Attitudes and willingness toward out-of-hospital cardiopulmonary resuscitation: a questionnaire study among the public trained online in China

Factors influencing civil servants' willingness to implement cardiopulmonary resuscitation in Chongqing, China: Based on the theory of planned behavior

Background

Timely bystander cardiopulmonary resuscitation is the key to improving the survival rate of out-of-hospital cardiac arrest. Civil servants are potential bystander CPR providers. This study aimed to explore civil servants' willingness to implement CPR in Chongqing, identify the influencing factors and mechanisms affecting civil servants' willingness to perform CPR, and then seek countermeasures to improve civil servants' willingness to implement CPR.

Methods

We introduced the theory of perceived risk into the theory of planned behavior, developed a 7-point Likert scale based on the extended theory of planned behavior, and conducted a questionnaire survey on civil servants in Chongqing, China. Descriptive statistical analysis and one-way ANOVA were employed to explore respondents' willingness and differences. Structural equation modeling was used to analyze the relationship between attitude, subjective norm, perceived behavioral control and perceived risk and respondents' willingness to implement CPR.

Results

A total of 1235 valid questionnaires were included for analysis. 50.1 % of respondents were willing to implement CPR. Male, over 40 years old, living with the elderly, having previous experience performing CPR on another person, and having higher CPR knowledge scores were associated with a more positive willingness to perform CPR. Attitude, subjective norm and perceived behavioral control had significant positive effects on willingness, and the standardized regression coefficients were 0.164, 0.326 and 0.313, respectively. The perceived risk has a significant negative effect on willingness, and the standardized regression coefficient was -0.109. The four latent variables accounted for 44.2 % of the variance in the willingness of civil servants to implement CPR.

Conclusions

The willingness of civil servants in Chongqing to implement CPR needs to be improved, and the countermeasures to enhance the subjective norm and perceived behavioral control of civil servants should be emphasized, such as developing a social support network for rescuing conduct, establishing regular training mechanisms and improving the practical applicability and popularization of the Chinese-style "Good Samaritan Law" etc., to improve the willingness of civil servants in Chongqing to implement CPR.

Nurses' motivation for performing cardiopulmonary resuscitation: a cross-sectional study

BACKGROUND

Nurse motivation can have a significant impact on the quality of cardiopulmonary resuscitation and the patients' survival. Therefore, the present study aimed to examine nurses' motivation for performing cardiopulmonary resuscitation.

METHODS

This cross-sectional study focused on 217 nurses in a teaching hospital in Iran, in 2023. A random sample of nurses was selected from four hospital departments (emergency, critical care, medical, and surgery). These nurses completed the demographic information and motivation for cardiopulmonary resuscitation questionnaires. The data were analyzed using Mann-Whitney, Spearman coefficients, and Kruskal-Wallis and multiple linear regression tests.

RESULTS

The mean score of the dimension of the feeling of achievement (4.10 ± 0.50) was high in the nurses' motivation for performing cardiopulmonary resuscitation. There were more motivational factors in the emergency department compared to the other departments in terms of the feeling of achievement, high chance of success, low chances of success, recognition and appreciation, perceived importance, and beliefs (p < 0.05). The nurses who had participated in cardiopulmonary resuscitation workshops and had a bachelor's degree had a higher mean score in the dimension of perceived importance (p < 0.05). The correlation coefficient showed that there was a significant negative correlation between the nurses' frequency of participation in cardiopulmonary resuscitation and their motivation scores in the dimensions of the feeling of achievement(r=-0.170), low chances of success(r=-0.183), perceived importance (r = -0.302), and beliefs (r = -0.250; p < 0.05). The department variable predicted the motivation score in the dimensions of feeling of achievement, high chance of success, low chance of success, perceived importance, and beliefs. The sex variable predicted the motivation score in the dimensions of facilitator of resuscitation and high chance of success. Besides, the variable of years of membership in the CPR team predicted the motivation score in the feeling of achievement and high chance of success (p < 0.05).

CONCLUSION

Nurses would be more motivated to perform a quality cardiopulmonary resuscitation if they had a feeling of success. The nurses' motivation was affected by certain factors such as their department, sex, education level, years of membership in CPR team, number of participation in CPR, and participation in educational workshops.

