Social attitude and willingness to attend cardiopulmonary resuscitation training and perform resuscitation in the Crimea

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.

2023 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations: Summary From the Basic Life Support; Advanced Life Support; Pediatric Life Support; Neonatal Life Support; Education, Implementation, and Teams; and First Aid Task Forces

The International Liaison Committee on Resuscitation engages in a continuous review of new, peer-reviewed, published cardiopulmonary resuscitation and first aid science. Draft Consensus on Science With Treatment Recommendations are posted online throughout the year, and this annual summary provides more concise versions of the final Consensus on Science With Treatment Recommendations from all task forces for the year. Topics addressed by systematic reviews this year include resuscitation of cardiac arrest from drowning, extracorporeal cardiopulmonary resuscitation for adults and children, calcium during cardiac arrest, double sequential defibrillation, neuroprognostication after cardiac arrest for adults and children, maintaining normal temperature after preterm birth, heart rate monitoring methods for diagnostics in neonates, detection of exhaled carbon dioxide in neonates, family presence during resuscitation of adults, and a stepwise approach to resuscitation skills training. Members from 6 International Liaison Committee on Resuscitation task forces have assessed, discussed, and debated the quality of the evidence, using Grading of Recommendations Assessment, Development, and Evaluation criteria, and their statements include consensus treatment recommendations. Insights into the deliberations of the task forces are provided in the Justification and Evidence-to-Decision Framework Highlights sections. In addition, the task forces list priority knowledge gaps for further research. Additional topics are addressed with scoping reviews and evidence updates.

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.

2023 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations: Summary From the Basic Life Support; Advanced Life Support; Pediatric Life Support; Neonatal Life Support; Education, Implementation, and Teams; and First Aid Task Forces

The International Liaison Committee on Resuscitation engages in a continuous review of new, peer-reviewed, published cardiopulmonary resuscitation and first aid science. Draft Consensus on Science With Treatment Recommendations are posted online throughout the year, and this annual summary provides more concise versions of the final Consensus on Science With Treatment Recommendations from all task forces for the year. Topics addressed by systematic reviews this year include resuscitation of cardiac arrest from drowning, extracorporeal cardiopulmonary resuscitation for adults and children, calcium during cardiac arrest, double sequential defibrillation, neuroprognostication after cardiac arrest for adults and children, maintaining normal temperature after preterm birth, heart rate monitoring methods for diagnostics in neonates, detection of exhaled carbon dioxide in neonates, family presence during resuscitation of adults, and a stepwise approach to resuscitation skills training. Members from 6 International Liaison Committee on Resuscitation task forces have assessed, discussed, and debated the quality of the evidence, using Grading of Recommendations Assessment, Development, and Evaluation criteria, and their statements include consensus treatment recommendations. Insights into the deliberations of the task forces are provided in the Justification and Evidence-to-Decision Framework Highlights sections. In addition, the task forces list priority knowledge gaps for further research. Additional topics are addressed with scoping reviews and evidence updates.

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.

Disparities in layperson resuscitation education: A scoping review

BACKGROUND

The aim of this scoping review was to identify factors that would enable or hinder the opportunity for laypersons to undertake resuscitation education.

METHODS

We searched PubMed, Ovid EMBASE, CINAHL, and the Cochrane Central Register of Controlled Trials (CENTRAL) to identify studies published from January 1, 1966 to December 31, 2022 including factors that could influence laypersons to undertake resuscitation education. Data regarding participant characteristics, interventions, and design and outcomes of included studies were extracted.

RESULTS

Of the initially identified 6627 studies, 23 studies (20 cross-sectional and 3 cohort studies) were finally included. Among them, a wide variety of enablers and barriers were identified. High heterogeneity among studies was observed. We categorized factors into three themes: personal factors (age, sex, race, family status, language, prior experience of resuscitation, and immigration status), socioeconomic and educational factors (income, societal status, occupation and legislation, and educational attainment), and geographic factors (birthplace and habitancy). Several barriers were identified that affect laypersons from participating in resuscitation training, such as personal factors like advanced age, lower socioeconomic and educational status, as well as being part of marginalized groups due to race or language barriers. On the other hand, several enablers identified in the study included prior experiences of witnessing someone collapsing, awareness of automated external defibrillators in public locations, certain occupations, or legal requirements for training.

