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. 2022 May 12:9:825823.
doi: 10.3389/fmed.2022.825823. eCollection 2022.

Innovative Tele-Instruction Approach Impacts Basic Life Support Performance: A Non-inferiority Trial

Michael Tobias Schauwinhold  1   2 , Michelle Schmidt  1   2 , Jenny W Rudolph  3   4 , Martin Klasen  1   2 , Sophie Isabelle Lambert  1   2 , Alexander Krusch  1   2 , Lina Vogt  1   2 , Saša Sopka  1   2
Affiliations

Innovative Tele-Instruction Approach Impacts Basic Life Support Performance: A Non-inferiority Trial

Michael Tobias Schauwinhold et al. Front Med (Lausanne). .

Abstract

Background: Sustaining Basic Life Support (BLS) training during the COVID-19 pandemic bears substantial challenges. The limited availability of highly qualified instructors and tight economic conditions complicates the delivery of these life-saving trainings. Consequently, innovative and resource-efficient approaches are needed to minimize or eliminate contagion while maintaining high training standards and managing learner anxiety related to infection risk.

Methods: In a non-inferiority trial 346 first-year medical, dentistry, and physiotherapy students underwent BLS training at AIXTRA-Competence Center for Training and Patient Safety at the University Hospital RWTH Aachen. Our objectives were (1) to examine whether peer feedback BLS training supported by tele-instructors matches the learning performance of standard instructor-guided BLS training for laypersons; and (2) to minimize infection risk during BLS training. Therefore, in a parallel group design, we compared arm (1) Standard Instructor Feedback (SIF) BLS training (Historical control group of 2019) with arm (2) a Tele-Instructor Supported Peer-Feedback (TPF) BLS training (Intervention group of 2020). Both study arms were based on Peyton's 4-step approach. Before and after each training session, objective data for BLS performance (compression depth and rate) were recorded using a resuscitation manikin. We also assessed overall BLS performance via standardized instructor evaluation and student self-reports of confidence via questionnaire. Non-inferiority margins for the outcome parameters and sample size calculation were based on previous studies with SIF. Two-sided 95% confidence intervals were employed to determine significance of non-inferiority.

Results: The results confirmed non-inferiority of TPF to SIF for all tested outcome parameters. A follow-up after 2 weeks found no confirmed COVID-19 infections among the participants.

Conclusion: Tele-instructor supported peer feedback is a powerful alternative to in-person instructor feedback on BLS skills during a pandemic, where infection risk needs to be minimized while maximizing the quality of BLS skill learning.

Trial registration: https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00025199, Trial ID: DRKS00025199.

Keywords: Cardiopulmonary Resuscitation (CPR); basic life support (BLS); external chest compression (ECC); historical control; non-inferiority; peer-teaching; tele-instructor; telehealth.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Flow Chart.
Figure 2
Figure 2
Non-Inferiority results for compression depth, compression rate and BLS algorithm. d1, non-inferiority margin set at Δ = −19% for compression depth and compression rate; d2, non-inferiority margin set at Δ = −27 % for BLS algorithm; CD, Compression depth; CR, Compression rate; BLS, Basic Life Support; SIF, Standard Instructor Feedback; TPF, Tele-Instructor Peer Feedback.
Figure 3
Figure 3
Non-inferiority confidence ratings. CPR, Cardiopulmonary Resuscitation; BLS, Basic Life Support; SIF, Standard Instructor Feedback; TPF, Tele-Instructor Peer Feedback.
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