Regional School-Based CPR Training With Low-Cost Manikin Delivered by School Nurses: The Home "Multiplier" Effect

To assess the feasibility and community reach of a regional, nurse-led school cardiopulmonary resuscitation (CPR) program using hand-made low-cost manikins, and to quantify the multiplying effect of student-led CPR teaching at home.

Prospective observational study in public and publicly funded private schools in Murcia, Spain (between June and August 2025). Community school nurses (one per health area; n=9) received standardized preparation and delivered a ∼60-minute basic life support session to intact classes of students aged 10 to 12 years old. Students built a low-cost manikin and were invited to teach CPR to a family member/close contact at home and submit a WhatsApp video. Two independent CPR experts, not involved in training delivery, scored eligible videos using an 11-item checklist (total 0 to 11); disagreements were resolved by consensus. Primary outcomes were school reach and multiplying effect (home trainees per participating student); secondary outcomes included video-based CPR performance scores.

Nurses trained 1,047 students. The at-home activity was completed by 472/1,047 students (45.1%; 95% confidence interval [CI] 42.1 to 48.1), who trained 1,136 family members/close contacts (multiplying effect 2.41 per student; 95% CI 2.27 to 2.55). Of 1,136 submitted videos, 489 were analyzable (43.0%; 95% CI 40.2 to 45.9). Trainees achieved a mean total performance score of 7.8/11 (95% CI 7.63 to 7.97), with higher scores for recognition/activation and chest compressions than for automated external defibrillator request/simulated use.

A community-nurse-delivered school CPR program using a low-cost manikin was feasible and produced a substantial home-training multiplier. Video-assessed performance of key basic life support steps was generally adequate, whereas automated external defibrillator-related actions were weaker.