Table 3 Summarized findings of included CPR training methodology research articles
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%). |