| Abstract |
Out-of-hospital cardiac arrest remains one of the leading causes of death, with a survival rate
of less than 5% reported in Greece1. When an event of out-of-hospital cardiac arrest occurs,
prompt initiation of Cardiopulmonary Resuscitation (CPR) and use of an Automatic External
Defibrillator (AED) from bystanders during the first 3-5 minutes after the event, will substantially
increase victim’s chances of survival2,3. To achieve a meaningful increase in the number of cases
where bystanders perform CPR, more than 25% of a country’s population should be trained in
CPR5. The most effective method to accomplish this aim is the integration of CPR training
programs into school curriculum, specifically, initiation of CPR 2-hours annual training for all
schoolchildren from the age of 12 years.
The limited availability of instructor is the main obstacle to the dissemination and
preservation over time of CPR training programs for schoolchildren.
In the present study, we designed a CPR training program where secondary school students
will act as peer-instructors for their classmates. The structure of this program is based on the
basic educational principles that are described in the medical literature and have been adopted
by the official courses organized by the European Resuscitation Council. The aim of this study
was to evaluate the effectiveness of three different types of potential instructors (healthcare
professionals, schoolteacher, or peer-students) on CPR training of secondary school students and
on students’ self-efficacy levels.
We recruited students from 3 different secondary schools, 2 urban area schools and one
rural area school in the Heraklion Region. The study took place over 3 school years (2017-2018,
2018-2019 and 2019-2020). The first phase of the study included CPR training of all 1st grade
secondary school students and their teachers by a group of healthcare professionals. All students
and teachers who expressed their interest in becoming instructors attended an instructor’s
course, based on the principles of CPR training.
During the next phase of this study, the rest of the students were randomized to receive CPR
training by either a healthcare professional, a schoolteacher, or a peer – student instructor. A
total of 408 students (199 girls) were trained. One hundred and sixty-four were trained by
healthcare professionals, 62 by schoolteachers and 182 by peer – instructors. All the students that participated in the second phase of the study were asked to fill in a selfefficacy
questionnaire before and immediately after the training. Furthermore, after the training,
they were asked to answer a multiple-choice questionnaire (MCQ). Finally, all students
underwent formal assessment by an experienced healthcare professional. Chest compressions’
quality was evaluated further using the QCPR (Laerdal®) application incorporated into the Little
Annie (Laerdal®) mannequins.
Six months after the training, all students were re-evaluated using the same methods. A
total of 225 students (125 girls), 62,5 % of the students who were initially trained were available
for reassessment.
There were no statistically significant differences between the 3 groups regarding factual
knowledge immediately after training (p=.226) and at 6 months (p=.867). Immediately after
training, more students trained by healthcare professionals or teachers performed safe
defibrillation (p=.000), however this finding was dissipated at 6 months re-assessment (p=.202).
Compliance with the CPR algorithm and quality of hands-only CPR was not different (p>.05)
amongst the groups. Finally, there were no statistically significant differences among the 3 groups
regarding the self-efficacy levels reported by students.
The main finding of our study was that CPR training of schoolchildren by appropriately
trained peers provided similar skill and knowledge retention compared to training by healthcare
professionals or teachers. This provides another pool of potential instructors except the known
gold-standard, which is the experienced healthcare professional, and increases the possibility of
efficient and consistent training projects that can engage a large proportion of the schoolchildren
population.
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