Do-it-yourself PET-bottle manikin: An understudied means for enhancing massive CPR training in a simple and affordable way

To the Editor

Effective training of lay people in cardiopulmonary resuscitation (CPR) is recognised as an important contributor to increased survival rates from cardiac arrest. However, owing to high risk of COVID-19, it is currently recommended to refrain from traditional instructor-led resuscitation training. As an alternative, individual self-directed learning is advisable [1]. Self-instruction programs utilising video or on-line learning with synchronous or asynchronous hands-on practice were shown to be at least as effective as classroom training both in producing necessary skills and improving willingness of trainees to attempt CPR.

For practicing resuscitation skills in individual environment, a manikin is required. Whereas simplified inflatable CPR manikins suitable for home use are currently available on market, a need to spend time and money to buy the manikin may limit motivation to initiate or complete the training. An interesting option for those who want to get a dummy right away and at no cost is the creation of a homebrew manikin.

The idea is not new. Two eighth grade schoolboys from New Jersey were probably the first inventors of a homemade CPR manikin as early as in 1960-s [2]. Using materials at hand (an empty one-gallon bleach bottle, a plastic bag, a book and a tape) they built a dummy for practicing rescue breathing in first aid classes. Nowadays, by searching online one can find a number of tutorials on how to make a manikin for practicing chest compressions at home from a recyclable polyethylene terephthalate (PET) bottle — one of the most common forms of our household waste. However, the scientific understanding for effects of resuscitation training with manikins made of PET bottles seems to be limited.

A comprehensive literature search conducted in mid-February 2021 revealed a total of three studies which evaluated effects of hands-on CPR training utilising PET-bottle manikins. Two randomised studies comparing effects of brief training in chest compressions with a PET-bottle manikin made by schoolchildren or a commercially available CPR manikin were reported by Piscopo et al. in conference abstracts [3,4]. Based on the post-training automated skills assessments, there were no significant between-group differences in compressions performance. Another recent observational study by Nakagawa and colleagues [5] showed that according to instructors' subjective assessments of resuscitation performance, a 40-minute CPR training program with a low-cost handmade PET-bottle manikin was adequate to acquire skills of chest-compression-only CPR in at least 89% lay trainees.

Taken together, these findings suggest a promising role for a do-it-yourself PET-bottle manikin in promoting massive training in resuscitation in a simple way and at no cost. In particular, it may add a tactile component to a home-based self-directed learning for individuals who are unlikely to participate in traditional classroom training due to low resources or restrictions related to the ongoing pandemic. Further experimental investigations are required in order to determine the optimal design of a PET-bottle manikin and to investigate effects of different modalities of training with handmade manikins on acquisition and retention of resuscitation competencies and on willingness of laypeople to undertake CPR.

Declaration of competing interest

The author declared no conflicts of interest.