CONCLUSIONS

Various barriers and enablers were found to influence laypersons to participate in resuscitation training. To enhance layperson response to cardiac arrest, targeted initiatives that aim to eliminate barriers need to be initiated, and further research is required to explore factors relating to populations with special needs.

Factors and Barriers on Cardiopulmonary Resuscitation and Automated External Defibrillator Willingness to Use among the Community: A 2016-2021 Systematic Review and Data Synthesis

Background

Bystander cardiopulmonary resuscitation (CPR) and using an automated external defibrillator (AED) can improve out-of-hospital cardiac arrest survival. However, bystander CPR and AED rates remained consistently low. The goal of this systematic review was to assess factors influencing community willingness to perform CPR and use an AED for out-of-hospital cardiac arrest survival (OHCA) victims, as well as its barriers.

Methods

The review processes (PROSPERO: CRD42021257851) were conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) review protocol; formulation of review questions; systematic search strategy based on identification, screening, and eligibility using established databases including Scopus, Web of Science, and Medline Complete via EBSCOhost; quality appraisal; and data extraction and analysis. There is identification of full-text journal articles that were published between 2016 and 2021 and written in English.

Results

Of the final 13 articles, there are six identified factors associated with willingness to perform CPR and use an AED, including socio-demographics, training, attitudes, perceived norms, self-efficacy, and legal obligation. Younger age, men, higher level of education, employed, married, having trained in CPR and AED in the previous 5 years, having received CPR education on four or more occasions, having a positive attitude and perception toward CPR and AED, having confidence to perform CPR and to apply an AED, and legal liability protection under emergency medical service law were reasons why one would be more likely to indicate a willingness to perform CPR and use an AED. The most reported barriers were fear of litigation and injuring a victim.

Conclusions

There is a need to empower all the contributing factors and reduce the barrier by emphasizing the importance of CPR and AEDs. The role played by all stakeholders should be strengthened to ensure the success of intervention programs, and indirectly, that can reduce morbidity and mortality among the community from OHCA.

Global prevalence of basic life support training: A systematic review and meta-analysis

BACKGROUND AND AIMS

Out-of-hospital cardiac arrest exerts a large disease burden, which may be mitigated by bystander cardiopulmonary resuscitation and automated external defibrillation. We aimed to estimate the global prevalence and distribution of bystander training among laypersons, which are poorly understood, and to identify their determinants.

METHODS

We searched electronic databases for cross-sectional studies reporting the prevalence of bystander training from representative population samples. Pooled prevalence was calculated using random-effects models. Key outcome was cardiopulmonary resuscitation training (training within two-years and those who were ever trained). We explored determinants of interest using subgroup analysis and meta-regression.

RESULTS

28 studies were included, representing 53,397 laypersons. Among national studies, the prevalence of cardiopulmonary resuscitation training within two-years and among those who were ever trained, and automated external defibrillator training was 10.02% (95% CI 6.60-14.05) and 39.64% (95%CI 29.11-50.67), and 15.70% (95% CI 10.17-22.18) respectively. Subgroup analyses by continent revealed pooled prevalence estimates of 31.58% (95%CI 18.70-46.09), 52.62% (95%CI 38.40-66.63), 18.93 (95%CI 0.00-62.94), 64.97% (95%CI 64.00-65.93), and 50.56% (95%CI 47.57-53.54) in Asia, Europe, Middle East, North America, and Oceania respectively, with significant subgroup differences (p<0.01). A country's income and cardiopulmonary resuscitation training (ever trained) (p=0.033) were positively correlated. Similarly, this prevalence was higher among the employed (p<0.00001) and highly educated (p<0.00001).

CONCLUSIONS

Large regional variation exists in data availability and bystander training prevalence. Socioeconomic status correlated with prevalence of bystander training, and regional disparities were apparent between continents. Bystander training should be promoted, particularly in Asia, Middle East, and low-income regions. Data availability should be encouraged from under-represented regions.

The psychological and behavioural factors associated with laypeople initiating CPR for out-of-hospital cardiac arrest: a systematic review

BACKGROUND

Prompt, effective CPR greatly increases the chances of survival in out-of-hospital c ardiac arrest. However, it is often not provided, even by people who have previously undertaken training. Psychological and behavioural factors are likely to be important in relation to CPR initiation by lay-people but have not yet been systematically identified.

METHODS

Aim: to identify the psychological and behavioural factors associated with CPR initiation amongst lay-people.

