Gathering Evidence on Best Practices for Lay Rescuer CPR Training

Generating Evidence to Optimize Lay Rescuer Cardiopulmonary Resuscitation (CPR) Training: a Longitudinal Study of Frequency, Modality, and Design Features Impacting Skill Retention

The goal of this prospective trial is to compare CPR skill and attitudes in lay rescuers. The main question[s] it aims to answer are:

• What is the optimal training timing, duration, and frequency for lay rescuers that leads to CPR skill retention?
• What is the impact of CPR manikin type (high-fidelity, inflatable, nontraditional objects) on skill retention?
• How do specific features of training modality -- such as contextualization, gamification, and emotional engagement -- impact skill proficiency, knowledge retention, and attitudes about CPR?

Participants will

• Answer pre-training questionnaires
• Participate in CPR training
• Participate in CPR skills testing
• Answer post-training questionnaires

Researchers will compare different methods of training, different frequencies of training, and different manikin types.

Study Overview

• Status: Not yet recruiting
• Conditions: Cardiac Arrest, Out-Of-Hospital
• Intervention / Treatment: Behavioral: CPR Training; Device: CPR Manikin Type

Detailed Description

Out-of-hospital cardiac arrest (OHCA) remains a major public health crisis in the United States, with over 350,000 cases annually and low survival rates. Lay rescuer cardiopulmonary resuscitation (CPR) can double survival, yet widespread gaps in training access, skill retention, and emotional readiness persist. While most U.S. states mandate high school CPR training, implementation quality varies, and traditional formats have remained unchanged for over 60 years. These methods are often time-consuming, expensive, and poorly suited for adolescents, leading to low participation and rapid skill decay.

This study addresses these critical gaps by comparing various CPR training methods and procedures. The project tests the effectiveness of different training frequencies, durations, and delivery modes-including traditional instructor-led sessions, brief refreshers, and a novel, emotionally immersive serious game. The serious game leverages gamification, competition, and scenario-based learning to build "emotional muscle memory" and prepare students for real-world emergencies.

Participants are enrolled from two high schools-one rural, one suburban-and randomized by class or individual into training arms with varied schedules and compression practice tools. These tools range from high-fidelity manikins to low-fidelity devices and improvised household objects. Outcomes include CPR performance metrics (compression rate, depth, recoil, and hand placement), knowledge retention, emotional engagement (measured via validated psychometric scales), and confidence in responding to cardiac arrest.

Training sessions are delivered during the academic year, and students are assessed immediately after training and again at annual follow-up points. Data are collected in a de-identified format using school-issued ID numbers, ensuring participant confidentiality. Analysis will use generalized estimating equations and mixed-effects models to assess the impact of training method and frequency on skill retention and psychosocial readiness. The study also explores the role of contextualization, emotional engagement, and gamification as mediators of improved CPR performance.

Ultimately, this multi-year trial aims to identify scalable, cost-effective strategies that optimize CPR training outcomes for lay rescuers. By improving technical skill retention and emotional preparedness, the study addresses key priorities for public health impact and aligns with NHLBI's strategic goals to reduce mortality from sudden cardiac arrest.

• Study Type: Interventional
• Enrollment (Estimated): 2100
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Lorrel Toft, MD; Phone Number: 4103028456; Email: ltoft@unr.edu

Study Locations

• United States
  • Nevada
    • Reno, Nevada, United States, 89557
      • University of Nevada Reno
      • Principal Investigator: Lorrel Toft, MD
      • Contact: Lorrel Toft; Phone Number: 4103028456; Email: ltoft@unr.edu

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Child; Adult; Older Adult
• Accepts Healthy Volunteers: Yes

Description

Inclusion Criteria:

• All students at participating schools

Exclusion Criteria:

• Previous CPR training (will be included in the CPR training but excluded from analysis)
• Physical injury which prevents performing CPR
• Student or parent opt-out

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Other
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

