The implementation of school based cardiopulmonary resuscitation and automated external defibrillation program among secondary school students in Kuantan, Pahang

Abstract

Bystander resuscitation efforts, such as cardiopulmonary resuscitation (CPR) and use of automatic external defibrillator (AED), save lives in out of hospital cardiac arrest (OHCA). School training in CPR and AED use may increase the currently low community rates of bystander resuscitation. Hence, the study objective was to determine the effectiveness of CPR and AED training among secondary school students. Prior to this study, quantitative design using cross sectional survey was used to determine the level of experiences and attitudes towards CPR and AED among students before the training. Further, prospective intervention study involving pre-test, post-test and retention test design was used to evaluate the effectiveness of the school based CPR and AED program on student’s knowledge and skills. The training consisted of lecture, video presentation, skills demonstration and practical session on CPR and AED. The questionnaire was provided before, immediately after and at one month after training. Finally, focus group discussion was used to explore the feelings of the student after completing the program. From the survey, out of 290 students, 89.3% know CPR whereas only 18.6% know AED and 15.5% had seen AED previously. Most of the students, 84.1% reported willingness to perform CPR on family members while only 46.6% willing to perform CPR on strangers. Majority reported reasons not do CPR and AED due to fear will harm patient (44.8%). For the training, 111 students were recruited from three types of school; daily school, cluster school and boarding school to provide greater generality. The median (IqR) total knowledge scores for the pre-test were 40.00 (20.00), post-test were 70.00 (20.00) and retention test were 70.00 (20.00). Students showed improvement in CPR and AED knowledge test following the training (p<0.01) and demonstrated knowledge retention after 4 weeks. On the other hand, following initial training the median (IqR) total skills scores test were 22.00 (4.00) and at four weeks, the median (IqR) were 22.00 (4.00), students demonstrated skill retention in similar adult cardiac arrest scenario testing. Demographic factors of school category, course stream and prior training were statistically significant with pre-test knowledge score with p value 0.023, 0.01 and <0.001 respectively whereas there was no factor associated with the skill score. During focus group discussion, most of the participants shared their positive feelings after completing the CPR and AED program. The level of knowledge and skills of secondary school students improved significantly after CPR and AED program. Increase the number of trained students may minimise the reluctance to conduct bystander CPR and AED and consequently will increase the survival rate of OHCA.