and seventy-two schoolchildren (8-12 years old).

INTERVENTIONS

Schoolchildren were instructed in BLS and then split into the following three groups: control group (CG), standard group (SG) and rolling-refresher group (RRG). Their BLS skills were assessed within 1 week (T1) and 2 years later (T2). Moreover, CG did not receive any additional training; SG received one 50 min retraining session 1 year later; RRG participated in very brief (5 min) rolling-refreshers that were carried out every 4 months.

PRIMARY AND SECONDARY OUTCOMES

Hands-on skills of BLS sequence and cardiopulmonary resuscitation.

RESULTS

BLS sequence performance was similar in all groups at T1, but SG and RRG followed the steps of the protocol in more proportion than CG at T2. When compared at T2, RRG showed higher proficiency than SG in checking safety, checking response, opening the airway and alerting emergency medical services. In addition, although the mean resuscitation quality was low in all groups, RRG participants reached a higher percentage of global quality cardiopulmonary resuscitation (CG: 16.4±24.1; SG: 25.3±28.8; RRG: 29.9%±29.4%), with a higher percentage of correct chest compressions by depth (CG: 3.9±11.8; SG: 10.8±22.7; RRG: 15.5±26.1 mm).

CONCLUSIONS

In 8-to-12-year-old schoolchildren, although annual 50 min retraining sessions help to maintain BLS performance, 4-month very brief rolling-refreshers were shown to be even more effective. Thus, we recommend implementing baseline BLS training at schools, with subsequently brief rolling-refreshers.

Cardiac Arrest Occurring in High-Rise Buildings: A Scoping Review

Out-of-hospital cardiac arrests (OHCAs) occurring in high-rise buildings are a challenge to Emergency Medical Services (EMS). Contemporary EMS guidelines lack specific recommendations for systems and practitioners regarding the approach to these patients. This scoping review aimed to map the body of literature pertaining to OHCAs in high-rise settings in order to clarify concepts and understanding and to identify knowledge gaps. Databases were searched from inception through to 6 May 2021 including OVID Medline, PubMed, Embase, CINAHL, and Scopus. Twenty-three articles were reviewed, comprising 8 manikin trials, 14 observational studies, and 1 mathematical modelling study. High-rise settings commonly have lower availability of bystanders and automatic external defibrillators (AEDs), while height constraints often lead to delays in EMS interventions and suboptimal cardiopulmonary resuscitation (CPR), scene access, and extrication. Four studies found return of spontaneous circulation (ROSC) rates to be significantly poorer, while seven studies found rates of survival-to-hospital discharge (n = 3) and neurologically favourable survival (n = 4) to be significantly lower in multistorey settings. Mechanical chest compression devices, transfer sheets, and strategic defibrillator placement were suggested as approaches to high-rise OHCA management. A shift to maximising on-scene treatment time, along with bundling novel prehospital interventions, could ameliorate some of these difficulties and improve clinical outcomes for patients.

Teaching Basic Life Support to 5- to 8-Year-Old Children: A Cluster Randomized Trial

OBJECTIVE

We aimed to compare traditional basic life support (BLS) education with specific and innovative educative didactic material that has been previously designed and validated.

METHODS

Fifteen classes of schoolchildren aged 5 to 8 years (n = 237) were randomly assigned to 4 groups in which different didactic and complementary materials were used: (1) the Rescube tool with a cuddly toy (n = 61), (2) the Endless Book tool with a cuddly toy (n = 74), (3) traditional teaching with a cuddly toy (n = 46), and (4) traditional teaching with a manikin (n = 55). The BLS sequence was assessed at baseline (T0). After that, children took part in a one-hour theory and practice session in their assigned training modality. BLS sequence was assessed again within one week (T1) and after one month (T2).

RESULTS

The 4 modalities were successful in improving children's skills when comparing T0 with both T1 and T2 (P < .05). At T2, more schoolchildren remembered the complete BLS sequence after using the Rescube (75%) compared with the number of schoolchildren who remember the complete BLS sequence after using the Endless Book (53%), a manikin (42%), or a cuddly toy (13%) (P < .05). A higher proportion of participants who used the Rescube correctly performed all the BLS steps analyzed compared with those who used only the manikin or a cuddly toy during the learning phase. The Endless Book was also more effective except for learning to check consciousness and breathing.

CONCLUSION

Better BLS learning and knowledge retention outcomes were achieved by using our specific and adapted didactic materials (Rescube and Endless Book). These new educational tools have the potential to substantially support BLS school education programs.

