Automated insulin delivery in war refugee children with type 1 diabetes: a 3-year follow-up.

Cardiac arrest represents a critical public health emergency, with out-of-hospital cardiac arrest (OHCA) survival rates remaining low worldwide [,]. In China, the prospective BASIC-OHCA registry reported a crude emergency medical services–assessed OHCA incidence of 95.7 per 100,000 population in 2020, and the overall survival rate at hospital discharge or 30 days was only 1.2% []. This survival figure is substantially lower than the 10% to 16% reported in high-income settings, such as the United States []. The provision of immediate and high-quality cardiopulmonary resuscitation (CPR) by bystanders is the single most crucial factor in improving survival outcomes [,]. In China, however, the prevalence of bystander CPR training remains critically insufficient. A 2023 survey of Chinese middle school students found that only 9.87% had received CPR training [], and a 2024 study of university freshmen reported that 82.61% cited a lack of first aid knowledge as the main barrier to performing CPR []. Global resuscitation bodies, including the International Liaison Committee on Resuscitation (ILCOR) and the European Resuscitation Council (ERC), have promoted universal first aid education. ILCOR launched the World Restart a Heart initiative, while the ERC’s 2015 Kids Save Lives campaign advocates formal school-based CPR training []. Many high-income countries (eg, the United States, Norway, and Japan) have mandated CPR training in primary and secondary school curricula through legislation, a policy that has significantly improved bystander CPR rates []. In China, however, this skills deficit is particularly pronounced among children—potential future first responders—a group that currently receives minimal effective training []. School-age children aged 6 to 12 years have sufficient cognitive ability for basic CPR [], which corresponds to the primary school stage in China—a critical period for health education. Early first aid education fosters long-term response capabilities, and skills acquired can be retained throughout life. Moreover, children can share first aid knowledge with families and friends, thereby contributing to broader public awareness. Current approaches to CPR training for children face several critical challenges, including a shortage of instructors, monotonous training formats that are insufficient to maintain engagement, and a lack of intrinsic motivators [,]. Moreover, existing training models and equipment may not be optimally aligned with children’s developmental characteristics (eg, shorter attention spans and a need for play-based learning) []. Consequently, conventional methods may fail to sustain children’s engagement, a key factor for long-term retention.