DESIGN

Systematic review Data sources: Cochrane Library, MEDLINE, EMBASE, CINAHL, PsycInfo and Google Scholar.

STUDY ELIGIBILITY CRITERIA

Primary studies reporting psychological or behavioural factors and data on CPR initiation involving lay-people published (inception to 31 Dec 2021).

STUDY APPRAISAL AND SYNTHESIS METHODS

Potential studies were screened independently by two reviewers. Study characteristics, psychological and behavioural factors associated with CPR initiation were extracted from included studies, categorised by study type and synthesised narratively.

RESULTS

One hundred and five studies (150,820 participants) comprising various designs, populations and of mostly weak quality were identified. The strongest and most ecologically valid studies identified factors associated with CPR initiation: the overwhelming emotion of the situation, perceptions of capability, uncertainty about when CPR is appropriate, feeling unprepared and fear of doing harm. Current evidence comprises mainly atheoretical cross-sectional surveys using unvalidated measures with relatively little formal testing of relationships between proposed variables and CPR initiation.

CONCLUSIONS

Preparing people to manage strong emotions and increasing their perceptions of capability are likely important foci for interventions aiming to increase CPR initiation. The literature in this area would benefit from more robust study designs.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO: CRD42018117438.

"Needed but lacked": Exploring demand- and supply-side determinants of access to cardiopulmonary resuscitation training for the lay public in China

Background

Despite years of public cardiopulmonary resuscitation (CPR) training efforts, the training rate and survival following out-of-hospital cardiac arrest (OHCA) have increased modestly in China. Access is imperative to increase the public CPR training rate, which is determined by both demand- (e.g., the lay public) and supply-side (e.g., CPR trainers) factors. We aimed to explore the demand and supply determinants of access to CPR training for the lay public in China.

Methods

Qualitative semi-structured interviews were conducted with 77 laypeople (demand side) and eight key stakeholders from CPR training institutions (supply side) in Shanghai, China. The interview guide was informed by Levesque et al. healthcare access framework. Data were transcribed, quantified, described, and analyzed through thematic content analysis.

Results

On the demand side, the laypeople's ability to perceive their need and willingness for CPR training was strong. However, they failed to access CPR training mainly due to the lack of information on where to get trained. Overestimation of skills, optimism bias, and misconceptions impeded laypeople from attending training. On the supply side, trainers were able to meet the needs of the trainees with existing resources, but they relied on participants who actively sought out and registered for training and lacked an understanding of the needs of the public for marketing and encouraging participation in the training.

Conclusion

Insufficient information and lack of initiative on the demand side, lack of motivation, and understanding of public needs on the supply side all contributed to the persistently low CPR training rate in China. Suppliers should integrate resources, take the initiative to increase the CPR training rate, innovate training modes, expand correct publicity, and establish whole-process management of training programs.

Effects of different cardiopulmonary resuscitation education interventions among university students: A randomized controlled trial

Cardiopulmonary resuscitation (CPR) education for the public may improve bystander intention to perform CPR on cardiac arrest patients. Studies have shown that different CPR education intervention methods can improve learning performance, with key indicators including attitude toward to CPR, intention to perform CPR, and degree of CPR knowledge and skills. The present study compared the traditional face-to-face method to hybrid and virtual reality (VR) methods to observe difference in learning performance and length of performance retention. This study adopted randomized controlled trial to compare CPR learning performance between traditional face-to-face, hybrid, and VR methods. Participants from each intervention group completed a pretest and 2 posttests. The measurement tools included an attitude and intention questionnaire, knowledge examination, and skill examination with a RESUSCI ANNE QCPR ® manikin. The performance among all participants in pretest showed no significant difference between the intervention groups, indicating no difference in their background attitude, knowledge, and skill level. Significant differences were observed in the average degree of intention to perform CPR between the hybrid and traditional groups in 1st and 2nd posttest. Compared to the pretest results, the posttests revealed significantly higher attitude toward CPR, intention to perform CPR, knowledge examination results, accuracy of overall chest compression, accuracy of CPR procedure, accuracy of AED usage, accuracy of chest compression rate, and accuracy of chest compression depth. The average time to reattending CPR learning and practice session was 11-12 weeks reported by participants. The hybrid and VR methods to CPR education resulted in the same level of improvement in learning performance as traditional face-to-face teaching. The suggested frequency for renewing CPR knowledge and skills is 12 weeks which may be considered in new strategies aimed at promoting CPR education and exposure to the public.

