A Scalable Feedback-Enabled Cardiopulmonary Resuscitation Training Model and Early Attainment of Guideline-Consistent Compression Skills: A Quasi-Experimental Study

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INTRODUCTION: Survival after out-of-hospital cardiac arrest (OHCA) depends on the immediate provision of high-quality bystander cardiopulmonary resuscitation (CPR) during the prehospital phase. In many community settings, repeated training opportunities are not guaranteed, making early attainment of guideline-consistent CPR skills during a single training exposure particularly important. STUDY OBJECTIVE: This study evaluated whether a scalable, feedback-enabled CPR training model was associated with earlier attainment of guideline-recommended chest compression metrics compared with conventional instruction. METHODS: A quasi-experimental study was conducted among medical students who received CPR instruction during two consecutive teaching periods (2014-2015, conventional instruction [CONV]; 2016-2017, simplified feedback-enabled kit [SIM]). Overall CPR performance was assessed at three pre-defined time points: pre-Basic Life Support (BLS), immediate post-BLS, and delayed follow-up (two-to-twelve months post-BLS). The primary outcome was attainment of the target compression rate (100-120 compressions/minute). Mixed-effects regression models were used to account for repeated measurements and to evaluate group × assessment interactions. RESULTS: A total of 334 students were included: 171 in the CONV group and 163 in the SIM group. At the pre-BLS assessment, students in the SIM group demonstrated higher odds of achieving the target compression rate (odds ratio [OR], 3.49; 95% confidence interval [CI], 2.13-5.71), target compression depth (OR, 2.65; 95% CI, 1.24-5.64), and complete chest recoil (OR, 1.71; 95% CI, 1.05-2.78). Mixed-effects modeling demonstrated that the between-group difference in target compression rate changed over time, with convergence observed at delayed follow-up. CONCLUSION: A scalable, feedback-enabled CPR training model was associated with earlier attainment of guideline-consistent chest compression performance. These findings may support further evaluation of scalable feedback-enabled approaches in community-based or resource-limited training environments where repeated CPR instruction may not be feasible.

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