Effectiveness of Blended Versus Traditional Refresher Training for Cardiopulmonary Resuscitation: A Prospective Comparison of 6-Month and 12-Month Sessions

Abstract

Background: People's cardiopulmonary resuscitation (CPR) skills significantly decline over time. By combining online selfregulated learning with hands-on practice, blended training can be a time- and resource-effective approach for individuals to acquire and refresh their CPR skills at their convenience. However, few studies have evaluated whether blended training models are effective as CPR refreshers compared with the traditional method. Objective: This study investigated and compared the effectiveness of traditional and blended CPR training and 6-monthly and 12-monthly refresher sessions on CPR ability indicators. Methods: This prospective observational design included participants aged ?18 years from the AED Donated Project by Chang Gung Memorial Hospital. The participants were divided into four groups on the basis of the format of CPR training and refreshers received: (1) initial traditional training (a 30-min instructor-led hands-on session) and 6-monthly traditional refreshers (the Traditional6 group), (2) initial traditional training and 6-monthly blended (an 18-min e-learning module) refreshers (the Mixed6 group), (3) initial traditional training and 12-monthly blended refreshers (the Mixed12 group), and (4) initial blended training and 6-monthly blended refreshers (the Blended6 group). CPR knowledge and skill performance were evaluated immediately after initial training. Each group will undergo a learning effectiveness assessment before refresher courses at 12th and 24th months following the initial training model. CPR knowledge was assessed using a written test with 15 multiple-choice questions, and CPR performance was assessed through an examiner-rated skill test and objectively through manikin feedback. A generalized estimating equation (GEE) model was used to analyze the changes in CPR ability indicators. Results: The study included 1163 participants (mean age: 41.82 ± 11.6 years; 64.8% women), with 332, 270, 258, and 303 participants in the Mixed6, Traditional6, Mixed12, and Blended6 groups, respectively. No significant between-group difference was observed in knowledge acquisition after the initial training (P = 0.227). Moreover, all the groups met the criteria for highquality CPR (i.e., average compression depth: 5~6 cm, average compression rate: 100-120 times/min, and chest recoil rate: >80%), but a higher proportion of participants receiving blended training initially demonstrated high-quality CPR. At 12 and 24 months, CPR skills declined in all groups, but the decline was significantly higher in the Mixed12 group, whereas the differences were not significant between the other groups. This finding indicates that more frequent retraining can help maintain high-quality CPR skills and that using blended training as refreshers are equally effective. Conclusions: Our findings indicate that 6-monthly refresher sessions are more effective for retaining high-quality CPR skills and that using self-learning e-modules can be as effective as instructor-led sessions for refreshers. However, although the blended learning approach can be cost and resource effective, factors such as participant demographics, training environment, and the level of engagement must be considered to maximize its potential. Clinical Trial: Nct05659108.