Is a homemade cardiopulmonary resuscitation (CPR) trainer non-inferior to a commercially available CPR mannequin in teaching high-quality CPR? A non-inferiority randomized control trial

INTRODUCTION: Studies demonstrate that feedback devices help students achieve mastery of critical CPR skills and shorten the time from demonstration to competence. CPR feedback devices are costly and may not be available in low resource settings or in the context of online classes. We have developed a homemade feedback enabled CPR trainer. This trainer consists of a lid with two toilet rolls stacked on top. We have shown it is feasible to generate high quality CPR using this trainer, however the ability for this trainer to successfully be used in skill acquisition is unknown. Our main objective was to assess if learning CPR on a homemade toilet paper trainer was non-inferior to a commercially available mannequin when comparing post-training CPR scores. METHODS: We conducted a parallel non-inferiority randomized control trial using a variable block randomization to a 10-min training session on either a toilet paper or commercial mannequin trainer. Primary outcome was mean overall CPR score as determined by high fidelity mannequin software. A sample size of 62 per group was calculated based on a 90% power to assess for the lower limit of a two-sided 95% confidence interval above the non-inferiority limit of 10%. RESULTS: 125 participants were randomized to the toilet paper (n = 64) or commercial mannequin trainer (n = 61). There was no difference between groups in age, sex, height, weight or previous CPR training. There was an absolute difference of 2% (CI 95% 3.3 to 7.3%) in mean overall CPR score between groups (toilet paper = 82% (SD 15.9%), commercial mannequin = 84% (SD 15%). CONCLUSION: A homemade CPR trainer was non-inferior to a commercially available trainer. This study provides preliminary evidence supporting the use of a homemade, easily accessible trainer for basic compression-only CPR skill acquisition.