Implementation of school-based CPR training – A systematic review and mixed-methods meta-analysis

IF 2.4 Q3 CRITICAL CARE MEDICINE Resuscitation plus Pub Date : 2025-05-01 Epub Date: 2025-04-10 DOI:10.1016/j.resplu.2025.100955

Mahan Sadjadi , Rebecca Brülle , Umut Onbasilar , Hendrik Booke , Christian Strauß , Thilo von Groote , Hugo van Aken , Antje Gottschalk

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Abstract

Aim

Despite initiatives like “Kids Save Lives”, CPR trainings are often poorly implemented, and bystander CPR rates remain low. This systematic review and mixed-methods meta-analysis of qualitative and quantitative studies aims to identify enablers and barriers to the implementation of school-based CPR training.

Methods

A systematic search was conducted across seven databases. Qualitative data were analyzed using thematic synthesis, and findings were evaluated with GRADE-CERQual. Quantitative data were synthesized through qualitative findings, providing deeper context using a convergent qualitative meta-integration approach.

Results

A total of 18 reports (7 qualitative and 11 quantitative) on school-based CPR training were included from an initial pool of 7914 records. Key enablers of successful school-based CPR training implementation were related either to program characteristics or to environmental factors, with both being equally important. Generally, programs are better implemented if they include high-quality resources, incur low costs in terms of funds, time and staffing, show adaptability to the setting in which they are implemented, and provide standardized training for teachers or implementers. Regarding environment factors, implementation is facilitated by broad support from school stakeholders (leadership, teachers, and parents) and is more successful where, supported by mandatory legislation and government endorsement, health is framed as a core business of schools.

Conclusion

The successful implementation of school-based CPR training depends on both program characteristics and environmental factors, operating together in a “seed and soil” manner. Addressing both aspects is essential for effective program planning. Future research should more broadly explore health outcomes beyond CPR-related measures and investigate how CPR training can be integrated into wider health-promoting school initiatives.

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实施校本心肺复苏术培训-系统回顾和混合方法荟萃分析

尽管有像“儿童拯救生命”这样的倡议，但心肺复苏术培训往往执行不力，旁观者心肺复苏术的比率仍然很低。本研究对定性和定量研究进行了系统回顾和混合方法荟萃分析，旨在确定实施校本心肺复苏术培训的促进因素和障碍。方法系统检索7个数据库。使用主题综合分析定性数据，并使用GRADE-CERQual对结果进行评估。定量数据通过定性研究结果合成，使用收敛的定性元整合方法提供更深层次的背景。结果从7914份初始记录中共纳入18份关于校本心肺复苏培训的报告（7份定性报告，11份定量报告）。成功实施以学校为基础的心肺复苏术培训的关键因素要么与项目特点有关，要么与环境因素有关，两者同等重要。一般来说，如果项目包含高质量的资源，在资金、时间和人员方面的成本较低，对实施环境的适应性较强，并为教师或实施人员提供标准化培训，则项目实施得更好。关于环境因素，学校利益相关者（领导、教师和家长）的广泛支持促进了实施，如果在强制性立法和政府认可的支持下，将卫生作为学校的核心业务，实施将更加成功。结论校本心肺复苏术培训的成功实施取决于项目特点和环境因素，以“种子和土壤”的方式共同运作。解决这两个方面对于有效的方案规划是必不可少的。未来的研究应该更广泛地探索心肺复苏术相关措施之外的健康结果，并研究如何将心肺复苏术培训纳入更广泛的健康促进学校倡议。

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