Online platform for cardiopulmonary resuscitation and automated external defibrillator training in a rural area: a community clinical trial protocol

INTRODUCTION

Sudden death resulting from cardiorespiratory arrest carries a high mortality rate and frequently occurs out of hospital. Immediate initiation of cardiopulmonary resuscitation (CPR) by witnesses, combined with automated external defibrillator (AED) use, has proven to double survival rates. Recognising the challenges of timely emergency services in rural areas, the implementation of basic CPR training programmes can improve survival outcomes. This study aims to evaluate the effectiveness of online CPR-AED training among residents in a rural area of Tarragona, Spain.

METHODS

Quasi-experimental design, comprising two phases. Phase 1 involves assessing the effectiveness of online CPR-AED training in terms of knowledge acquisition. Phase 2 focuses on evaluating participant proficiency in CPR-AED simulation manoeuvres at 1 and 6 months post training. The main variables include the score difference between pre-training and post-training test (phase 1) and the outcomes of the simulated test (pass/fail; phase 2). Continuous variables will be compared using Student's t-test or Mann-Whitney U test, depending on normality. Pearson's χ2 test will be applied for categorical variables. A multivariate analysis will be conducted to identify independent factors influencing the main variable.

ETHICS AND DISSEMINATION

This study adheres to the tenets outlined in the Declaration of Helsinki and of Good Clinical Practice. It operated within the Smartwatch project, approved by the Clinical Research Ethics Committee of the Primary Care Research Institute IDIAP Jordi Gol i Gurina Foundation, code 23/081-P. Data confidentiality aligns with Spanish and European Commission laws for the protection of personal data. The study's findings will be published in peer-reviewed journals and presented at scientific meetings.

TRIAL REGISTRATION NUMBER

NCT05747495.

Willingness and Barriers to Undertaking Cardiopulmonary Resuscitation Reported by Medical Students after the SARS-CoV-2 Pandemic-Single-Center Study

Most of the studies in the field of willingness and barriers to resuscitation (CPR) were conducted before the SARS-CoV-2 pandemic. The aim of the study was to assess the number and types of barriers to CPR among medical students after the pandemic ended. This study was based on a survey. The data was collected from 12 April 2022 to 25 May 2022. A total of 509 complete questionnaires were obtained. The number of barriers depending on the time elapsed from the last CPR course did not differ significantly (Me = 4 [IQR 2-6] vs. Me = 5 [IQR 3-7]; p = 0.054, respectively). The number of all barriers reported by respondents differed significantly and was higher in those reporting fear of coronavirus (Me = 4 [IQR 2-6] vs. Me = 7 [IQR 4-9]; p < 0.001, respectively). A total of 12 out of all 23 barriers were significantly more frequent in this group of respondents. Barriers to CPR are still common among medical students, even despite a high rate of CPR training. The pandemic significantly affected both the number and frequency of barriers. The group of strangers and children, as potential cardiac arrest victims, deserve special attention. Efforts should be made to minimize the potentially modifiable barriers.

Urban residents' self-rescue in response to public health emergencies in China: a qualitative study

BACKGROUND

The abject uncertainty and unpredictability of public health emergencies have plagued various countries. Global health governance and international communities are facing long-term and arduous challenges. The self-rescue ability of individuals in a public emergency may be the most powerful trait to improve the survival rate outside the hospital. The study explores the cognitive ability and attitudes of urban residents in China towards self-rescue in response to public health emergencies. It provides appropriate evidence for improving the self-rescue ability of urban residents in China.

METHODS

Sixteen urban residents were selected using the purposive sampling method for semi-structured interviews. Theme analysis was used to collate and analyse the interview data.

RESULTS

Two themes and five sub-themes were analysed. The two themes included cognition and attitude of Chinese urban residents for self-rescue in an emergency. Urban residents believed that their knowledge and skills for self-rescue in an emergency were low. The ability for emergency self-rescue is affected by multiple factors, with relatively limited options for improvement. Nonetheless, the respondents expressed a desire to accept interventions under psychological crisis and a strong willingness to acquire knowledge and skills required for emergency self-rescue.

CONCLUSION

This study investigated the perceptions and attitudes of Chinese urban residents towards emergency self-rescue. The results support enhanced ability of urban residents to respond to public health emergencies, thereby diminishing the negative outcomes. The findings suggest the need for strategies to address the factors affecting emergency self-rescue.

