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Table 3 Summarized findings of included CPR training methodology research articles

From: Cardiopulmonary resuscitation (CPR) training strategies in the times of COVID-19: a systematic literature review comparing different training methodologies

Year and Country Intervention Tested Study Design Sample Size Target Group Prior Training Outcome Measures Key Findings
Standard versus Non-standard Face to Face CPR Training
 Singapore
2018 [19]
Simplified vs. standard CPR Randomized Controlled Trial 85 Layperson No CPR quality Simplified CPR group followed algorithm better (p < 0.01), had higher number and proportion of adequate compressions (p < 0.01), and had shorter hands-off time (p < 0.001).
 Germany
2015 [20]
Peer-instructor vs. professional instructor Randomized Controlled Trial 1087 School Children No CPR performance Similar CPR performance between groups (40.3% vs. 41.0%).
 Belgium
2016 [21]
Peer-based (jigsaw model) vs. expert instructor Randomized Controlled Trial 137 School Children No CPR performance All groups met European Resuscitation Council 2010 guideline.
Chest compression depth different between ventilation vs. compression group (p < 0.01).
 Austria
2013 [22]
Flowchart supported training Randomized Controlled Trial 83 Layperson No CPR performance and quality Flowchart group showed shorter hands-off time (147 s vs. 169 s, p = 0.024) and more confidence (7 vs. 5, p = 0.0009) but had longer time to chest compression (60s vs. 23 s, p < 0.0001).
 UK
2001 [23]
Three-stage vs. conventional training Randomized Controlled Trial 495 Layperson No CPR quality and knowledge In first 8 min, using 50:5 ratio, 58% more compressions can be made. Staged group had better ‘shout for help’ after 2 months (p = 0.02 to p < 0.01) and adequate compressions after retraining (p = 0.05) and at 4 months (p = 0.04).
 Korea
2015 [24]
Peer-assisted learning vs. professional instructor training Prospective Case-Control Study 187 High-school Students No CPR performance and knowledge No difference in willingness to perform CPR (64.7% vs. 55.2%, p = 0.202) and knowledge retention (61.76 ± 17.80 vs. 60.78 ± 39.77, p = 0.848) between peer-assisted and professional instructor groups.
Standard versus Hybrid CPR Training
 Japan
2017 [25]
Coventional vs. flipped learning Interventional Study 108 Medical Students No CPR quality No difference in time to first chest compression (33 s vs. 31 s, p = 0.73) or number of chest compressions (101.5 vs. 104, p = 0.75).
 USA
2019 [26]
Traditional vs. video-only vs. video + hands-on session at a Kiosk Randomized Controlled Trial 738 layperson No CPR performance and quality After the initial education session, the video-only group had a lower total score (compressions correct on hand placement, rate, and depth) (−9.7; 95% confidence interval [CI] -16.5 to −3.0) than the classroom group. There were no significant differences on total score between classroom and kiosk participants.
 USA
2006 [27]
Interactive-computer training and interactive-computer training plus instructor-led (hands-on) practice vs. traditional training Cluster Controlled Trial 784 High School Students No CPR performance and knowledge For all outcome measures mean scores were higher in the instructional groups than in the control group. Two days after training all instructional groups had mean CPR and AED knowledge scores above 75%, with use of the computer program scores were above 80%.
Standard versus Online CPR Training
 USA
1998 [28]
Heartsaver CPR training (traditional) vs. video self instruction Prospective Randomized Controlled Trial 89 Incoming Freshmen Medical Graduates No CPR performance VSI trainees displayed superior overall performance compared with traditional trainees. Twenty of 47 traditional trainees (43%) were judged not competent in their performance of CPR, compared with only 8 of 42 VSI trainees (19%; absolute difference, 24%; 95% confidence interval, 5 to 42%).
 USA
2009 [29]
Traditional (group 1) vs. online (group 2 - computerized module with video) version Randomized Controlled Trial 64 Undergrad Freshmen No CPR quality and knowledge On the standardized knowledge examination and skill performance evaluation, Group 2 scored lower than Group 1; however, no statistically significant difference between the groups existed. MANOVA indicated there was a significant difference in the quality of CPR compressions (location, rate, depth, and release), ventilation rate and volume.
