Free distance learning of cardiopulmonary resuscitation for laypeople – A reasonable way for improving cardiac arrest outcomes in low-resource settings

Out-of-hospital cardiac arrest (OHCA) outcomes are worse in low- and middle-income countries (LMIC) compared with high-income economies

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due to a lack of healthcare resources and low bystander engagement in provision of lifesaving help. Effective education of laypeople in resuscitation is crucial for increasing bystander cardiopulmonary resuscitation (CPR) rates, but nowadays both availability and accessibility of CPR training are limited for lay public in low-resource settings. Additionally, conventional face-to-face training in resuscitation is compromised globally by the ongoing COVID-19 pandemic. There is a pressing need to implement large-scale educational interventions in communities with low resources in order to improve frequency of bystander CPR and survival from OHCA.

It is currently recommended by the International Liaison Committee on Resuscitation (ILCOR) to utilise alternative instructional strategies for teaching resuscitation in low-resource settings.

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Besides being better-than-nothing solution for people who have no way to attend resuscitation training in person, distance learning possess a set of important advantages including cost-effectiveness, time savings, learning autonomy and flexibility, and standardisation of delivery of training content, while maintaining trainees’ safety, satisfaction and positive learning outcomes. When supported with hands-on practice, online training can be at least as effective as traditional classroom CPR training both in acquisition of knowledge and psychomotor skills.

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Furthermore, web-based learning improves public awareness and attitudes toward resuscitation, thus increasing the number of people willing to provide bystander CPR.

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Recent study has shown another valuable effect of digital resuscitation training. In April 2020–July 2021, a total of 3232 lay trainees of the Russian-language massive open online course in CPR (stepik.org/course/13222) were surveyed to investigate their readiness to train other people in resuscitation. Over 76.5% of the course completers confirmed their willingness to teach CPR, suggesting the opportunity to further intensify mass public resuscitation education by means of engaging the volunteers for conducting instructor-led distance training.

Percentage of individuals using the Internet in LMIC consistently increases. With active promotion through social media, an open access distance resuscitation training could eventually reach hundreds millions people worldwide.

ILCOR’s scoping review by Schnaubelt and colleagues

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highlighted the need for developing minimum CPR standards for low-resource settings, including a list of essential resuscitation equipment. It seems reasonable to complement these clinical practice standards with expert-developed minimum standards for public resuscitation training, along with a free-of-charge web-based and/or downloadable training package, containing reliable and approved electronic teaching materials. Contents of the e-learning kit should be adopted to various low-income and middle-income communities considering diverse languages and limited amount of resources. In particular, for developing psychomotor skills, free distance theoretical learning could be supplemented with instructions on self-guided hands-on practice utilising a do-it-yourself CPR training manikin made of material available at hand.

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Being essentially in line with ILCOR’s vision of “Saving more lives globally through resuscitation”, the international initiative for developing the standardized and expert-validated free CPR e-learning curriculum has a potential to greatly improve availability and accessibility of safe and effective public education in resuscitation, thus contributing to decreasing mortality from OHCA in resource-challenged regions of the world.