The School Lifesavers Study: A Randomised Controlled Trial Comparing the Impact of Lifesaver Programme Only, Lifesaver With Face-to-face Training and Face-to-face Training Only on CPR Knowledge, Skills and Attitudes in School Children

The UK has one of the highest rates of cardiovascular disease in the world and approximately 60,000 out-of-hospital cardiac arrests occur every year, half of which are attended to by the emergency services. The public health implications of this are significant as the number of out of hospital cardiac arrests will increase with the rising incidence of obesity and other co-morbidities in the UK's ageing population. Basic Life Support (BLS) can improve the outcomes of these people if it is swiftly performed at the scene of the cardiac arrest.

BLS is defined as a set of skills that can be used to 'help keep someone alive in an emergency...before professional help arrives'. One of the main elements of BLS is cardio- pulmonary resuscitation (CPR). Bystander CPR is important because it slows down the rapid decline in a patient's chances of survival while waiting for professional help. If a patient is found to be in a 'shockable rhythm' such as ventricular fibrillation (VF) or ventricular tachycardia (VT) then receiving bystander CPR could treble the chances of survival.

Currently the average bystander CPR rate in the UK is 30%. This figure is very poor when compared to Seattle where the bystander CPR rates are 61% after routinely training school children for the past 32 years. Similar results have also been achieved in Norway.

While educating the lay public in BLS is key to increasing survival from cardiac arrests, it is difficult to reach the entire population. One potential strategy is to educate school children as young as 12 years old. The American Heart Association advocated compulsory resuscitation training in American schools in 2011, and countries in which resuscitation has been integrated into educational programs in schools report significantly higher resuscitation rates. In Denmark, successful training of school children has led to the rate of bystander CPR doubling after 5 years with a threefold improvement in survival following out-of-hospital cardiac arrest over 10 years. A threefold improvement in survival cannot be achieved solely by improvements in professional medical care in this area.

CPR training in school children has many potential benefits. School children at a young age have a less inhibited approach to resuscitation training and both medical professionals and teachers achieve success after appropriate training themselves. The response to instruction is easier and better at a younger age. Research has shown that the strongest factor preventing laypeople to help in real-life cardiac arrest is a fear of making mistakes. This fear can hopefully be prevented when taught during a young age at school. A more favourable attitude to learning is also reflected by the fact that practical training can be communicated in a more positive way. Embedding resuscitation in related school subjects such as biology, sports or health education is possible and it can make it meaningful.