Bystander CPR training: is non-classroom based CPR training as effective as a classroom based approach? A systematic review of randomised controlled trials.

INTRODUCTION: In Scotland, approximately 5% of out-of-hospital cardiac arrest patients survive to hospital discharge. Improving bystander cardiopulmonary resuscitation (CPR), especially in rural areas, could have a significant effect on the numbers of lives saved. The objective of this study was to systematically review whether non-classroom-based bystander CPR training is as effective as classroom-based training.. METHODS: A database search for randomised controlled trials that compared classroom-based to non-classroom-based training in bystanders (non-medical professionals) was performed in Medline and Embase with no date restrictions. Relevant studies were critically appraised. Differences in the efficacy of CPR training between the two study arms of non-classroom and classroom-based training were measured by outcomes of compression depth, compression rate and correct hand positioning. RESULTS: Eight studies in total met the inclusion criteria. Thirteen out of a total of 15 outcomes showed non-classroom-based CPR training to be as effective as or more effective than classroom-based training. A high risk of bias was identified in every study. CONCLUSION: From the available evidence, non-classroom-based training appears at least as effective as classroom-based training for CPR. This could have significant implications for delivery of CPR training nationally, especially in remote and rural areas. However, due to the variation in how outcomes were measured, and the high risk of the presence of bias in each of the studies, further research into CPR training strategies is strongly recommended.