Aussie KIDS SAVE LIVES: A position statement from the Australian Resuscitation Council and supported by stakeholders

Every year 25 000 Australians experience a cardiac arrest in our community, but only 12% survive. The faster cardiopulmonary resuscitation and defibrillation, known as basic life support (BLS), is commenced, the greater the chance of survival. Currently, only half of the Australian adults are trained in BLS. The Australian Resuscitation Council and key stakeholder organisations believe that the best way to ensure all Australians know how to save a life is by mandating BLS education and training in our schools. This ‘Aussie KIDS SAVE LIVES’ position statement outlines our strategy to help facilitate the introduction of a programme of regular BLS training into the Australian school curriculum.

Evaluating Quality, Usability, Evidence-Based Content, and Gamification Features in Mobile Learning Apps Designed to Teach Children Basic Life Support: Systematic Search in App Stores and Content Analysis

BACKGROUND

Globally, 3.7 million people die of sudden cardiac death annually. Following the World Health Organization endorsement of the Kids Save Lives statements, initiatives to train school-age children in basic life support (BLS) have been widespread. Mobile phone apps, combined with gamification, represent an opportunity for including mobile learning (m-learning) in teaching schoolchildren BLS as an additional teaching method; however, the quality of these apps is questionable.

OBJECTIVE

This study aims to systematically evaluate the quality, usability, evidence-based content, and gamification features (GFs) of commercially available m-learning apps for teaching guideline-directed BLS knowledge and skills to school-aged children.

METHODS

We searched the Google Play Store and Apple iOS App Store using multiple terms (eg, cardiopulmonary resuscitation [CPR] or BLS). Apps meeting the inclusion criteria were evaluated by 15 emergency health care professionals using the user version of the Mobile Application Rating Scale and System Usability Scale. We modified a five-finger mnemonic for teaching schoolchildren BLS and reviewed the apps' BLS content using standardized criteria based on three CPR guidelines. GFs in the apps were evaluated using a gamification taxonomy.

RESULTS

Of the 1207 potentially relevant apps, only 6 (0.49%) met the inclusion criteria. Most apps were excluded because the content was not related to teaching schoolchildren BLS. The mean total scores for the user version of the Mobile Application Rating Scale and System Usability Scale score were 3.2/5 points (95% CI 3.0-3.4) and 47.1/100 points (95% CI 42.1-52.1), respectively. Half of the apps taught hands-only CPR, whereas the other half also included ventilation. All the apps indicated when to start chest compressions, and only 1 app taught BLS using an automated external defibrillator. Gamification was well integrated into the m-learning apps for teaching schoolchildren BLS, whereas the personal and fictional, educational, and performance gamification groups represented most GFs.

CONCLUSIONS

Improving the quality and usability of BLS content in apps and combining them with GFs can offer educators novel m-learning tools to teach schoolchildren BLS skills.

Peer Education Model for Basic Life Support Training among High School Children: A Randomized Trial

BACKGROUND AND OBJECTIVES

The aim of the study was to test the effectiveness of the peer education method on the learning and application of Basic Life Support (BLS) in high school students and to test the effectiveness of the peer education model on the BLS instructor training.

METHODS

High school grade one students were included in the study. Students were divided in two groups (Group A and Group B). Peer instructors who were trained by health professionals trained students in Group A. Peer instructors who were trained by their peers trained students in Group B. Pre- and post-training awareness and knowledge tests were applied to measure the awareness and knowledge of all students. Students' success in applying BLS steps was evaluated by a practical exam that was coordinated by physicians using a checklist.

RESULTS

Result of the pre-post training awareness questionnaire, pre-post training knowledge tests, and practical exam indicated that instructors trained by their peers were as effective as the instructors trained by medical physicians in terms of giving BLS training to high school students. In the 16-step BLS application competence evaluation, the students in Group A applied BLS with a success rate of 90.2% and in Group B with a success rate of 93.4%.

CONCLUSION

In the current study, it was shown that the peer education model is effective in BLS training and BLS instructor training in high school students. This novel method of peer education gives an opportunity to overcome the stated shortage in the budget and in trained instructors.

