We included nine of the 14 papers reviewed and found evidence on the following four topics:

1. The combination of video and facilitator-led learning.
2. The difference in learning outcomes between video-only and facilitator-led learning.
3. The difference between video learning compared to no learning.
4. The effect of using video to learn CPR and how to use a defibrillator.

Our main findings are as follows:

• There is good evidence in favour of combining video instruction with facilitator-led learning for CPR and defibrillator training, compared to video-only learning (Bylow et al., 2019; Godfred et al., 2013; Heard, 2018; Nishiyama et al., 2009). This is particularly evident when the facilitator-led training includes opportunities for learners to practise the skill (De Vries et al., 2010).
• Studies that compared video-only to classroom learning showed mixed results (Beskind et al., 2016; Chung et al., 2010; De Vries et al., 2010; Kim et al., 2016).
• Video learning is effective compared to no learning (Capone, 2000; Eisenberg et al., 1995).

Video and facilitator-led learning

There is adequate evidence on combining video and facilitator-led learning. 

Heard et al. (2019) used a prospective randomised controlled trial that compared a one-minute video, a four-minute online tutorial and a 30-minute facilitator-led session to learn compression-only CPR. The video group was the least effective, while the online group outperformed the classroom group on hand positioning but scored lower on compression depth. 

Godfred et al. (2013) conducted a prospective randomised controlled trial with three groups:

• Untrained
• Watching a 10-minute video on chest compression-only CPR (CCO).
• Watching a 22-minute video on chest compression and ventilation CPR (CCB).

The primary outcome was that participants showed a composite (combined) skill competence of 90 per cent during a five-minute demonstration. The three groups resulted in:

• Untrained before testing (control) – 3% competency.
• 10-minute video (CCO group) – 4.9% competency.
• 22-minute video (CCB group) – 10.1% competency.

The 10-minute CCO group had a greater proportion of correct compressions (p-value = 0.028) and compressions with correct hand placement (p-value = 0.0004) compared to the untrained group. 

Bylow et al. (2019) used a cluster randomised controlled trial to compare the impact of self-led and facilitator-led learning using a standard training CPR video. The self-led group was provided with training instructions based on the video content. The facilitated group was able to ask questions and discuss the video content as part of their training. There was no statistically significant difference between the two groups’ total scores after six months of training. However, the facilitator-led group had a statistically significant higher total score than the self-led learning group immediately after training.

We considered an additional paper with a water safety perspective that investigated the use of video as part of a summer camp’s water safety classroom session for children. The study did not collect data specifically on the video learning element, but the children across all age and ethnic groups improved their knowledge and retention over three weeks (Lawson et al., 2016).

Difference between video-only and facilitator-led learning

Beskind et al. (2016) conducted a cluster randomised controlled trial where one intervention group received a short video on CPR, and another intervention group received a video combined with a 20-minute classroom session. These were compared to a control group that watched a sham video on college recruitment. Results showed that the two intervention groups called 9-1-1 more frequently and sooner; they started chest compressions earlier and had improved chest compression rates and hands-off time post-intervention, compared to their baselines and the control group. Chest compression depth improved significantly from the baseline in the classroom cohort, but not in the video learning cohort neither immediately after the intervention nor two months later. The authors concluded that brief CPR video training resulted in improved CPR quality and responsiveness in high school students. Compression depth only improved with a traditional classroom experience.

De Vries et al. (2010) ran a prospective randomised study with a non-inferiority design that compared facilitator-led defibrillator training to three alternative methods using DVDs consisting of: 2.5 minutes without practice, 4.5 minutes with practice and nine minutes with practice and scenario training. All DVD-based groups performed significantly higher on the retention test (two months after the training) than on the post-test (immediately after the training). Participants who received scenario training also scored significantly higher on the post-test compared to the other DVD-based groups. Still, the study showed that none of the DVD groups was adequate compared to the 90-minute facilitator-led training.

