Pedagogical Aspects on Training in Basic Life Support

Pedagogical Aspects on Education in Basic Life Support: A Cluster Randomized Trial on Effectiveness, Comparing Different Educational Methods for Adults in the Society of Sweden.

Cardio vascular disease (CVD) including out-of-hospital cardiac arrest (OHCA) is still the leading cause of death in a global perspective. Start of cardiopulmonary resuscitation (CPR) with automated external defibrillator (AED) may double or quadruple survival. Scientific research on education in Basic Life Support (BLS) in the society is active in different part of Europe but low in Sweden. The aim of this study is to investigate the effectiveness and retention after different training interventions in BLS and willingness to act in a real-life cardiac arrest situation in the society of Sweden, based on European Resuscitation Council (ERC) guidelines. This is an experimental cluster randomized trial, including participants from a BLS education project in Sweden.

Study Overview

• Status: Completed
• Conditions: Basic Life Support
• Intervention / Treatment: Other: Instructor-led training; Other: Self-learning training

Detailed Description

Introduction: The single most important factor for survival from sudden cardiac arrest (SCA) is to minimize the time from cardiac arrest to cardiopulmonary resuscitation (CPR) and to provide an electric chock through the heart with an automated external defibrillator (AED). Early start with CPR-AED increases the chance of survival two to four times. It is therefore important that as many people as possible have knowledge to quickly identify SCA and to start CPR-AED.

In this research, education efforts are directed for the adult public at workplaces in Sweden. The Investigator have designed an intervention in accordance to guidelines from European Resuscitation Council (ERC) and the Swedish national education for Basic Life Support (BLS).

This is a cluster randomized trial primarily comparing in the first study, instructor-led training as the control group and self-learning training as the experimental group. In the second study the Investigator plan to compare a preparatory web-education on CVD before the BLS training versus no web-education before the BLS. The Investigator have conducted quality tests on practical skills on BLS, administered questionnaires to the participants about theoretical knowledge, self-assessed confidence and willingness to act in a real-life SCA situation. It is crucial to be able to identify factors that affect knowledge and retention after BLS training and the willingness to intervene in an acute situation.

Background: With modern IT technology, several different options and learning strategies are available. At the same time pedagogical thoughts have emerged on learning. Education can be instructor-led or self-directed and with preparatory courses for theoretical knowledge. The quality of BLS skills and theoretical knowledge can be measured through validated instruments. Against this background, the research goal is to identify how the study can improve retention and which training methods for BLS that should be recommended for the public in the future.

Objectives: The overall objective is to increase survival from OHCA. The aim is to identify factors that affect retention and contributes to intended practical skills, theoretical knowledge and willingness to act after BLS training and whether these goals are affected by the type of training intervention.

Hypothesis: The main hypothesis is that retention of practical skills after BLS training is affected by the type of educational intervention. The hypothesis in the first study is that an instructor present at the time of training have a positive impact on retention six months after the intervention compared to self-directed training. In the second study the hypothesis is that a preparatory web-education on CVD before the BLS has a positive impact on retention six months after intervention compared to no web-education.

Questions: The Primary question is which intervention is most effective for the total score and contributes to intended practical skills and adherence to protocol, the BLS algorithm, six months after the intervention. Secondary questions deal with if other variables such as practical skills, theoretical knowledge, self-assessed confidence and willingness to intervene in a SCA situation are affected when comparing each intervention both direct after and six months after training.

Method: Voluntary, participants from a BLS project at workplaces in Sweden have been included. The participants have been randomized from a randomization list and organized for the study, from an independent coordinator. After training and at six months, a quantitative approach and data collection measured the quality of practical skills in a simulated SCA scenario, on a Laerdal Resusci Anne manikin, connected to the PCSkillReporting system. The assessor was blinded for the type of training intervention. At data collection, the variables were structured according to a modified international quality test, Cardiff Test of basic life support and automated external defibrillation (Cardiff Test) that scored adherence to the treatment algorithm and practical skills. The modified Cardiff Test included 19 variables with a total score of 70 points. A questionnaire scored theoretical knowledge, self-assessed confidence and willingness to act in a real-life situation. At the practical quality tests, the total score was the primary endpoint with other individual variables as the secondary endpoint.

Study population: Strategic sampling was used to include participants from different workplaces in a number of counties in Sweden.

Planned Studies: 1) Self-learning training versus Instructor-led training. 2) A preparatory web-education on CVD before the BLS training versus no web-education before the BLS training. 3) A register study on bystander activity 4) Instructor-led training versus subgroups of training from the BLS intervention project.

Statistics: All statistical analyses will be analysed in SASforwindows and calculated on a cluster level with an alpha level of five percent.

Ethical considerations: Ethical principles for research are carefully considered in the research process. Ethical vetting from Ethical Review of Research, involving Humans is approved (Regional Ethical Review Board in Gothenburg, diaries number 134-14) and Guidelines from the Swedish Research Council, Good Research Practice is actively used. Information has been given both individually to all participants and to the working places. All participant had to read and sign a personal consent form before participating. The result will be published according to the Declaration of Helsinki.

