10
Schoolchildren as lifesavers in Europe – Training in cardiopulmonary resuscitation for children

https://doi.org/10.1016/j.bpa.2013.07.002Get rights and content

Sudden cardiac arrest is a major contributor to avoidable deaths in Europe. Immediate initiation of basic life support (BLS) by lay bystanders is among the most successful strategies in its treatment. Despite the fact that more than half of all cardiac arrests are witnessed in a number of European countries, layperson resuscitation is initiated in only one-fifth of all cases. One strategy to promote bystander BLS is to establish cardiac resuscitation training in schools. BLS instructions for schoolchildren – including the use of automatic external defibrillators (AEDs) – have been shown to be feasible independently of the children's age or physical ability. Nonetheless, it appears reasonable to implement age-adjusted curricula. The earlier in the course of life-long learning BLS instruction begins, the more sustainable training may be.

Section snippets

Background

In Europe, a sudden cardiac death is the most frequent preventable cause of death outside hospitals. There is sound scientific evidence that the performance of bystander cardiopulmonary resuscitation (CPR) improves the outcome after prehospital cardiac arrest by a factor of 2–4 ∗[1], [2]. The European Resuscitation Council (ERC) estimates that up to 100,000 additional lives could be saved each year in Europe if the incidence and quality of bystander resuscitation were raised substantially [3].

Lay resuscitation

Despite the importance of lay resuscitation for survival, the rate achieved has been stagnating at a low level in several European countries for years. The lay resuscitation rate in Germany, for example, is 15–30% [4] and is thus low. In a registry study in Germany, a bystander resuscitation was only carried out in 20% of cases, although witnesses were present in half of all cases of cardiac arrest [5], [6]. A similar picture is seen in most countries [7], [8]. There is a broad scientific

Reasons for CPR training at school

Training a large cohort of schoolchildren over a period of years or decades offers many advantages. In the short term, attentiveness in recognising a state of cardiac arrest and awareness of the basic measures involved in resuscitation are increased. Schoolchildren and teachers are important ‘multipliers’ in both private and public settings. In the longer term, the proportion of trained individuals in society will increase, leading to an increase in the rate of lay resuscitation [14].

In

Example projects on resuscitation as a school subject

In the region of Stavanger in Norway, the lay resuscitation rate was raised from 60% to 73%. Survival (the hospital discharge rate) also increased significantly from 18% to 25%. The authors attributed this among other things to an extensive resuscitation training of >54,000 schoolchildren using a self-instruction kit and a 30-min training video [20], [21].

A similar approach in Copenhagen [22] was also successful. After 35,000 schoolchildren had received training in resuscitation using a

Prerequisites for schoolchildren

Age: Independently of the children's age (4–20 years), all the studies conducted to date have shown a positive learning effect. In most of the studies, it has been adolescent pupils who have received a resuscitation training ∗[24], [25], [26], [27], [28]. However, children aged 4–5 years who have received resuscitation training are also able to recognise cardiac arrest, call the emergency number and open the airways [29]. There is a trend showing that older pupils are able to carry out chest

Content of training events

The content of resuscitation training classes in school should follow evidence-based criteria and should not necessarily be based on the content of complete first-aid courses, which are often no longer up to date [4].

Evidence-based minimum requirements for the content of the lessons are as follows:

  • recognising cardiac arrest

    • particularly, training in recognising ‘agonal breathing’

  • activating assistance

    • knowing the emergency number

  • interacting with the emergency dispatch centre

    • following instructions

Type of training

Although theoretical training alone is easier to carry out there is poorer theoretical knowledge than with a combination of theory and practice [43], [44]. As expected, a combination of theory and practice is necessary.

Self-instruction: One way of offering resuscitation training to schoolchildren is to distribute self-instruction kits made by commercial manufacturers. These include a simple practice manikin and an introduction in the book form or as a film material. Studies in Norway [20], [45]

Training frequency

A single resuscitation training event leads to an improvement in the short term, but several studies have shown a significant decline in the results if the training is not repeated or if only a video training is carried out ∗[14], [29], [52]. A research on long-term memory for the skills that have been learned is therefore decisive for the actual victims of cardiac arrest. It has been shown that the skills are maintained at least for a few months, but that after 2 years at the latest there is a

Implementation strategies

Curriculum: The United States Department of Health and Human Services already developed a model framework for resuscitation teaching in schools in 1999, and in 2011 the American Heart Association (AHA) published an ‘Advisory Statement’ on the compulsory introduction of basic resuscitation skills in schools [12], ∗[53].

