Development and validation of a distance-based training program of Basic Cardiac Life Support for laypersons and comparison with traditional in-person methodology: A non-inferiority study

Abstract Background: This study aimed to compare a distance-based CPR training program with asynchronous feedback for laypersons to a traditional in-person Basic Life Support (BLS) course. Methods: After approval by the ethics committee, 192 non-medical personnel were recruited to participate in this study. Participants were randomly assigned to two different training methods: - Traditional American Heart Association BLS in-person course (T-course). - Distance-based course offering asynchronous feedback through an online platform (D-course). For the distance-based course, materials for practice were available at the participants' workplace (pad, resuscitation torso, an automated external defibrillator). The video-based assessment and feedback platform C1DO1 was used (https://c1do1.ai/). The course was structured in 9 stages on the platform, with theoretical and practical steps. Participants reviewed the videos and practiced unsupervised, uploading video recordings of their practice, and instructors assessed and provided feedback asynchronously on these videos. Participants then reviewed their own videos with the feedback and practiced again until approval. Both groups completed a pre-training (PRE) and post-training assessment (POST). During both assessments, participants were recorded performing CPR. Videos were evaluated by two independent, blinded reviewers who rated participants’ performance using the AHA CPR and AED Skills Testing Checklist. Additionally, the quality of chest compressions (CC) was measured with the Prestan simulator application. Results: Of the 192 participants recruited, 172 completed the training, and 158 took the PRE and POST assessments. (83 finished the T-course and 75 the D-course). Median AHA CPR and AED Skills Checklist scores increased from 2 (0-3) to 15 (14-16.5) points in the T-course and from 1 (0-2.5) to 16 (15.5-17) points in the D-course. The difference in POST assessment median scores between groups was -1 (95% CI: [-1.5, -0.5]), with the lower bound above the pre-established non-inferiority margin, confirming the non-inferiority of the D-course. The median CC rate increased from 82 (0-106)/min to 105 (102-110)/min in the T-course and from 86 (0-109.5)/min to 105 (105-108)/min in the D-course. The median CC depth rose from 38 (0-57.5) mm to 58 (49.5-60) mm in the T-course and from 32 (0-56) mm to 59 (55-60) mm in the D-course. Conclusions: Both training programs significantly improve participants’ proficiency in CPR. The distance-based course with asynchronous platform feedback was non-inferior to the traditional BLS course.