Facilitators and barriers for the implementation of resuscitation training programmes for schoolchildren: A systematic review

BACKGROUND: Training schoolchildren in resuscitation seems to improve rates of resuscitation by bystanders. Leading medical societies recommend comprehensive resuscitation education in schools. To date, no widespread implementation within the European Union has happened.

OBJECTIVE: The study aim was to identify facilitators and barriers for the implementation of cardiopulmonary resuscitation training for schoolchildren within the European Union.

DESIGN: Systematic review.

DATA SOURCES: A literature search in PubMed was conducted between 1 January 1999 and 30 June 2020 in accordance with the PRISMA statement. The search terms 'resuscitation', 'children' and 'Europe' were combined with the Boolean Operator 'AND' and 'OR'. Medical subject heading terms were used in order to include relevant articles.

ELIGIBILITY CRITERIA: Articles were included if cardiopulmonary resuscitation training specifically tailored for schoolchildren aged 12 to 18 years was considered in countries of the European Union. Articles that fulfilled the following criteria were excluded: duplicates, training methods only for specific patient groups, articles not accessible in the English language, and articles that did not include original data. Findings were structured by an evidence-based six-level approach to examine barriers and facilitators in healthcare.

RESULTS: Thirty out of 2005 articles were identified. Large variations in cardiopulmonary resuscitation training approaches ranging from conventional to innovative training methods can be observed. Schoolteachers as resuscitation instructors act either as barrier or facilitator depending on their personal attitude and their exposure to training in resuscitation. Cardiopulmonary resuscitation training in schoolchildren is effective. The uncoordinated interplay between the generally motivated schools and the political orientation towards resuscitation training for schoolchildren serve as barrier. The lack of financial support, absent systematic organisation and standardisation of training create major barriers.

CONCLUSION: Training schoolchildren in cardiopulmonary resuscitation is effective. More financial support and political guidance is needed. Until then, local initiatives, motivated teachers, and dedicated principles combined with innovative and low-cost training methods facilitate cardiopulmonary resuscitation training in schools.