Peer education for BLS-training in schools? Results of a randomized-controlled, noninferiority trial

BACKGROUND: The rate of bystanders who provide cardiopulmonary resuscitation (CPR) is low in Germany. To increase the bystander CPR rates of lay-rescuers in Germany, the national "einlebenretten" ("save one life") campaign was initiated, and the introduction of CPR-training for all seventh-grade students was recommended. To meet the requirement of offering effective and low-cost mass-training to lay-rescuers, we adopted peer education for the basic life support (BLS) training of the students.

METHODS: We used an experimental, prospective, randomized, controlled, and open-label noninferiority trial to test whether the hands-on BLS training of the students that was provided by peers was inferior to the training by professional instructors using a predefined noninferiority margin of 5%. The students from eight different schools were trained in one 45 min practice session to perform BLS based on the educational framework provided by "einlebenretten". The students were randomly assigned to be trained either by peer-instructors (students in the same school who had been instructed in advance) or by professional instructors. In a structured practical assessment, the eight essential skills of BLS were tested and the examination was scored as either pass or fail.

RESULTS: The study included 1087 students 14-18 years of age. The performance in the assessment was similar between the two groups: 40.3% (n=471) of the students in the peer-led group and 41.0% (n=466) in the professional-led group passed the examination.

CONCLUSION: The students who were trained by peer-instructors showed comparable skills in BLS to the students who were trained by professional instructors. The sample size was too small to demonstrate the noninferiority of the peer-led training.