Attitudes of Asian and Polish Adolescents towards the Use of Ecological Innovations in CPR Training

BACKGROUND

The potential use of manikins made of environmentally friendly materials (biodegradable or easily recycled) could be a milestone in promoting cardiac arrest awareness and mass resuscitation training without the threat of generating large amounts of unprocessable waste. The main aim of the study was to compare the attitude of young adults from Asia and Poland towards cardiopulmonary resuscitation training forms and to evaluate the innovative concept of an ecological resuscitation manikin; Methods: This was a survey-based study conducted during two events in Thailand and Poland in 2023; Results: A total of 226 questionnaires were included in the final analysis. Asian respondents were significantly more likely to choose traditional training than Polish participants (78% vs. 58%, respectively). A manikin that is mainly biodegradable was the most common choice across the entire study group. Young Asians were significantly more likely to choose a traditional stationary course, while Polish respondents were highly significantly more likely to opt for hybrid training (online with practical training provided at the student's home).

CONCLUSIONS

In the total study group, young people from Poland and parts of Asia are most likely to participate in traditional on-site instructor-led training, but a comparison across groups showed a significant tendency for young Poles to choose a hybrid training option, i.e., a combination of online and hands-on training. Despite some differences, both study groups showed a strong interest in pro-environmental behavior and the use of more ecofriendly solutions than previously used in resuscitation training.

Attitudes and willingness toward out-of-hospital CPR and AED: A questionnaire study among Chinese middle school students

Objectives

This study's purpose was to assess the attitudes and willingness of middle school students to perform cardiopulmonary resuscitation (CPR) and to use automated external defibrillator (AED) in emergencies, and to evaluate the overall effects of first aid training.

Results

Middle school students demonstrated a high willingness to learn CPR (95.87%) and AED (77.90%). However, the rate of CPR (9.87%) and AED (3.51%) training was relatively low. These trainings could improve their confidence while facing emergencies. Their main concerns were "Lack of first aid knowledge", "Lack of confidence in rescue skills" and "Fear of hurting the patient".

Conclusions

Chinese middle school students are willing to learn CPR and AED skills, but relative trainings are insufficient and should be reinforced.

Survival outcome among patients with out-of-hospital cardiac arrest who received cardiopulmonary resuscitation in China: a systematic review and meta-analysis

BACKGROUND

This study aimed to assess the survival outcomes among patients with out-of-hospital cardiac arrest (CA) who received cardiopulmonary resuscitation (CPR) in China.

METHODS

Relevant studies, published between January 1, 2010 and September 5, 2022, were retrieved from databases, including EMBASE, PubMed, Cochrane Library, the China Biology Medicine disk, China National Knowledge Infrastructure, and Wanfang databases. We included clinical studies in which all patients were diagnosed with CA and underwent out-of-hospital CPR, and the outcome variables were at least one of the following: return of spontaneous circulation (ROSC), survival to admission, survival to hospital discharge, 1-month survival, achieved good neurological outcomes, and 1-year survival. Two investigators independently extracted the study data and assessed its quality using a modified Newcastle-Ottawa Scale tool. The data were pooled using random-effects models.

RESULTS

Of the 3620 identified studies, 49 (63,378 patients) were included in the meta-analysis. The pooled ROSC rate was 9.0% (95% confidence interval [CI] 7.5-10.5%, I² = 97%), the pooled survival to admission rate was 5.0% (95% CI 2.7-8.0%, I² = 98%), and the pooled survival to discharge rate was 1.8% (95% CI 1.2-2.5%, I² = 95%). Additionally, the ROSC rate of patients with bystander CPR was significantly higher than that of those without bystander CPR, and the pooled odds ratio (OR) was 7.92 (95% CI 4.32-14.53, I² = 85%). The ROSC rate of participants who started CPR within 5 min was significantly higher than that of those who started CPR after 5 min, and the pooled OR was 5.92 (95% CI 1.92-18.26, I² = 85%). The ROSC rate of participants with defibrillation was significantly higher than that of those without defibrillation, and the pooled OR was 8.52 (95% CI 3.72-19.52, I² = 77%).

CONCLUSION

The survival outcomes of out-of-hospital CPR in China are far below the world average. Therefore, the policy of providing automated external defibrillators (AEDs) in public places and strengthening CPR training for healthcare providers and public personnel should be encouraged and disseminated nationwide. Trial registration This study was registered in PROSPERO (CRD42022326165) on 29 April 2022.