Although there have been occasional – but very successful – projects in Europe, there is currently a lack of consistent implementation. There is a very wide range of approaches in

Conclusions

Sudden cardiac death is one of the most frequent preventable causes of death in Europe. Although bystanders are present in more than half of the cases of cardiac arrest, lay resuscitation by lay bystanders only takes place in approximately 20%. One important way of increasing the rate of lay resuscitation is to offer resuscitation already as a subject in schools. It may be implemented as a school subject independently of children's age and physical abilities. Resuscitation training appropriate

Conflict of interest

None. All of the authors hereby declare that they have no competing interests concerning any issues connected with this article. There was no external funding.

References (53)

  • T. Lorem et al.

    Impact of a self-instruction CPR kit on 7th graders' and adults' skills and CPR performance

    Resuscitation

    (2008)
  • T.W. Lindner et al.

    Good outcome in every fourth resuscitation attempt is achievable—an Utstein template report from the Stavanger region

    Resuscitation

    (2011)
  • D.L. Isbye et al.

    Skill retention in adults and in children 3 months after basic life support training using a simple personal resuscitation manikin

    Resuscitation

    (2007)
  • A. Bohn et al.

    Teaching resuscitation in schools: annual tuition by trained teachers is effective starting at age 10. A four-year prospective cohort study

    Resuscitation

    (2012)
  • B.K. Kanstad et al.

    CPR knowledge and attitude to performing bystander CPR among secondary school students in Norway

    Resuscitation

    (2011)
  • S. Reder et al.

    Cardiopulmonary resuscitation training in Washington state public high schools

    Resuscitation

    (2003)
  • G. Bollig et al.

    Primary school children are able to perform basic life-saving first aid measures

    Resuscitation

    (2009)
  • T. Uray et al.

    Feasibility of life-supporting first-aid (LSFA) training as a mandatory subject in primary schools

    Resuscitation

    (2003)
  • G.D. Perkins et al.

    Birmingham assessment of breathing study (BABS)

    Resuscitation

    (2005)
  • L. Wik et al.

    Quality of bystander cardiopulmonary resuscitation influences outcome after prehospital cardiac arrest

    Resuscitation

    (1994)
  • B. Kleikamp et al.

    Resuscitation training in schools: the dilemma of the recovery position

    Resuscitation

    (2010)
  • L. Lawson et al.

    Automated external defibrillation by very young, untrained children

    Prehosp Emerg Care

    (2002)
  • J. Kelley et al.

    Eighth grade students become proficient at CPR and use of an AED following a condensed training programme

    Resuscitation

    (2006)
  • G. Teague et al.

    Online resuscitation training. Does it improve high school students' ability to perform cardiopulmonary resuscitation in a simulated environment?

    Resuscitation

    (2006)
  • R. Lubrano et al.

    How to become an under 11 rescuer: a practical method to teach first aid to primary schoolchildren

    Resuscitation

    (2005)
  • T. Lorem et al.

    High school students as ambassadors of CPR—a model for reaching the most appropriate target population?

    Resuscitation

    (2010)
  • Cited by (31)

    • Kids (learn how to) save lives in the school with the serious game Relive

      2017, Resuscitation
      Citation Excerpt :

      Unfortunately, bystander CPR is delivered in less than 20% of instances, often due to fear or lack of knowledge and bystander intervention is variable around the world [5,6]. Training schoolchildren to perform CPR is a long-term strategy for the community to increase bystander CPR rate and survival, spreading CPR knowledge among kids and prompting them to act as ‘multipliers’ in both private and public settings [7,8]. The “next generation” of schoolchildren will access innovative means to learn CPR such as internet, social networks, smartphones and tablets, and videogames [9].

    • Out-of-hospital cardiac arrest in schools: A systematic review

      2015, Resuscitation
      Citation Excerpt :

      Bystander CPR is more likely to be given by those who have had some training,44 and schools provide access to a large captive audience in a structured learning environment. Older students can learn and practise resuscitation skills effectively,45,46 and the benefits of training large numbers of students to perform CPR and use an AED would extend beyond the school, creating a generation of trained bystanders who can disseminate their knowledge further. 17 states in the US mandate CPR training for students44 but efforts to introduce this in the UK have been unsuccessful.

    • Schoolchildren as BLS instructors for relatives and friends: Impact on attitude towards bystander CPR

      2014, Resuscitation
      Citation Excerpt :

      The mass distribution of resuscitation manikins at school to promote BCPR has been studied in general,25,26 but without specifically investigating the impact on the instructed relatives and friends of the schoolchildren towards BCPR and quality indicators of the BLS instructions by the children. Children are physically and emotionally able to perform BLS,27–29 and their access to relatives and friends with skills they learned at school is considerable, as shown in our study. This could be of great importance also to access the older population which is believed to be most likely to witness cardiac arrest.30

    • Calls to the SAMU from schools of a deprived district

      2019, Journal Europeen des Urgences et de Reanimation
    View all citing articles on Scopus
    View full text