Sudden cardiac death (SCD) is one of the leading causes of death in industrialized countries, and more than 90% happen outside the hospital setting.1 In Europe, it is estimated that the average incidence rate of cardiorespiratory arrests (CRA) is 84% for every 100,000 inhabitants per year,2 with an average survival rate after hospital discharged of 10.3%. In Spain, back in the year 2013, there were 115,752 cases of acute coronary syndrome, of which 100,000 suffered from an acute myocardial infarction, 33% of which died before arriving to a health center.3 It is estimated that by 2021 this figure will remain stable until reaching 109,772 cases, of which 81% will be due to acute myocardial infarctions.3 On the other hand, the average response time of the emergency medical teams (EMT) is between 7 and 20min,4 based on the resources and location of the victim. According to a study conducted in the Balearic Islands, Spain, the average response time in Spain since the basic life support (BLS) is initiated by these EMTs5 is 8.3min, which is why starting the BLS maneuvers by whoever witnesses the CRA is of paramount importance here. All citizens should have some sort of basic training on how to perform cardiopulmonary resuscitation (CPR) maneuvers since they are usually the first witnesses and responders to an out-of hospital cardiac arrest (OHCA). Thus, the measures established by international ogranizations6,7 to increase the survival rates of OHCA should be observed. These measures should be oriented toward the early activation of the EMT, the performance of CPR maneuvers by first responders, early defibrillation, and further care by the advance life support team. This is even more important if we take into consideration that most OHCAs happen at the victim's own house and in public places,8–10 where the first responders can be the family members or acquaintances. This is why it is crucial that everybody knows how to initiate BLS maneuvers immediately after witnessing an OHCA, since it is of vital importance for the victim's survival.6,7,11,12 However, there is a lack of information and training when it comes to reacting to this urgent situation, and a small percentage of the population knows how to perform CPR maneuvers.13,14 Due to how difficult it is to guarantee the training of the entire population, back in the year 2015, the World Health Organization together with other international societies published a series of recommendations to teach CPR maneuvers to kids—the Hands that help-Training children is training for life initiative15 in an attempt to increase the percentage of CPR performed by witnesses—taking as an example the high rates of CPR performed by witnesses of Scandinavian countries. The initiative recommended two (2) hours of mandatory CPR training a year starting at 12 years old in schools everywhere.15

The manifest states that both healthcare professionals and teachers trained in CPR maneuvers can teach these techniques to school children, meaning that in order to meet the requirements of official BLS training in schools, teachers should be the providers of information. It is estimated that even scholars trained in CPR maneuvers15 could teach these skills to their families and friends,16 the basic skills needed to perform external chest compressions and use an automated external defibrillator (AED). This school training proposal is motivated by the fact that, at one time or another in a person's lifetime, schools are visited by nearly 100% of the population.17

So, teachers, the cornerstone of experience, should be trained, prepared, and motivated to be able to perform this task. This is why college training can increase the ratio of witnesses capable of performing CPR maneuvers.18 However, according to several reports and studies, these days, CPR is not part of the teachers’ curricula,19 which is why they do not teach CPR maneuvers to their students, because they do not have enough information on this topic, or they are not ready to deal with CPR in their classes.20,21

Due to how important it is to guarantee the best teachers’ training in BLS who, by the way should be the providers of this experience, and knowing the actual time constraints and limited resources to put it into practice, the goal of this study is to compare the degree of acquisition of the 2 fundamental skills needed to provide BLS: chest compressions, and use of AED22 in future teachers through the implementation of three (3) different short-term training methods (<1h): one traditional course; multimedia devices; and CPR feedback devices.

The goal of this article was to verify the different training/educational methods of the BLS skill set.

The study was designed to assess three (3) teaching methods as part of one pilot experience in BLS training, and focused on eliminating confounding factors after the course, such as the material hand-out to participants, or the training that each participant could have carried out individually with such material. The organization chosen—the Faculty of Teacher Training at the Universidad de Santiago de Compostela, Spain was the target population (the future teachers) who, according to the European Resuscitation Council, should be the leading force in the teaching of CPR.15 Age differences may be a determinant factor when it comes to learning and performing CPR maneuvers; this study sample has one homogeneous average, which is why no age analysis was conducted. The three (3) training activities were conducted by personnel from the aforementioned Faculty of Teacher Training following recommendations from the “kids save lives” initiative,15 that states what the most important moment is for the acquisition of this skill set, which is why the Faculty of Teacher Training was chosen as the ideal place for the consolidation of prior skills in BLS of future teachers, or if they already had such skills, to initiate them, and guarantee training.