Willingness and Predictors of Bystander CPR Intervention in the COVID-19 Pandemic: A Survey of Freshmen Enrolled in a Japanese University

The coronavirus disease 2019 (COVID-19) pandemic has decreased bystander cardiopulmonary resuscitation (BCPR) intervention rates. The purpose of this study was to elucidate the willingness of university freshmen to provide BCPR during the COVID-19 pandemic and the predictors thereof. A cross-sectional survey of 2789 newly enrolled university students was conducted after the end of the sixth wave of the COVID-19 epidemic in Japan; predictors of willingness to provide BCPR were assessed by regression analysis. Of the 2534 participants 1525 (60.2%) were willing to intervene and provide BCPR during the COVID-19 pandemic. Hesitancy due to the anxiety that CPR intervention might result in poor prognosis was a negative predictor of willingness. In contrast, anxiety about the possibility of infection during CPR intervention did not show a negative impact. On the other hand, interest in CPR and willingness to participate in a course, confidence in CPR skills, awareness of automated external defibrillation, and knowledge of CPR during the COVID-19 pandemic, were also positive predictors. This study suggests that the barrier to willingness to intervene with BCPR during a COVID-19 pandemic is not fear of infection, but rather hesitation due to the possibility of poor prognosis from the intervention. The significance of conducting this study during the COVID-19 epidemic is great, and there is an urgent need for measures to overcome hesitation regarding BCPR.

Factors Influencing Self-Confidence and Willingness to Perform Cardiopulmonary Resuscitation among Working Adults-A Quasi-Experimental Study in a Training Environment

Background: There is a potential relationship between the self-confidence and the willingness of bystanders to undertake resuscitation (CPR) and its training. The current guidelines increasingly focus on both the importance of the human factor and the fact that training programs should increase the willingness of bystanders to undertake resuscitation, which may have a direct impact on improving survival in out-of-hospital cardiac arrest (OHCA). Aim: The objective of the study was to analyze factors influencing the assessment of own skills crucial in basic life support (BLS) and the willingness to provide CPR to individual victims. Methods: A pre-test and post-test quasi-experimental design was used in this study. The data was collected from 4 December 2019 to 3 October 2020 in workplaces, during instructor-led BLS courses. Each intervention (training) consisted of a theoretical and a practical part. The program was focused both on the skills and the human factor. Results: Comparison of pre-test and post-test data concerning self-confidence scores of the ability to recognize OHCA among 967 participants demonstrated a significant difference (respectively, Me = 2.2, IQR [2−3] vs. Me = 3.4, IQR [3−4]; p = 0.000). Additionally, self-assessment scores for the ability to perform proper chest compressions between pre-test and post-test also differed significantly (respectively Me = 2.3, IQR [2−3] vs. Me = 3.3, IQR [3−4]; p = 0.000). A highly significant difference was found in the likelihood of changing the decision in favor of the willingness to undertake CPR for all types of victims, with the greatest difference found in relation to the willingness to conduct resuscitation on strangers (OR = 7.67, 95% CI 5.01−11.73; p < 0.01). Conclusions: Completing hands-on training has a highly significant, beneficial effect on the readiness to undertake resuscitation for all types of victims, strangers in particular. Training programs should place particular emphasis on developing readiness to undertake resuscitation for both those who have never been trained and those who had their last training more than one year ago.

Laypersons' Psychological Barriers Against Rescue Actions in Emergency Situations - A Questionnaire Survey

BACKGROUND

Although bystanders' performance is important to improve outcomes of patients after cardiac arrests, few studies have investigated the barriers of bystanders, including those who could not perform cardiopulmonary resuscitation or any other rescue actions in emergency situations. This study aimed to assess the relationship between the psychological barriers of laypersons who encountered emergency situations and their rescue actions.Methods and Results:A questionnaire survey was conducted and this included laypersons who had encountered emergency situations during the last 5 years. Six questions were about the psychological barriers and 8 questions were about the laypersons' rescue actions. The primary outcome was any rescue actions performed by laypersons in an actual emergency situation. Overall, 7,827 (92.8%) of 8,430 laypersons responded; of them, 1,361 (16.1%) had encountered emergency situations during the last 5 years, and 1,220 (14.5%) were eligible for inclusion in the analyses. Of the 6 psychological barriers, "fear of approaching a collapsed person" (adjusted odds ratio [AOR] 0.50; 95% confidence interval [95% CI] 0.32-0.79) and "difficulties in judging whether to perform any rescue action" (AOR 0.63; 95% CI 0.40-0.99) were significantly associated with performing any rescue actions.