KIDS SAVE LIVES in schools: cross-sectional survey of schoolteachers

Training schoolchildren in basic life support (BLS) is strongly recommended to effectively increase bystander cardiopulmonary resuscitation (CPR) rates. Paediatricians and other health staff members used to be involved in BLS training, but the wide dissemination of BLS skills would need additional support; as a solution, schoolteachers might have enough knowledge necessary to help to achieve this goal. The aim of this cross-sectional survey study, which involved 3423 schoolteachers, was to evaluate the knowledge related to first aid (FA) and BLS of schoolteachers in Spain. In addition, the study aimed to evaluate the content taught to the schoolchildren regarding FA and teachers' attitudes towards teaching FA. Three-quarters of the surveyed schoolteachers reported knowing FA, and 17% reported teaching it. The emergency medical telephone number and CPR were the subjects taught most often by schoolteachers. However, the schoolteachers demonstrated a lack of knowledge in the identification of cardiac arrest and in CPR. Ninety-eight percent of the respondents agreed with including FA training in schools and as part of university degree programmes and supported the KIDS SAVE LIVES statement. Teaching FA was a positive predictor to be willing to perform CPR (OR: 1.7; 95% CI 1.32-2.31) and to use a defibrillator (OR: 1.4; 95% CI 1.10-1.67).Conclusions: Schoolteachers are willing to teach FA in schools. However, more training and specific curricula are needed to increase the quality of schoolchildren's CPR training. The training of schoolteachers in CPR might be the foundation for the sustainable transfer of CPR-related knowledge to schoolchildren. Therefore, the inclusion of FA and BLS in university degree programmes seems to be essential. What is Known: • Bystander cardiopulmonary resuscitation rates are associated with improved survival rates. • Resuscitation training in schools increases the bystander cardiopulmonary resuscitation rate. What is New: • Schoolteachers are willing to teach basic life support, but they need more and better training. • Schoolteachers agreed with the inclusion of first aid training in schools and university degree programmes aimed at training teachers/undergraduate teaching degrees.

[Education for resuscitation]

Diese Leitlinien des European Resuscitation Council basieren auf dem internationalen wissenschaftlichen Konsens 2020 zur kardiopulmonalen Reanimation mit Behandlungsempfehlungen (International Liaison Committee on Resuscitation 2020 International Consensus on Cardiopulmonary Resuscitation Science with Treatment Recommendations [ILCOR] 2020 CoSTR). Dieser Abschnitt bietet Bürgern und Angehörigen der Gesundheitsberufe Anleitungen zum Lehren und Lernen der Kenntnisse, der Fertigkeiten und der Einstellungen zur Reanimation mit dem Ziel, das Überleben von Patienten nach Kreislaufstillstand zu verbessern.

Die Ausbildung von Lehrerinnen und Lehrern als Multiplikatoren für den Wiederbelebungsunterricht an Schulen

Zielsetzung

Die Einführung des Wiederbelebungsunterrichts an Schulen soll die Reanimationsbereitschaft in der Gesellschaft und das Überleben von Menschen mit einem außerklinischen Herz-Kreislauf-Stillstand nachhaltig verbessern. Ziel der vorliegenden Untersuchung war es zu prüfen, wie Lehrkräfte als qualifizierte Multiplikatoren den Wiederbelebungsunterricht in ihren Schulen eigenständig durchführen.

Methodik

Die Uniklinik Köln qualifizierte in Kooperation mit dem Deutschen Rat für Wiederbelebung e. V. in einem speziell entwickelten Kurs Lehrkräfte von weiterführenden Schulen. Von Juli bis November 2019 erfolgte die Evaluation dieses Lehrermultiplikationskonzepts mittels einer webbasierten Umfrage.

Ergebnisse

An der Befragung nahmen 23 von 26 Schulen teil (88 %). Insgesamt haben 96 % (n = 22) der an der Befragung teilnehmenden Schulen den Wiederbelebungsunterricht eingeführt. Es wurden 229 Lehrkräfte ausgebildet, die in dem 2‑jährigen Beobachtungszeitraum 8612 Schüler trainierten. Im Mittel trainierte eine qualifizierte Lehrkraft in ihrer Schule 38 Schüler in Wiederbelebung. Die Multiplikationsfaktoren (Anzahl der trainierten Schülerinnen und Schüler pro Lehrkraft) waren schulindividuell unterschiedlich (Minimum/Maximum: 10/1747). Die schulintern projektverantwortlichen Lehrkräfte gaben an, sich sehr sicher in der eigenständigen Durchführung des Wiederbelebungsunterrichts zu fühlen.

Zusammenfassung

Speziell qualifizierte Lehrkräfte führen den Wiederbelebungsunterricht an ihren Schulen zuverlässig ein. Um noch mehr Schüler mit dem Wiederbelebungstraining zu erreichen, müssen die Multiplikationsfaktoren durch gezielte Unterstützungsangebote weiter erhöht werden.

