Elsevier

Resuscitation

Volume 83, Issue 5, May 2012, Pages 619-625
Resuscitation

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

https://doi.org/10.1016/j.resuscitation.2012.01.020Get rights and content

Abstract

Aims

Evaluation of school pupils’ resuscitation performance after different types of training relative to the effects of training frequency (annually vs. biannually), starting age (10 vs. 13 years) and facilitator (emergency physician vs. teacher).

Methods

Prospective longitudinal study investigating 433 pupils in training and control groups. Outcome criteria were chest compression depth, compression frequency, ventilation volume, ventilation frequency, self-image and theoretical knowledge. In the training groups, 251 pupils received training annually or biannually either from emergency physicians or CPR-trained teachers. The control group without any training consisted of 182 pupils.

Results

Improvements in training vs. control groups were observed in chest compression depth (38 vs. 24 mm), compression frequency (74 vs. 42 min−1), ventilation volume (734 ml vs. 21 ml) and ventilation frequency (9/min vs. 0/min). Numbers of correct answers in a written test improved by 20%, vs. 5% in the control group. Pupils starting at age 10 showed practical skills equivalent to those starting at age 13. Theoretical knowledge was better in older pupils. Self-confidence grew in the training groups. Neither more frequent training nor training by emergency physicians led to better performance among the pupils.

Conclusions

Pupils starting at age 10 are able to learn cardiopulmonary resuscitation with one annual training course only. After a 60-min CPR-training update, teachers are able to provide courses successfully. Early training reduces anxieties about making mistakes and markedly increases participants’ willingness to help. Courses almost doubled the confidence of pupils that what they had learned would enable them to save lives.

Introduction

It is becoming increasingly clear that shortening the treatment-free interval following cardiac arrest is extremely important. When bystander CPR is carried out the survival rate doubles or triples.1, 2

The current lay resuscitation rate is less than 30%,3 with variations between countries and regions. The major reasons for low bystander CPR rates are: missed recognition of a cardiac arrest, lack of knowledge about first aid,4 fear of infection,5 and fear of doing something wrong.6 In addition to the problem of “agonal breathing” as a major reason for laypersons not starting CPR,4, 7 there may be an aversion to mouth-to-mouth ventilation, as even resuscitation trainers are willing to carry out mouth-to-mouth ventilation in only 10% of patients.4, 8, 9

Approaches in which CPR training is offered as early as school age are not new.10, 11 However, published research on the topic has been limited to study periods of only a few weeks or months,10, 11 limiting the validity of the investigations. Studies conducted over several years involve a high level of logistic effort and are therefore rare. The present study addresses this challenge. The influence of training frequency, starting age and type of facilitator were explored over 4 years. It was hypothesized that annual CPR training in schools starting at age 10 and provided by trained teachers leads to results comparable with biannual training starting at age 13 with training provided by emergency physicians. It was also expected that annual resuscitation courses would reduce participants’ anxiety about providing CPR. The results were compared with those obtained in a control group over a 2-year period.

Section snippets

Methods

After approval and patronage from the Ministry of Schools and Education and the chamber of the medical association had been received, individual consent to participate was obtained.

Is the resuscitation course effective?

The consistently better results in the TG in comparison with the CG for all performance parameters (Table 2) are attributable to the resuscitation course. This is further supported by the effect sizes observed in the interaction effects (Table 3).

After 2 years, participants in the TG were able to answer more questions correctly (Table 2). No significant differences in the evaluations of the different training groups were observed. The initially better results in theory observed in the CG were

Discussion

The major result of this study is that resuscitation courses for schoolchildren starting at the age of 10 are useful, as the children are capable of carrying out vigorous chest compression on a manikin. They also have the theoretical knowledge required, even after a single training course.

Surprisingly, pupils in both groups did well in the theoretical test. This might be due to the fact that the level of the questions was not high enough. Some questions were too easy to answer, others dealt

Conclusions

Annual resuscitation training provided by trained teachers are effective and adequate in children aged 10 years. More frequent courses and the use of emergency physicians did not provide any advantages in relation to either theoretical or practical skills. Although improvements were achieved, the CPR training provided was unable to ensure that guideline targets in terms of compression depth and rate were met. Whilst pupils in the CG were unable to ventilate the manikin, the ventilation volume

Limitations

This study included three schools in two cities. The extent to which motivation, social structure, and the local teaching staff influenced the results remains unclear. The starting age of 10 years was selected on the basis of the educational system in Germany, where secondary school starts at that age. It can be expected that even younger children may be capable of contributing to survival after cardiac arrest if trained.

As a result of the study design, a total of 153 of the 433 participants

Ethical approval

This study (reference: 621-6.08.03 no. 40386) was conducted with the approval and patronage of the Ministry of Schools and Education of the state of North Rhine-Westphalia (Ministerium für Schule und Weiterbildung des Landes Nordrhein-Westfalen) and the chamber of the medical association of Westphalia.

Funding

The study was supported by Dräger Ltd., Lübeck, Germany; the Else Kröner-Fresenius Foundation, Bad Homburg, Germany; and by Grünenthal Ltd., Aachen, Germany.

Conflicts of interest

None declared.

Acknowledgements

This study would not have been possible without the support of the Gymnasium Paulinum in Münster and the Bischhöfliches Pius-Gymnasium in Aachen. The authors would like to thank all of the pupils and teachers at the participating schools, and in particular the headmasters, Dr. Gerd Grave and Dr. Josef Els, for their contribution.

The authors are grateful in particular to Monika Rammert and Christine Witteler (of the departments of educational psychology and sports science at the University of

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A Spanish translated version of the abstract of this article appears as Appendix in the final online version at doi:10.1016/j.resuscitation.2012.01.020.

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