When it comes to defibrillation, all three (3) training methods achieved the goal of reducing the AED defibrillation times.

Out of the three (3) short-term training methods under comparison, the CPR training program with feedback devices was the one that score the best when it comes to quality of the 2-min continuous chest compressions; results that remained in the groups of both men and women. The multimedia group scored the worst when it comes to quality in the parameters analyzed during the 2-min chest compression period. In a study based on a short training of laypersons with feedback devices, González-Salvado et al., confirmed that these people scored quality ratios that were similar to those of healthcare personnel when performing chest compressions.25

With respect to other studies on this issue when it comes to teacher training few experiences have been published to date. In one of them, teachers-in-training who do not have any BLS training scored worse results in the quality of chest compression than groups from this study when they performed CPR only with chest compressions on a phantom with real time guidance from an emergency call center.26

When it comes to researches from other groups, the results obtained in our study are similar to other studies that showed that 30-min CPR seminars and courses on a personal phantom using DVDs are almost as effective as the classic 4-h courses.27 We should mention here that, in our case, this training lasted less than an hour, and the results were somehow better in the traditional training group than in the multimedia one. Thus, 1-h long trainings allow students to acquire the CPR hand skills needed,28 something that can be easily be taught at the classes.

When it comes to the multimedia training group, the results obtained were not consistent with the results coming from the actual studies that say that the results obtained in self-educational courses are the same as the ones obtained in traditional courses,29 or even help train special populations.30 We should mention here that in the actual study, we used a unique training experience under controlled training time, the same for everyone, which means that we never saw the advantages of self-educational courses, or continuous training and reinforcements, given the availability of material at the trainee's house. We share the idea that watching multimedia materials and then practicing on a phantom is the cheapest training available and allows acquiring skills similar to the skills acquired with traditional courses29 and, also, mass train young people.31,32 With this alternative, it is possible to educate populations on CPR training with a personal kit in just 30min.33

When it comes to feedback devices, the actual guidelines34 recommend that their clinical use should only be taken into consideration as a part of a wider healthcare system, that should include CPR training, since it has been confirmed that they significantly improve the ratios of spontaneous circulation in in-hospital CRAs when used in combination with a system to improve CPR through weekly training and debriefing sessions of those cases where the resuscitation maneuvers took place,35 which is consistent with what the actual study says, that they are an important piece of the puzzle in the learning of CPR skill sets.

The actual study is the first case of an educational/training plan developed in the Faculty of Teacher Training at the Universidad de Santiago de Compostela, Spain in an attempt to guarantee the training of future teachers as key participants in the training of BLS contents.15

After confirming the validity of the three (3) initial experiences and their training possibilities as a unique experience, now the strategy will be focused on new studies that will assess both the “forgetting effect” of initial experience, and the most appropriate type (self-training vs scheduled vs combined) and frequency of experience reinforcements. The goal here is to guarantee quality training for a population that is essential spreading BLS knowledge, and contribute to the implementation of the motto established by the European Resuscitation Council “community response saves lives”.36

As some of our study limitations, we should mention here that no randomization was ever conducted; nevertheless, the fact that the prior state was not knowing anything on BLS, and that the results in the most important parameters of compressions (CRA, HR, CCR) were maintained when isolating the groups into men and women, could be a plus that would be favoring homogeneous distribution. Also, it was a study conducted on a phantom, meaning that it cannot be completely generalized to the medical practice with real patients. Although the assessment of the skill set was conducted using the same conditions and times in the three (3) groups, it was an immediate post-course measure, and it was not part of the study to assess the quality of compressions after the “forgetting period”,37 which is why we do not know if, eventually, this aspect could modify long-term results. On the other hand, we should mention as well that no official materials were used to train CPR as established by the European Resuscitation Council that recommends an annual 2-hour training starting at 12 years old. Time constraints have conditioned the use of adapted materials with less training time.

The training program with feedback devices scored the best quality results in the item of chest compressions, followed by the traditional course, and the multimedia method ranking last. Results that were reported in both men and women.

The three (3) training programs achieved the goal of reducing fibrillation times.

All authors have participated in all sections of this research and, also, in the preparation of this paper including the study idea and design, data mining, the statistical analysis, the interpretation of data, the writing of the draft, the critical review of the intellectual content, and the approval of the final version of this document.

The authors declare no conflict of interests associated with this article whatsoever, and that they have received no funding while conducting this study.