CONCLUSIONS

The fear of approaching a collapsed person and difficulties in judging whether to take any actions were identified as the psychological barriers in performing any rescue actions by laypersons who encountered emergency situations.

Study department and gender affects the knowledge and attitude of students towards cardio pulmonary resuscitation procedure at the University of Gondar, northwest Ethiopia, 2019

Cardiopulmonary Resuscitation (CPR) life-saving procedures, for emergency case purposes, to increase the victim's blood circulation and oxygen for vital organs. The World Health Organization and American Heart Association recommended that CPR learns from schools to increase the rate and reduce mortality. There is no known level of Knowledge and attitude acquisition towards CPR for graduate medical and health science students at the University of Gondar. This study aimed to assess knowledge, attitude, and associated factors towards CPR among final year undergraduate students at the University of Gondar, Northwest Ethiopia.

METHODS

An institution-based prospective cross-sectional study was conducted among 422 participants. A simple random sampling technique was used to draw the study participants. A pre-tested self-administered questioner was used to collect the data. Data was entered into Epi-info version7 and analysis by SPSS version20. Descriptive statics of frequency and percentage was done and presented by tables and figures. Logistic regression analysis was done. In bi-variable logistic regression analysis, variables P.V<0.2 were entered to multivariable analysis and statistical significance was declared at P.V<0.05 with 95% Confidence Interval (CI).

RESULTS

In this study; more than half of the participants, 58.8% were males. The mean ages were 24.5 ± (SD2.48). The knowledge and attitude levels of the study participant for CPR were [44.1%, 95% CI: (39.3-49.3)], and [45.7%, 95% CI: (41.0-50.5)], respectively. Age ranges from 20-24; [AOR = 1.73 (1.06-2.84)], medical students [AOR = 9.69 (5.06-18.56)], and advance nursing students [AOR = 4.63 (1.71-9.48)] were significantly associated to Knowledge. Male participants [AOR = 2.00 (1.32-3.01)], and age ≥25 years old [AOR = 1.90 (1.27-2.86)] were significantly associated with the attitude of CPR.

CONCLUSIONS

The level of knowledge and attitude of this study was not sufficient and favorable. Age and department are associated with knowledge of CPR, in turn, sex and age are also similarly associated with attitude. The authors recommended that CPR should be given an in the common course for all departments by revising their curriculum with up-to-date information, engaged female students to participate in life-saving procedure to adapt and perform at the health care, community, or whatever the causality founds.

Analysis of the Status Quo and Influencing Factors of Community Residents' Awareness of Basic Life Support and Willingness to Attempt Rescue

Objective

This study aimed to investigate community residents’ awareness of basic life support (BLS) and their willingness to attempt rescue.

Methods

From October to December 2020, in the communities of Nantong City, a stratified three-stage random sampling method was adopted to select residents from 12 neighborhood committees over the age of 18 with whom to conduct a cross-sectional questionnaire survey. A self-designed questionnaire was adopted, the contents of which included the general situation of the respondent, knowledge, attitude, and behavior in relation to BLS; the Cronbach’s α coefficient of the questionnaire was 0.719.

Results

A total of 3000 questionnaires were distributed, of which 2812 were valid, with a valid response rate of 93.73%. Of the 2812 respondents, 41.18% had seen an automatic external defibrillator (AED), 48.83% had experience of’ cardiopulmonary resuscitation (CPR), and 25.07% of the respondents had experience of’ AEDs. When an accident occurred, 50.50% of residents were willing to attempt rescue, 70.80% were willing to attempt rescue under professional guidance, and 71.23% were willing to attempt rescue after learning BLS techniques. Of the residents who were unwilling to attempt rescue, 32.75% were worried about their lack of ability, 27.91% were concerned about legal issues, 14.01% feared infectious diseases, and 10.35% were unwilling to perform mouth-to-mouth artificial respiration. Age, occupation, education level, and whether they had participated in first aid training were the influencing factors.

Conclusion

Residents in Nantong have less knowledge of BLS, and their knowledge of CPR is better than that of AEDs. Residents have a strong willingness to learn BLS. Measures need to be taken to improve their understanding of BLS and their application skills. Residents have high levels of willingness to attempt rescue, but a certain percentage of residents have concerns. Interventions can be made to target the different reasons.