Mandating Training Is Not Enough: The State of Cardiopulmonary Resuscitation and Automated External Defibrillator Training in Ontario Schools

Cardiopulmonary resuscitation (CPR) and automated external defibrillator (AED) training in schools are mandated in the Ontario high school curriculum. We surveyed schools to understand the scope of this training, including its barriers and facilitators. We recruited 120 (58.5%) elementary, 25 (12.2%) middle, and 60 (29.3%) high schools. Almost 60% (120 of 200) provided staff with CPR training, but only 56% (27 of 48) of high schools trained students. Major barriers included lack of funding, time, and trainers. Despite government-mandated curriculum, only 56% of high schools offer CPR and AED training. More research is needed to understand the barriers to implementing this lifesaving training.

European Resuscitation Council Guidelines 2021: Systems saving lives

The European Resuscitation Council (ERC) has produced these Systems Saving Lives guidelines, which are based on the 2020 International Consensus on Cardiopulmonary Resuscitation Science with Treatment Recommendations. The topics covered include chain of survival, measuring performance of resuscitation, social media and smartphones apps for engaging community, European Restart a Heart Day, World Restart a Heart, KIDS SAVE LIVES campaign, lower-resource setting, European Resuscitation Academy and Global Resuscitation Alliance, early warning scores, rapid response systems, and medical emergency team, cardiac arrest centres and role of dispatcher.

European Resuscitation Council Guidelines 2021: Education for resuscitation

These European Resuscitation Council education guidelines, are based on the 2020 International Consensus on Cardiopulmonary Resuscitation Science with Treatment Recommendations. This section provides guidance to citizens and healthcare professionals with regard to teaching and learning the knowledge, skills and attitudes of resuscitation with the ultimate aim of improving patient survival after cardiac arrest.

Comparison of Out-of-Hospital Cardiac Arrests Occurring in Schools and Other Public Locations: A 12-Year Retrospective Study

Objective: Out-of-hospital cardiac arrests (OHCA) in schools and universities are uncommon. However, these institutions must plan and prepare for such events to ensure the best outcomes. To evaluate their preparedness we assessed baseline characteristics, survival outcomes and 12-year trends for OHCA in schools/universities compared to other public locations.Methods: We conducted a retrospective analysis of OHCA in schools/universities and public locations between 2008 and 2019 using Victorian Ambulance Cardiac Arrest Registry data.Results: We included 9,037 EMS attended cases, 131 occurred in schools/universities and 8,906 in public locations. Compared to public locations, a significantly higher proportion of EMS treated cases in schools/universities received bystander cardiopulmonary resuscitation (CPR) (95.5% vs. 78.5%, p < 0.001), public access defibrillation (PAD) (26.1% vs. 9.9%, p < 0.001) and presented in shockable rhythms (69.4% vs. 50.9%, p < 0.001). Unadjusted survival to hospital discharge rates were also significantly higher in schools/universities (39.6% vs. 24.2%, p < 0.001). The long-term unadjusted trends for bystander CPR in schools/universities increased from 91.7% (2008-10) to 100% (2017-19) (p-trend = 0.025), for PAD from 4.2% (2008-10) to 47.5% (2017-19) (p-trend < 0.001) and for survival to hospital discharge from 16.7% (2008-10) to 57.5% (2017-19) (p-trend = 0.004). However, after adjustment for favorable cardiac arrest factors, such as younger age, bystander CPR and PAD, survival was similar between schools/universities and public locations.Conclusion: The majority of OHCA in schools and universities were witnessed and received bystander CPR, however less than half received PAD. Developing site-specific cardiac emergency response plans and providing age appropriate CPR training to primary, secondary and university students would help improve PAD rates.

Effects of a Clinical Simulation Course about Basic Life Support on Undergraduate Nursing Students' Learning

Training in basic life support (BLS) using clinical simulation improves compression rates and the development of cardiopulmonary resuscitation (CPR) skills. This study analyzed the learning outcomes of undergraduate nursing students taking a BLS clinical simulation course. A total of 479 nursing students participated. A pre-test and post-test were carried out to evaluate theoretical knowledge of BLS through questions about anatomical physiology, cardiac arrest, the chain of survival, and CPR. A checklist was used in the simulation to evaluate practical skills of basic CPR. The learning outcomes showed statistically significant differences in the total score of the pre-test and after completing the BLS clinical simulation course (pre-test: 12.61 (2.30), post-test: 15.60 (2.06), p < 0.001). A significant increase in the mean scores was observed after completing the course in each of the four parts of the assessment protocol (p < 0.001). The increase in scores in the cardiac arrest and CPR sections were relevant (Rosenthal’s r: −0.72). The students who had prior knowledge of BLS scored higher on both the pre-test and the post-test. The BLS simulation course was an effective method of teaching and learning BLS skills.

