Abstract

Background:

Sudden out-of-hospital cardiac arrest remains a leading cause of preventable mortality, with survival hinging on timely bystander cardiopulmonary resuscitation (CPR). Although school-based CPR training is routinely implemented in many high-income countries, such initiatives remain scarce in India, where bystander CPR rates are critically low. Adolescents, though often overlooked, represent a promising and untapped target group for early CPR education.

Objective:

To assess the effectiveness of structured school-based CPR training in improving adolescents’ knowledge, skill competency, and confidence, and to evaluate its feasibility as a scalable public health strategy in Tamil Nadu.

Materials and Methods:

This pre-post intervention study involved 306 students aged 13–18 years from two rural and two urban government and private schools in Tamil Nadu, selected through two-stage stratified random sampling. The intervention comprised structured theoretical sessions, mannequin-based CPR demonstrations, and hands-on simulated scenarios, delivered using a low-cost, replicable training model. Structured assessments were administered before and after the intervention to evaluate changes in knowledge, skill competency (via standardised checklists), and attitude.

Results:

Post-training assessments showed:

•43% increase in knowledge scores (p < 0.001)

•56% improvement in skill competency (based on checklist)

•68% increase in self-reported confidence

•Significant rise in self-reported confidence, with higher gains among female students (+1.8 vs. +1.2 on a 5-point scale; p = 0.04)

•Urban students outperformed rural peers, potentially due to better infrastructure and teaching aids.

Conclusion:

School-based CPR training program significantly improved adolescents’ knowledge, skills, and confidence.The notable improvements, especially among girls and across urban- rural settings, highlight its potential to fill critical gaps in emergency response. Scaling this low cost yet impactful intervention could be a vital step towards increasing bystander CPR rates and reducing preventable cardiac deaths in India.