 USA
2016 [30]
Brief video vs. traditional training Cluster Randomized Trial 179 School Children No CPR quality At post-intervention and 2 months, BV and CCO class students called 911 more frequently and sooner, started chest compressions earlier, and had improved chest compression rates and hands-off time compared to baseline.
 USA
1999 [31]
Video self instruction vs. traditional CPR training Randomized Controlled Trial 190 Layperson No CPR performance and knowledge VSI trainees displayed a comparable level of performance to that achieved by traditional trainees. Observers scored 40% of VSI trainees competent or better in performing CPR, compared with only 16% of traditional trainees (absolute difference 24, 95% confidence interval 8 to 40%).
 Korea
2011 [32]
Video based vs. traditional training Single-Blind Case-Control Study 75 Students No CPR performance Three months after initial training, the video-reminded group showed more accurate airway opening (P < 0.001), breathing check (P < 0.001), first rescue breathing (P = 0.004), and hand positioning (P = 0.004) than controls. They also showed significantly higher self-assessed CPR confidence scores and increased willingness to perform bystander CPR in cardiac arrest than the controls at 3 months (P < 0.001 and P = 0.024, respectively).
 USA
2010 [33]
HeartCode™BLS with VAM vs. instructor-led training Randomized Controlled Trial 604 Nursing Students No CPR quality No difference in compression rate between groups.
HeartCode™BLS with VAM group had more compressions with adequate depth and correct hand placement, and had more ventilations with adequate volume.
 Spain
2013 [34]
Voice Advisory Mannequin vs. instructor training Randomized Controlled Trial 43 Medical Students No CPR performance VAM group performed more correct hand position (73% vs. 37%, p = 0.014) and had better compression rate (124/min vs. 135/min, p = 0.089). Women in VAM group showed improvement in compression depth (36 mm to 46 mm, p = 0.018) and percentage of insufficient compressions (56 to 15%, p = 0.021) after training.
 India
2019 [35]
Video-based CPR training vs. instructor-based CPR training Randomized Controlled Trial 109 Undergrad University Students No CPR performance Video-based group performed better scene safety (95.2% vs. 76.1%) and call for help (97.6% vs. 76.1%) than the instructor-based group (p < 0.05). Moreover, the video-based group had shorter response to compression time (35 ± 9 s vs. 54 ± 14 s) as compared to the instructor-based group (p < 0.001).
 Denmark
2006 [36]
DVD-based self training vs. instructor training Interventional Study 238 Layperson No CPR knowledge After 3 months, no significant difference in total scores of CPR performance between groups. The instructor group had better score in assessment of breathing (91% vs. 72%) as compared to the DVD-based group (p = 0.03). However, DVD-based group had better average inflation volume (844 ml vs. 524 ml, p = 0.006) and chest compression depth (45 mm vs. 39 mm, p = 0.005).
 Netherland
2020 [37]
Virtual reality CPR training vs. face-to-face CPR training Randomized Controlled Trial 381 Layperson No CPR performance The VR group was inferior to face-to-face training in chest compression depth (49 mm vs. 57 mm), chest compression fraction (61% vs. 67%, p < 0.001), proportion of participants fulfilling depth (51% vs. 75%, p < 0.001), and rate requirements (50% vs. 63%, p = 0.01), but superior in chest compression rate (114/min vs. 109/min) and compressions with full release (98% vs. 88%, p = 0.002). The VR group had lower overall scores (10 vs. 12, p < 0.001) as compared to the face-to-face group.
 USA
2007 [38]
Video self-training vs. instructor training Randomized Controlled Trial 285 Layperson No CPR performance and knowledge Immediately post-training, video group had higher scores in overall performance (60% vs. 42%), assessing responsiveness (90% vs. 72%), ventilation volume (61% vs. 40%), and correct hand placement (80% vs. 68%) but lower scores in calling 911 (71% vs. 82%). At 2 months post-training, video group had higher scores in overall performance (44% vs. 30%), assessing responsiveness (77% vs. 60%), ventilation volume (41% vs. 36%), and correct hand placement (64% vs. 59%) but lower scores in calling 911 (53% vs. 74%).