Validated Assessment of Schoolchildren’s Attitude Towards Basic Life Support and Automated External Defibrillator Use

As knowledge and attitude towards performing basic life support and using an automated external defibrillator (BLS and AED) contribute equally to improving survival after out-of-hospital cardiac arrest, we aimed to develop a measuring instrument for a validated assessment of schoolchildrens' attitude towards BLS and AED. The objective was to identify, measure, and address pertinent attitude dimensions that influence the intention to actually perform BLS and AED. We conducted a BLS and AED course for seventh and ninth grade students. Students fulfilled pre- and post-course questionnaires on attitude and intention to perform BLS and AED. The measuring instrument was developed with the use of exploratory factor analysis with application of principal component analysis and confirmatory factor analysis with application of structural equation modeling. Measurement invariance across different groups (gender, grades, previous courses) was tested with Wilcoxon signed ranks test and Mann–Whitney U test. Differences in attitude pre- and post-course were evaluated by application of Mann–Whitney U test. The final attitude model consisted of 3 behavioral constructs (self-confidence, positive motivation, and amotivation). Self-confidence was the major construct directly affecting the intention to act. Positive motivation had a negligible direct effect on intention but correlated strongly with self-confidence. The effect of attitude on the intention to help is therefore less complicated than was expected, which relieves the non-professional educators of having to know the specifics of the different behavioral constructs.

[Learning to resuscitate at school. Study in 8-12 year-old schoolchildren]

OBJECTIVE

To quantitatively assess the learning capacity of school children aged between 8-12 years in basic life support (theory and practice) after a feasible school training programme.

MATERIAL AND METHODS

Quasi-experimental study with a convenience sample of 567 pupils in 3rd, 5th and 1st year of Primary Education, and Compulsory Secondary Education, respectively, from 3 public schools in Galicia. They received 2h (one theoretical and another practical) of basic life support training by their Physical Education teachers, as part of the school program. The children were evaluated by a theoretical test and a practical skill test that measured the quality of chest compressions, and assessed the performance of the basic life support sequence.

RESULTS

The level of knowledge increased with respect to the baseline, and was higher in the higher grades (P<.001). The complete basic life support sequence was carried out by 16.5% of pupils in the 3rd year of Primary Education, 54.4% of pupils in the 5th year of Primary Education, and 28.5% of pupils in the 1st year of Secondary Education (P=.030). The following compression quality parameters improved significantly with age: continuity of compressions (P<.001), percentage of compressions performed at correct depth (P=.002), and median depth (P<.001), while the percentage of compressions with correct decompression decreased significantly (P<.001).

CONCLUSIONS

Although their anthropometric characteristics may not allow them to achieve the ideal quality of this manoeuvre, a 2-h theoretical and practical training programme, taught by Physical Education teachers, helps to improve the ability of children younger than 13 years-old to recognise the emergency, start the chain of survival, and initiate chest compressions.

Shock to the Heart: Psychosocial Implications and Applications of Sudden Cardiac Death in the Young

PURPOSE OF REVIEW

Although rare, sudden cardiac death (SCD) in the young is a tragic event, having a dramatic impact upon all involved. The psychosocial burden associated with SCD can leave friends, families, and entire communities bereft. With only limited evidence to describe the volatile emotional reactions associated with a young SCD, there is an urgent need for care providers to better understand the psychological complexities and impacts faced by both at-risk individuals and those directly affected by these tragic events.

RECENT FINDINGS

Current knowledge of the psychosocial implications associated with SCD in the young has recently generated interest in the cardiovascular community, with the goal of addressing prevention strategies (screening), family bereavement, and the psychological impact of at-risk or surviving individuals. With the emergence of novel strategies aimed at reducing the public health impact of SCD in the young, further discussion regarding the psychosocial impact of SCD, encompassing prevention, survivorship, and the downstream communal effects of a young death is required. Support systems and intervention could assist in the management of the associated psychosocial burden, yet there is a lack of clinical guidelines to direct this form of care. There is an important need for multidisciplinary collaboration across subspecialties to provide support to grieving individuals and manage patient well-being throughout the screening process for SCD. This collaborative approach requires the integration of cardiovascular and psychological expertise where relevant.

