Innovative Tele-Instruction Approach Impacts Basic Life Support Performance: A Non-inferiority Trial

Abstract

BackgroundSustaining Basic Life Support (BLS) training during the COVID-19 pandemic bears substantial challenges. The limited availability of highly qualified instructors and tight economic conditions complicates the delivery of these life-saving trainings. Consequently, innovative and resource-efficient approaches are needed to minimize or eliminate contagion while maintaining high training standards and managing learner anxiety related to infection risk.MethodsIn a non-inferiority trial 346 first-year medical, dentistry, and physiotherapy students underwent BLS training at AIXTRA—Competence Center for Training and Patient Safety at the University Hospital RWTH Aachen. Our objectives were (1) to examine whether peer feedback BLS training supported by tele-instructors matches the learning performance of standard instructor-guided BLS training for laypersons; and (2) to minimize infection risk during BLS training. Therefore, in a parallel group design, we compared arm (1) Standard Instructor Feedback (SIF) BLS training (Historical control group of 2019) with arm (2) a Tele-Instructor Supported Peer-Feedback (TPF) BLS training (Intervention group of 2020). Both study arms were based on Peyton's 4-step approach. Before and after each training session, objective data for BLS performance (compression depth and rate) were recorded using a resuscitation manikin. We also assessed overall BLS performance via standardized instructor evaluation and student self-reports of confidence via questionnaire. Non-inferiority margins for the outcome parameters and sample size calculation were based on previous studies with SIF. Two-sided 95% confidence intervals were employed to determine significance of non-inferiority.ResultsThe results confirmed non-inferiority of TPF to SIF for all tested outcome parameters. A follow-up after 2 weeks found no confirmed COVID-19 infections among the participants.ConclusionTele-instructor supported peer feedback is a powerful alternative to in-person instructor feedback on BLS skills during a pandemic, where infection risk needs to be minimized while maximizing the quality of BLS skill learning.Trial registrationhttps://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00025199, Trial ID: DRKS00025199.

2023 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations: Summary From the Basic Life Support; Advanced Life Support; Pediatric Life Support; Neonatal Life Support; Education, Implementation, and Teams; and First Aid Task Forces

“…For the important educational outcome of skill performance from end-of-course up to 3 months, (Table 30) we found 13 studies. 423,424,426,427,429-431,433-438 Eleven studies did not find differences for the primary outcomes, 423,424,427,429-431,433-437 but 2 studies found an advantage of 4 steps over 2 steps. 426,438…”

“…This SysRev included 16 studies, of which 13 were RCTs [423][424][425][426][427][428][429][430][431][432][433][434][435] and 3 were non-RCTs. [436][437][438] All studies showed a high degree of heterogeneity with respect to skills and populations taught, skill complexity, studentto-instructor ratios, and alternatives that were tested against the classic 4-step approach. Therefore, no metaanalyses could be performed.…”

Stepwise approach to skills teaching in resuscitation: A systematic review

“…Study characteristics, designs, and main outcomes are described in Table 1 . Fourteen studies were RCTs, 12 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 and 3 non-RCTs 34 , 35 , 36 with a total number of 2,906 participants. Publication dates ranged from 2010 to 2022 (with data acquisition between 2004 and 2020).…”

“…Fourteen studies (82%) were undertaken in Europe, and the studies analyzed nine different skills related to resuscitation. Fourteen studies 12 , 21 , 22 , 24 , 25 , 26 , 28 , 29 , 30 , 32 , 33 , 34 , 35 , 36 reported short term outcomes (up to less than 3 months), while five studies 23 , 27 , 31 , 32 , 35 reported mid- to long-term retention (from 3 months up to 6 months post training). We found a wide range of target populations with 15 studies investigating various groups of healthcare professionals, 12 , 21 , 22 , 23 , 24 , 25 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 and two studies investigating lay persons 26 , 27 ( Table 1 , Table 2 ).…”

“…All studies reported educational outcomes only, and no patient related outcomes were included. For a summary table of study characteristics including the alternative interventions, 12 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 see Table 2 .…”