Chung et al. (2010) conducted a prospective randomised controlled trial comparing the effects of video-only and face-to-face facilitation on learning CPR. There was no significant difference between the two groups.

Kim et al. (2016) used a randomised controlled trial to evaluate the effect of patient-centred CPR education delivered through a facilitator, followed by a revision session two weeks later (intervention group). The control group received booklets and a self-directed video with CPR information. Both the intervention and control groups contained 26 participants. Results showed the intervention group demonstrated significant improvements in knowledge (F=91.09, p<.001), confidence (F=15.19, p <.001) and performance of CPR skills (F=8.10, p =.008).

Difference between video learning and no learning

Eisenberg et al. (1995) conducted a prospective randomised controlled trial where half of a community was sent a 10-minute video on CPR (n=8659), and the other half was not (n=8659). For 15 months, all households were monitored for cardiac arrest and whether CPR was administered. In total, 65 cardiac arrests occurred; 31 in homes that had received the video and 34 where they had not. The rate of bystander CPR was 47 per cent in the intervention group and 53 per cent in the control group. In nine instances of cardiac arrest, an individual was present who had watched the video, and in six of these cases, bystander CPR was administered.

Capone et al. (2000) tested the effect of brief first aid skills videos on two groups of factory workers. The intervention group (n=116) watched the videos on television while the control group (n=86) did not. Skills were tested at one week, one month and 13 months. The control group performed 1–31 per cent correctly, and the intervention group performed 9–96 per cent correctly (p<0.001).

Using video to learn CPR and how to use a defibrillator

There is limited, mixed evidence on using video to learn CPR and how to use a defibrillator.

Nishiyama et al. (2009) used a randomised controlled trial to test a simplified compression-only CPR programme. One group received an introductory video beforehand, and the other did not. In a simulation test just before practical training began, 88 (92.6%) participants from the intervention group attempted chest compressions, while only 58 (64.4%) from the control group did (p<0.001). The total number of chest compressions was significantly higher in the intervention group, and the proportion of those who attempted to use a defibrillator was substantially higher as well. After an hour-long practice session, the number of total chest compressions markedly increased regardless of the type of CPR training received and the differences between the two groups became insignificant.

There is insufficient evidence to support using video as a standalone educational tool. There is also not enough evidence to suggest the optimal length or content of a video. Furthermore, we did not find evidence on using videos for first aid topics outside of CPR, which indicates a gap in the evidence base.

While cost might be a barrier to providing video learning, with new and accessible technology, it is now easier to create and share videos with a broad audience. More exploration needs to be done with regards to videos as a learning method for first aid education.

Beskind, D. L., Stolz, U., Thiede, R., Hoyer, R., Burns, W., Brown, J., Ludgate, M., Tiutan, T., Shane, R., McMorrow, D., Pleasants, M., & Panchal, A. R. (2016). Viewing a brief chest-compression-only CPR video improves bystander CPR performance and responsiveness in high school students: A cluster randomized trial. Resuscitation, 104, 28–33.
https://doi.org/10.1016/j.resuscitation.2016.03.022
https://www.sciencedirect.com/science/article/abs/pii/S0300957216300041

Bylow, H., Karlsson, T., Claesson, A., Lepp, M., Lindqvist, J., & Herlitz, J. (2019). Self-learning training versus instructor-led training for basic life support: A cluster randomised trial. Resuscitation, 139, 122–132.
https://doi.org/10.1016/j.resuscitation.2019.03.026
https://research-repository.griffith.edu.au/bitstream/handle/10072/386738/Lepp214313.pdf?sequence=2

Capone, P. L., Lane, J. C., Kerr, C. S., & Safar, P. (2000). Life supporting first aid (LSFA) teaching to Brazilians by television spots. Resuscitation, 47(3), 259–265.
https://doi.org/10.1016/S0300-9572(00)00230-6
https://www.sciencedirect.com/science/article/abs/pii/S0300957200002306