ASSESSMENT OF KNOWLEDGE AND SELF EFFICACY BEFORE AND AFTER TEACHING BASIC LIFE SUPPORT TO SCHOOLCHILDREN

OBJECTIVE

Teaching basic life support to schoolchildren is well established as one of the most effective strategies in increasing bystander CPR rates. However, there is a lack of scientific evidence concerning the Portuguese pediatric population. The present study aims to evaluate the outcome of a basic life support training session on theoretical knowledge and self-efficacy, immediately after the training and 6 months later, in a pediatric population.

METHODS

A total of 392 schoolchildren, aged seven to 12 years old, participated in this prospective longitudinal study, answering a questionnaire before, immediately after, and six months after receiving 120 minutes of resuscitation training from medical students.

RESULTS

There was a significant increase in the knowledge and self-efficacy after one single training session. Both decreased over a period of six months but remained significantly higher than the baseline. These results were homogeneous across classes.

CONCLUSIONS

Medical students provided adequate basic life support training to a group of Portuguese schoolchildren, with effects in the knowledge and self-efficacy lasting for at least six months.

Implementation of basic life support training for school children: Online education for potential instructors? Results of a cluster randomised, controlled, non-inferiority trial

AIM OF THE STUDY

Comprehensive training of the population in basic life support (BLS) increases the chance of survival in cardiac arrest. To implement BLS trainings at schools a high number of instructors will be needed. This non-inferiority study investigated, if online education is effective to prepare instructors to teach BLS compared to face-to-face education.

METHODS

A cluster randomised, controlled, single blinded study was performed in 2018 in Hamburg, Germany. A mixed group of potential instructors were allocated alternately to either the intervention or control group and participated in a four-hour instructor training. The instructor training of the control group was realised by trained educators. The intervention group participated in a self-regulated online training with hands-on training supported by peers. Instructors provided BLS training for high school students. The primary endpoint was a mean score in the BLS skills assessment of the students. The secondary endpoint was teaching effectiveness of the instructors.

RESULTS

BLS assessments of 808 students of 46 classes, who were taught by 74 instructors could be analysed. The students trained by interventional instructors achieved 0.14 points less (95% CI: -0.27 to 0.56) compared to students trained by control instructors (9.34 vs. 9.48). The non-inferiority could not be confirmed. The teaching performance in the intervention group was better in some aspects compared to the control group.

CONCLUSION

Integrating all results of this study, online education may be an effective alternative to prepare potential BLS instructors. Using free online courses, motivated persons can independently acquire necessary skills to become instructors and autonomously realise low cost BLS trainings at schools.

A pilot study of Practice While Watch based 50 min school quality cardiopulmonary resuscitation classroom training: a cluster randomized control trial

Aim

Cardiopulmonary resuscitation (CPR) training in schools can increase the rate of bystander CPR. We assessed whether a "Quality CPR (QCPR) Classroom" can support CPR performance by students trained by a teacher who is not a CPR instructor.

Methods

A cluster randomized trial was undertaken to assess the effectiveness of a 50-min Practice While Watch CPR training program enhanced by QCPR Classroom, which used 42 manikins connected by Bluetooth to real-time feedback monitoring. Fifty-seven students were divided into Group 1, taught by a non-CPR-instructor, and Group 2, taught by a CPR instructor. Psychomotor and cognitive tests were administered before and after training. Primary outcomes were post-training compression depth and rate and percent of improvement in adequate depth, recoil, and overall score. The secondary outcome was risk improvement.

Results

Post-training, Group 1 achieved 62.1 ± 7.7 mm and 118.0 ± 3.6 compressions/min whereas Group 2 achieved 57.4 ± 9.8 mm and 119.8 ± 5.4 compressions/min. The overall score improvement in percentage points was 36.4 ± 25.9% and 27.0 ± 27.7%, respectively (P ≤ 0.001 for both). The adequate depth improvement in percentage points was 22.4 ± 35.4% and 32.5 ± 40.0%, respectively (P = 0.33). Teaching by a non-CPR instructor improved student cognitive knowledge.

Conclusions

Using a QCPR Classroom to enhance CPR teaching by a non-CPR-instructor results in similar or better outcomes compared to using a CPR instructor. Use of a Practice While Watch QCPR Classroom will provide adequate quality in preparing students for CPR.