Original article
Training adult laypeople in basic life support. A systematic reviewFormación de población adulta lega en soporte vital básico. Una revisión sistemática

https://doi.org/10.1016/j.rec.2018.11.013Get rights and content

Abstract

Introduction and objectives

Bystander assistance is decisive to enhance the outcomes of out-of-hospital cardiac arrest. Despite an increasing number of basic life support (BLS) training methods, the most effective formula remains undefined. To identify a gold standard, we performed a systematic review describing reported BLS training methods for laypeople and analyzed their effectiveness.

Methods

We reviewed the MEDLINE database from January 2006 to July 2018 using predefined inclusion and exclusion criteria, considering all studies training adult laypeople in BLS and performing practical skill assessment. Two reviewers independently extracted data and evaluated the quality of the studies using the MERSQI (Medical Education Research Study Quality Instrument) scale.

Results

Of the 1263 studies identified, 27 were included. Most of them were nonrandomized controlled trials and the mean quality score was 13 out of 18, with substantial agreement between reviewers. The wide heterogeneity of contents, methods and assessment tools precluded pooling of data. Nevertheless, there was an apparent advantage of instructor-led methods, with feedback-supported hands-on practice, and retraining seemed to enhance retention. Training also improved attitudinal aspects.

Conclusions

While there were insufficiently consistent data to establish a gold standard, instructor-led formulas, hands-on training with feedback devices and frequent retraining seemed to yield better results. Further research on adult BLS training may need to seek standardized quality criteria and validated evaluation instruments to ensure consistency.

Resumen

Introducción y objetivos

La asistencia de los testigos es decisiva para mejorar los resultados de la parada cardiaca extrahospitalaria. Pese al número creciente de métodos de formación en soporte vital básico (SVB), la fórmula más efectiva no está definida. Esta revisión sistemática pretende describir los posibles métodos de entrenamiento en SVB para población general adulta y analizar su eficacia aspirando a identificar un patrón de referencia.

Métodos

Se revisó la base de datos MEDLINE (de enero de 2006 a julio de 2018) empleando criterios de inclusión y exclusión predefinidos y considerando todos los estudios que evaluaron métodos prácticos de formación en SVB. Dos revisores extrajeron los datos de manera independiente y evaluaron la calidad de los estudios mediante la escala MERSQI (Medical Education Research Study Quality Instrument).

Resultados

Se incluyeron 27 de los 1.263 estudios identificados. Los ensayos aleatorizados y controlados eran minoría, con una calidad media de 13 sobre 18 y un considerable acuerdo interobservadores. La heterogeneidad de los contenidos y los instrumentos de formación y evaluación limitan la comparabilidad. Los métodos guiados por instructor, incluyendo práctica y apoyados por dispositivos de retroalimentación, parecen haber obtenido los mejores resultados y el reentrenamiento facilitó la retención. La formación mejoró además aspectos actitudinales.

Conclusiones

Aunque los datos no son lo bastante coincidentes para establecer el método óptimo, hubo una aparente ventaja de los guiados por instructor, con práctica y apoyados por retroalimentación, así como del reentrenamiento. Futuros estudios deberían perseguir criterios de calidad estandarizados e instrumentos de evaluación validados para garantizar la coherencia y la comparabilidad.

Section snippets

INTRODUCTION

Bystander basic life support (BLS) is a well-known critical factor to improve prognosis of out-of-hospital cardiac arrest.1 The acknowledged role of education in overcoming knowledge and psychological barriers in this regard has placed laypeople BLS training in a priority position in clinical practice guidelines.2, 3 Over the last decades, increasing interest in this field has been reflected in a growing number of studies reporting different BLS training approaches targeted at citizens,

METHODS

We conducted a comprehensive search of the scientific literature in MEDLINE (PubMed), using a combination of MeSH terms and free text words (Appendix 1 of the supplementary data). The initial literature search was performed on January 2018 and was updated until July. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) recommendations were followed in this systematic review.4

Our PICO (Population, Intervention, Comparison, Outcomes)5 question was as follows: “Among

Type of Studies and Participants’ Characteristics

The initial search retrieved 1247 abstracts and 16 additional studies were identified by checking the list of references (Figure 1). Twenty-seven studies were finally included, with characteristics detailed in Table 1. Ten were individually randomized controlled trials and the sample size ranged from 12 to 450 participants. There was marked participation of University students (n = 11), particularly of first-year health care-related degrees and Education Sciences, and a lesser presence of

DISCUSSION

The markedly heterogeneous nature of the studies included in this systematic review hampered data pooling and the establishment of definitive recommendations on the optimal strategy to train adult laypeople in BLS. However, there was an apparent advantage of instructor-led methods, with hands-on practice, supported by real-time feedback. Retraining enhanced skill retention, especially if this was frequent and included hands-on practice, but was only reported in 2 studies.

Regarding study

CONCLUSIONS

A systematic review of strategies to train laypeople in BLS was not able to define the gold standard method, given the wide heterogeneity of contents, methods, assessment tools, and variables that precluded the establishment of definitive conclusions. The simplicity of BLS protocols, intended to reach the entire population, allowed a wide diversity of training approaches to obtain positive results to some extent in the short-term. However, instructor-led methods with hands-on feedback-supported

CONFLICTS OF INTEREST

None declared.

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