Choa, M., Cho, J., Choi, Y. H., Kim, S., Sung, J. M., & Chung, H. S. (2009). Animation-assisted CPRII program as a reminder tool in achieving effective one-person-CPR performance. Resuscitation, 80(6), 680–684.
10.1016/j.resuscitation.2009.03.019
https://www.sciencedirect.com/science/article/abs/pii/S0300957209001385

Chung C. H., Siu, A. Y., Po L. L., Lam, C.Y., & Wong, P. C. (2010). Comparing the effectiveness of video self instruction versus traditional classroom instruction targeted at cardiopulmonary resuscitation skills for laypersons: a prospective randomised controlled trial. Hong Kong Med Journal, 16(3), 165–170.
https://www.hkmj.org/system/files/hkm1006p165.pdf

De Vries, W., Turner, N. M., Monsieurs, K. G., Bierens, J. J., & Koster, R. W. (2010). Comparison of instructorled automated external defibrillation training and three alternative DVD-based training methods. Resuscitation, 81(8), 1004–1009.
https://doi.org/10.1016/j.resuscitation.2010.04.006
https://www.sciencedirect.com/science/article/abs/pii/S0300957210002327

Eisenberg, M., Damon, S., Mandel, L., Tewodros, A., Meischke, H., Beaupied, E., Bennett, J., Guildner, C., Ewell, C., & Gordon, M. (1995). CPR instruction by videotape: results of a community project. Annals of emergency medicine, 25(2), 198–202.
DOI: 10.1016/s0196-0644(95)70324-1
https://www.sciencedirect.com/science/article/abs/pii/S0196064495703241

Godfred, R., Huszti, E., Fly, D., & Nichol, G. (2013). A randomized trial of video self-instruction in cardiopulmonary resuscitation for lay persons. Scandinavian Journal of Trauma Resuscitation and Emergency Medicine, 21, 36.
DOI: 10.1186/1757-7241-21-36
https://link.springer.com/article/10.1186/1757-7241-21-36

Heard, D. G., Andresen, K. H., Guthmiller, K. M., Lucas, R., Heard, K. J., Blewer, A. L., Abella, B. S., Gent, L. M., & Sasson, C. (2019). Hands-only cardiopulmonary resuscitation education: A comparison of on-screen with compression feedback, classroom, and video education. Annals of Emergency Medicine, 73(6), 599–609.
DOI:https://doi.org/10.1016/j.annemergmed.2018.09.026
https://www.sciencedirect.com/science/article/abs/pii/S0196064418312861

Kim, H. S., Kim, H. J., & Suh, E. E. (2016). The effect of patient-centered CPR education for family caregivers of patients with cardiovascular diseases. Journal of Korean Academic Nursing, 46(3), 463–474.
https://doi.org/10.4040/jkan.2016.46.3.463
https://synapse.koreamed.org/DOIx.php?id=10.4040/jkan.2016.46.3.463

Lawson, K. A., Duzinski, S. V., Wheeler, T., Yuma-Guerrero, P. J., Johnson, K. M., Maxson, R. T., & Schlechter, R. (2012). Teaching safety at a summer camp: evaluation of a water safety curriculum in an urban community setting. Health Promotion Practice, 13(6), 835–841.
https://doi.org/10.1177/1524839911399428

Nishiyama, C., Iwami, T., Kawamura, T., Ando, M., Kajino, K., Yonemoto, N., Fukuda, R., Yuasa, H., Yokoyama, H., & Nonogi, H. (2009). Effectiveness of simplified chest compression-only CPR training program with or without preparatory self-learning video: A randomized controlled trial. Resuscitation, 80(10), 1164–1168.
DOI:https://doi.org/10.1016/j.resuscitation.2009.06.019
https://www.sciencedirect.com/science/article/abs/pii/S0300957209003347