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