背景:针对青少年的心肺复苏(CPR)培训是一项突出的策略,可以增加能够识别心脏骤停并启动CPR的社区第一反应者的数量。越来越多的学校正在采用基于技术的CPR培训方式,以减少上课时间和对讲师的依赖,并提高其广泛传播培训的能力。然而,目前尚不清楚这些基于技术的模式是否与标准培训具有可比性.
目的:本研究旨在系统回顾和进行荟萃分析,以评估基于技术的心肺复苏训练对青少年心肺复苏技能和知识的有效性。
方法:在PubMed中进行搜索,Embase,科克伦图书馆,OvidMEDLINE,CINAHL,PsycINFO,教育资源信息中心,ProQuest论文和论文全球,和Scopus从成立到2021年6月25日。符合条件的随机对照试验(RCT)比较了12至18岁青少年的基于技术的培训与标准培训。使用Cochrane偏倚风险工具对研究进行了评估。使用ReviewManager(CochraneCollaboration)进行随机效应荟萃分析。进行亚组分析以探索异质性的来源。证据的总体确定性是使用建议等级评估来评估的,发展,和评价方法。
结果:纳入了涉及5578名青少年的17项随机对照试验。大多数研究有不清楚的选择偏倚风险(9/17,53%)和高风险的表现偏倚(16/17,94%)。包括指导员指导的干预措施增加了青少年检查心脏骤停患者反应性的可能性(风险比1.39,95%CI1.19-1.63)并致电紧急医疗服务(风险比1.11,95%CI1.00-1.24)。没有指导者指导的自我指导的基于技术的CPR培训与较差的整体技能表现相关(Cohend=-0.74,95%CI-1.02至-0.45)。没有动手练习的训练增加了平均压缩率(平均差9.38,95%CI5.75-13.01),而实时反馈可能产生较慢的压缩率。通过实践实践(Cohend=0.45,95%CI0.13-0.78)和使用计算机程序或移动应用程序(Cohend=0.62,95%CI0.37-0.86)提高了知识得分。然而,证据的确定性很低。
结论:在青少年中,由讲师指导的基于技术的CPR培训,包括动手实践和实时反馈,在CPR技能和知识方面不劣于标准培训。我们的发现支持使用基于技术的组件,如视频,计算机程序,或用于自我指导理论教学的移动应用程序。然而,指导员指导,动手实践,和实时反馈仍然是培训的必要组成部分,以实现青少年更好的学习成果。这种混合学习方法可以减少上课时间和对教师可用性的依赖。由于所审查研究的高度异质性,本研究的结果应谨慎解释.需要更多具有大样本量和随访数据的高质量RCT。最后,基于技术的培训可以被认为是学校的常规进修培训方式,以便将来进行研究。
Cardiopulmonary resuscitation (CPR) training for adolescents is a prominent strategy to increase the number of community first responders who can recognize cardiac arrest and initiate CPR. More schools are adopting technology-based CPR training modalities to reduce class time and reliance on instructor availability and increase their capacity for wider training dissemination. However, it remains unclear whether these technology-based modalities are comparable with standard training.
This study aimed to systematically
review and perform meta-analyses to evaluate the effectiveness of technology-based CPR training on adolescents\' CPR skills and knowledge.
Searches were conducted in PubMed, Embase, Cochrane Library, Ovid MEDLINE, CINAHL, PsycINFO, Education Resources Information Center, ProQuest Dissertations and Theses Global, and Scopus from inception to June 25, 2021. Eligible randomized controlled trials (RCTs) compared technology-based training with standard training for adolescents aged 12 to 18 years. Studies were appraised using the Cochrane risk-of-bias tool. Random-effects meta-analyses were performed using
Review Manager (The Cochrane Collaboration). Subgroup analyses were conducted to explore sources of heterogeneity. Overall certainty of evidence was appraised using the Grading of Recommendations Assessment, Development, and Evaluation approach.
Seventeen RCTs involving 5578 adolescents were included. Most of the studies had unclear risks of selection bias (9/17, 53%) and high risks of performance bias (16/17, 94%). Interventions that included instructor guidance increased the likelihood of adolescents checking the responsiveness of the person experiencing cardiac arrest (risk ratio 1.39, 95% CI 1.19-1.63) and calling the emergency medical services (risk ratio 1.11, 95% CI 1.00-1.24). Self-directed technology-based CPR training without instructor guidance was associated with poorer overall skill performance (Cohen d=-0.74, 95% CI -1.02 to -0.45). Training without hands-on practice increased mean compression rates (mean difference 9.38, 95% CI 5.75-13.01), whereas real-time feedback potentially yielded slower compression rates. Instructor-guided training with hands-on practice (Cohen d=0.45, 95% CI 0.13-0.78) and the use of computer programs or mobile apps (Cohen d=0.62, 95% CI 0.37-0.86) improved knowledge scores. However, certainty of evidence was very low.
Instructor-guided technology-based CPR training that includes hands-on practice and real-time feedback is noninferior to standard training in CPR skills and knowledge among adolescents. Our findings supported the use of technology-based components such as videos, computer programs, or mobile apps for self-directed theoretical instruction. However, instructor guidance, hands-on practice, and real-time feedback are still necessary components of training to achieve better learning outcomes for adolescents. Such a blended learning approach may reduce class time and reliance on instructor availability. Because of the high heterogeneity of the studies reviewed, the findings from this study should be interpreted with caution. More high-quality RCTs with large sample sizes and follow-up data are needed. Finally, technology-based training can be considered a routine refresher training modality in schools for future research.