The impact of video-based instruction on CPR knowledge in elementary school students (10–11 years)
Authors: Chang J , Biswas A , Iftikhar S , Gelman S , Biswas M 
Published: October 2022

Abstract

Introduction
The European Resuscitation Council recommends cardio-pulmonary resuscitation (CPR) training at age 12 or earlier to improve CPR utilization. [1] The COVID-19 pandemic has caused limitations on resources and in-person instruction (IPI). Remote video instruction (RVI) may increase participation in CPR education in areas with otherwise limited capacity.

Purpose
The study compares the efficacy of RVI versus IPI on elementary school students' theoretical knowledge, confidence, and attitudes about CPR.

Methods
Data for in-person and remote instruction was collected in fifth grade classrooms (age 10–11 years) from 2019 to 2021. In the experimental RVI group, a total of 62 students (50.0% female) viewed a thirty-minute video-based lesson, practiced on household objects, and were invited to create their own instructional video. A total of 385 students (53.3% female) in the control IPI group participated in a one-hour traditional lesson with video and hands-on instruction. After their respective lesson, students completed a questionnaire assessing demographics, knowledge, and attitudes about CPR within 24 hours.

Results
Demographics are listed for the participating students in Table 1. There was a significantly higher rate of previous training for the in-person group. A logistic regression showed that this did not correlate with performance on knowledge items. In-person instruction did not demonstrate superiority to remote video instruction in any of the knowledge items tested, as listed in Table 2. In fact, the students in the RVI group achieved significantly better outcomes in knowledge of compression rate (85.5% vs 55.7%, p&lt;0.001). The RVI group also showed a trend towards superiority in knowledge of the first step of CPR (79.0% vs 68.6%, p=0.0964)
Compared to students in the control group, students receiving RVI achieved confidence at similar levels (p=0.546). There was an increase in confidence from a median of 3 to 4 in both the RVI and IPI groups. Students from both groups similarly agreed at high levels that CPR should be required, and that training should start at 5th grade.
Of note, the students receiving RVI demonstrated a willingness to disseminate their knowledge, with 37.1% willing to share with 6 or more people. Altogether, these students created 62 videos to share with members of their community.

Discussion
The results show that remote instruction is a viable method that can achieve similar if not better results versus in-person instruction. A growing body of evidence supports that children as young as 11 years can acquire CPR knowledge and skills. [2] Students in both arms strongly supported training starting in 5th grade. Previous research has shown that younger learners have a higher likelihood of sharing CPR training with others. [3] In our study, a significant portion of students created and planned to share videos with community members, suggesting a powerful multiplier effect.

Funding Acknowledgement
Type of funding sources: Private hospital(s). Main funding source(s): HCA Healthcare