Skill retention after school-based CPR training - a systematic review and meta-analysis

Early cardiopulmonary resuscitation (CPR) is a key intervention for improving outcomes after out-of-hospital cardiac arrest. School-based CPR training is aimed at enhancing bystander CPR rates. However, uncertainty exists regarding long-term retention of CPR skills and the need for refresher training. This systematic review and meta-analysis assessed the effectiveness of school-based CPR training regarding skill acquisition and retention.

A pre-registered (CRD42021249778) systematic search across eight databases identified randomized controlled trials (RCTs) and non-randomized studies of interventions (NRSIs) evaluating school-based CPR training (in participants aged 6-18 years) with follow-up assessments after ≥ 3 months. Key outcomes were correct technique and skill retention over time. Study quality was assessed systematically using the ROBINS-I and RoB 2 tools. Meta-analysis of weighted means and paired comparisons was performed.

Eighteen studies (twelve RCTs and six NRSIs) met the inclusion criteria. CPR training was associated with a significant improvement in skill acquisition, with rates of correct CPR performance ranging from 74% to 90% across various components. However, a notable decline in skill retention was observed over time, with a particularly marked reduction in chest compression quality within 6 to 8 months post-training.

School-based CPR training effectively teaches children CPR skills, but these newly acquired skills may deteriorate over time, suggesting a need for periodic refresher courses to sustain proficiency. Standardized evaluation methods and reinforcement strategies could be incorporated into training programs in an effort to ensure sustained competence and maximize educational outcomes.