9

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Active Comparator: Every 2 year standard CPR training; Receives two 60-minute instructor-led CPR trainings: once in 9th grade and again in 11th grade	Behavioral: CPR Training; Various durations and frequencies of CPR training
Active Comparator: Annual Standard CPR training; Receives a 60-minute instructor-led CPR training each year for three years.	Behavioral: CPR Training; Various durations and frequencies of CPR training
Active Comparator: High-Frequency, Blended Training; Starts with a 30-minute serious game-based session, followed by 10-minute refreshers every semester for four years (8 total sessions).	Behavioral: CPR Training; Various durations and frequencies of CPR training
Active Comparator: Annual Serious Game Training; Receives a 30-minute serious game-based training session once per year for three years.	Behavioral: CPR Training; Various durations and frequencies of CPR training
No Intervention: Control; No CPR training
Active Comparator: Standard High-fidelity Manikin; Uses a commercially available torso manikin with realistic chest mechanics and feedback. Serves as the gold standard comparator for CPR training.	Device: CPR Manikin Type; Various types of CPR manikins are compared
Active Comparator: Low-Fidelity Manikin; Uses a basic inflatable torso manikin with minimal feedback or resistance. Represents a low-cost, commonly used alternative in schools and communities.	Device: CPR Manikin Type; Various types of CPR manikins are compared
Active Comparator: No-Head Manikin (Prototype); Uses a custom-built spring-based device with a silicone topper and realistic force-displacement properties that closely mimic the human chest. Tests whether an affordable, biomechanically accurate prototype can improve compression quality.	Device: CPR Manikin Type; Various types of CPR manikins are compared
Active Comparator: Non-Traditional Object; Uses improvised materials (e.g., toilet paper rolls) to simulate chest compressions. Evaluates the feasibility and effectiveness of ultra-low-cost CPR practice tools	Device: CPR Manikin Type; Various types of CPR manikins are compared

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
CPR Skill Retention	High-quality CPR as measured by compression rate (per minute), depth (inches), and correct hand placement. High-quality CPR is defined as correct rate (100-120/min) AND >70% of compressions at appropriate depth (2-2.4inches) with appropriate hand placement.	1-4 years

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
CPR Attitudes	Participant confidence and intention to perform CPR, measured using Likert-scale items and validated engagement questionnaires.	1-4 years
CPR Knowledge Retention	Percentage of correct answers on a standardized multiple-choice test assessing CPR knowledge and AED use.	1-4 years
Emotional Profile	Emotional responses captured by the Positive and Negative Affect Schedule (PANAS), measuring affective realism and readiness.	1-4 years
Learner Engagement	Subjective engagement and perceived relevance of CPR training, measured via Likert scales and the Narrative Engagement Scale.	1-4 years

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Training Feature Effects (Contextualization, Gamification, Emotional Impact)	Exploratory outcome assessing how specific training design elements influence CPR skills, knowledge, and self-efficacy through mediation and regression analyses.	1-4 years

Collaborators and Investigators

• Sponsor: University of Nevada, Reno
• Investigators: Principal Investigator: Lorrel Toft, University of Nevada, Reno

Study record dates

Study Major Dates

• Study Start (Estimated): April 1, 2026
• Primary Completion (Estimated): March 31, 2030
• Study Completion (Estimated): March 31, 2031

Study Registration Dates

• First Submitted: January 13, 2023
• First Submitted That Met QC Criteria: June 9, 2023
• First Posted (Actual): June 18, 2023

Study Record Updates

• Last Update Posted (Actual): June 4, 2025
• Last Update Submitted That Met QC Criteria: May 29, 2025
• Last Verified: May 1, 2025

More Information

Terms related to this study

• Keywords: Cardiopulmonary Resuscitation; cardiopulmonary resuscitation training; Lay Rescuer cardiopulmonary resuscitation; lay rescuer cardiopulmonary resuscitation training
• Additional Relevant MeSH Terms: Cardiovascular Diseases; Heart Diseases; Heart Arrest; Out-of-Hospital Cardiac Arrest
• Other Study ID Numbers: Lay Rescuer CPR Training 2026

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO
• IPD Plan Description: All data is gathered and reported in de-identified, aggregate form, per IRB and school official direction.

Drug and device information, study documents

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