• Study Type: Interventional
• Enrollment (Actual): 2623
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Sweden
  • Borås, Sweden, SE 501 90
    • University of Borås Sweden

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 16 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion criteria

• Adults in society over eighteen years old
• Working at workplaces outside hospital
• Without training in BLS or within the past five years
• A completed and signed consent form.

Exclusion criteria

• Participants younger than 18 years old
• Undergone training on BLS within the past five years
• Working at hospital as health care personnel
• Do not want to participate

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Basic Science
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Active Comparator: Instructor-led training; Instructor-led training contents a supervised practical training for BLS, facilitated by a certified instructor.	Other: Instructor-led training; The Instructor-led training contents a supervised practical training with a standard kit for training in BLS
Experimental: Self-learning training; Self-learning training is self-directed and contents practical training for BLS	Other: Self-learning training; The self-learning training contents a standard kit for self-directed training in BLS

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Total score from Cardiff Test for retention at 6 months	Total score from the modified instrument Cardiff Test on the participants individual practical skills and adherence to the Basic Life Support algorithm in retention-test at six months after intervention.	6 months after intervention

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Individual quality variables from PC SkillReporting System at baseline and at retention at 6 months.	Individual quality variables from the instrument and data program PC SkillReporting system on the participants quality on practical skills for Basic Life Support at baseline as post-test direct after intervention, as retention-test at six months later and as a change in quality of Basic Life Support	0 days + 6 months later
Self-assessed theoretical knowledge from questionnaires at baseline and retention at 6 months	Self-assessed theoretical knowledge with data collected from the participants individual questionnaires at baseline as post-test direct after intervention and as retention-test at six months later.	0 days + 6 months later
Self-assessed confidence from questionnaires at baseline and retention at 6 months	Self-assessed confidence after the intervention with data collected from the participants individual questionnaires at baseline and retention at six months later.	0 days + 6 months later
Self-assessed willingness from questionnaires at baseline and retention at 6 months	Self-assessed willingness to act in a real-life sudden cardiac arrest situation with data collected from the participants individual questionnaires at baseline and retention at six months later.	0 days + 6 months later
Theoretical knowledge on cardio vascular disease, symptoms and first actions from questionnaires at baseline and retention at 6 months	Theoretical knowledge on cardio vascular disease, first actions and healthy life style factors with data collected from the participants individual questionnaires at baseline and retention at six months later. Secondary Outcome for study 2) A preparatory web-education on CVD before the BLS training versus no web-education before the BLS training.	0 days + 6 months later
Self-assessed experience on learning outcome at baseline and retention at 6 months	Self-assessed experience on the participants individual learning outcome at baseline and retention at six months with data collected from the participants individual questionnaires at baseline and retention at six months later. Secondary Outcome for study 4) Instructor-led training versus subgroups of training from the BLS intervention project.	0 days + 6 months later

Collaborators and Investigators

• Sponsor: University of Boras
• Collaborators: Swedish Heart Lung Foundation
• Investigators: Principal Investigator: Johan D Herlitz, Professor, University of Borås Sweden

Publications and helpful links

General Publications

• Bylow H, Karlsson T, Lepp M, Claesson A, Lindqvist J, Svensson L, Herlitz J. Learning Outcome After Different Combinations of Seven Learning Activities in Basic Life Support on Laypersons in Workplaces: a Cluster Randomised, Controlled Trial. Med Sci Educ. 2020 Nov 18;31(1):161-173. doi: 10.1007/s40670-020-01160-3. eCollection 2021 Feb.
• Bylow H, Karlsson T, Claesson A, Lepp M, Lindqvist J, Herlitz J. Self-learning training versus instructor-led training for basic life support: A cluster randomised trial. Resuscitation. 2019 Jun;139:122-132. doi: 10.1016/j.resuscitation.2019.03.026. Epub 2019 Mar 26.

Study record dates

Study Major Dates

• Study Start (Actual): March 1, 2014
• Primary Completion (Actual): December 31, 2016
• Study Completion (Actual): December 31, 2019

Study Registration Dates

• First Submitted: July 21, 2018
• First Submitted That Met QC Criteria: August 5, 2018
• First Posted (Actual): August 7, 2018

Study Record Updates

• Last Update Posted (Actual): March 27, 2020
• Last Update Submitted That Met QC Criteria: March 26, 2020
• Last Verified: March 1, 2020

More Information

Terms related to this study

• Keywords: Basic Life Support; Cardiopulmonary Resuscitation; Out-of-Hospital Cardiac arrest; Automated External Defibrillator; Self-learning
• Other Study ID Numbers: Johan Herlitz

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: No
• IPD Plan Description: Data will be analysed and published on group level only

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No