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CPR instruction methods (self-instruction vs traditional)

Question Type:
Intervention
Full Question:
Among students who are taking BLS courses in an educational setting (P), does video or computer self instructions (I), compared with traditional instructor-led courses (C), change improve survival, skill performance in actual resuscitations, skill performance at 1 year, skill performance at course conclusion, cognitive knowledge (O)?
Consensus on Science:
No studies addressed the critical outcomes of skill performance in actual resuscitations or survival of patients.For the important outcome of cognitive knowledge, we have identified low-quality evidence (downgraded for serious risk of bias and imprecision) from 4 RCTs with a total of 370 students showing no differences between self-instruction and instructor-led course (using a multiple-choice questionnaire at course conclusion and at 2 months to 1 year).(Nelson 1984, 118; Fabius 1994, 262; Todd 1998, 364; Todd 1999, 730)For the important outcome of skill performance at course conclusion, we have identified very-low-quality evidence (downgraded for risk of bias, inconsistency, and imprecision) from 9 RCTs(Fabius 1994, 262; Dracup 1998, 170; Batcheller 2000, 101; Lynch 2005, 31; Einspruch 2007, 476; Roppolo 2007, 276; Cason 2009, E1; Mancini 2009, 159; Chung 2010, 165) and 1 randomized cluster-controlled trial(Roppolo 2011, 319) with a total of 2023 students showing no differences between self-instruction and instructor-led courses based on failure to pass total performance evaluation by instructors using checklists (relative risk [RR], 1.09; 95% confidence interval [CI], 0.66–1.83).For the important outcome of skill performance at 1 year, we have identified low-quality evidence (downgraded for risk of bias and imprecision) from 2 RCTs with a total of 234 students showing no differences between self-instruction and traditional instruction based on failure to pass the total performance evaluation by instructors using checklists (RR, 0.91; 95% CI, 0.61–1.35).(Nelson 1984, 118; Barrington 1989, 1293)
Treatment Recommendation:
We suggest that video and/or computer-based self-instruction with synchronous or asynchronous hands-on practice may be an effective alternative to instructor-led courses (weak recommendation, very-low-quality evidence).Values, Preferences, and Task Force InsightsDespite heterogeneity in the delivery of video and/or computer-based instruction and in the evaluation methods among different studies, we make this recommendation based on the absence of differences in the outcomes between self-instruction versus instructor-led courses. In making this recommendation, we place higher value on the potential reduction in time and resources with self-instruction, which could translate to increased CPR training.The EIT Task Force recognized the considerable heterogeneity in the interventions on self-instruction (computer versus video assisted; with or without hands-on practice) and challenge with lumping them together (ie, a poorly designed computer-based learning activity is very different from a well-designed one), yet they are grouped together in the GRADE process. Nonetheless, the task force developed consensus that this was an important PICO question that had the potential to increase the number of lay providers available to respond to cardiac arrests and potentially the subsequent survival for victims in a time- and resource-wise manner.
CoSTR Attachments:
EIT647_ILCORSlideDallas2015.plenary and TFfinal.ppt    
GradeTablesfinal.pdf    
List of 21 papersFinal_n.docx    

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