Public attitudes towards bystander CPR and their association with social deprivation: Findings from a cross sectional study in North England

Background

Bystander cardiopulmonary resuscitation (BCPR) is undertaken in only 40% of out of hospital cardiac arrests (OHCAs) in the UK. Lower rates of BCPR and public access defibrillator (PAD) use have been correlated with lower socio-economic status (SES). The aim of this study was to examine knowledge and attitudes towards BCPR and PAD's using a study specific questionnaire, and to understand how these potentially interact with individual characteristics and SES.

Methods

Cross-sectional study between July-December 2021 across areas of varying SES in North England.

Results

Six hundred and one individuals completed the survey instrument (mean age = 51.9 years, 52.2 % female). Increased age was associated with being less willing to call 999 (p < 0.001) and follow call handler advice (p < 0.001). Female respondents were less comfortable performing BCPR than male respondents (p = 0.006). Individuals from least deprived areas were less likely to report comfort performing CPR, (p = 0.016) and less likely to know what a PAD is for, (p = 0.025). Higher education level was associated with increased ability to recognise OHCA (p = 0.005) and understanding of what a PAD is for (p < 0.001). Individuals with higher income were more likely to state they would follow advice regarding BCPR (p = 0.017) and report comfort using a PAD (p = 0.029).

Conclusion

Individual characteristics such as age and ethnicity, rather than SES, are indicators of knowledge, willingness, and perceived competency to perform BCPR. Policy makers should avoid using SES alone to target interventions. Future research should examine how cultural identity and social cohesion intersect with these characteristics to influence willingness to perform BCPR.

Acceptability of telephone-cardiopulmonary resuscitation (T-CPR) practice in a resource-limited country- a cross-sectional study

BACKGROUND

T-CPR has been shown to increase bystander CPR rates dramatically and is associated with improved patient survival.

OBJECTIVE

To evaluate the acceptability of T-CPR by the bystanders and identify baseline quality measures of T-CPR in Karachi, Pakistan.

METHODS

A cross-sectional study was conducted from January to December 2018 at the Aman foundation command and control center. Data was collected from audiotaped phone calls of patients who required assistance from the Aman ambulance and on whom the EMS telecommunicator recognized the need for CPR and provided instructions. Information was recorded using a structured questionnaire on demographics, the status of the patient, and different time variables involved in CPR performance. A One-way ANOVA was used to compare different time variables with recommended AHA guidelines. P-value ≤ 0.05 was considered significant.

RESULTS

There were 481 audiotaped calls in which CPR instruction was given, listened to, and recorded data. Out of which in 459(95.4%) of cases CPR was attempted Majority of the patients were males (n = 278; 57.8%) and most had witnessed cardiac arrest (n = 470; 97.7%) at home (n = 430; 89.3%). The mean time to recognize the need for CPR by an EMS telecommunicator was 4:59 ± 1:59(min), while the mean time to start CPR instruction by a bystander was 5:28 ± 2:24(min). The mean time to start chest compression was 6:04 ± 1:52(min.).

CONCLUSION

Our results show the high acceptability of T-CPR by bystanders. We also found considerable delays in recognizing cardiac arrest and initiation of CPR by telecommunicators. Further training of telecommunicators could reduce these delays.

The willingness to perform first aid among high school students and associated factors in Hue, Vietnam

Background

Adolescents who are willing to perform first aid can help prevent injuries and ultimately death among themselves and others involved in accidents or injuries. This study aims to estimate the prevalence of students’ willingness to perform first aid procedures and additionally examine associated factors among high school students in Hue, Vietnam.

Methods

A cross-sectional study utilizing multi-stage stratified random sampling was conducted between April to July 2020 by investigating 798 high school students in Hue, Vietnam. Participants were invited to complete a self-reported questionnaire pertaining to individual demographic characteristics, personal perception of self-efficacy, and willingness to perform first aid. To better interpret these findings, both multivariable linear and Poisson regression models were fitted to evaluate the association between individual student characteristics and the willingness to perform first aid.

Results

The prevalence of having willingness to perform first aid (defined as ≥4 points out of 5 to all three questions) was 49.9% (95%CI:28.6–71.2%). The major reported barriers in performing first aid were fear of making mistakes and hurting victims (34.4%, 95%CI:31.9–37.0%), no prior first aid training (29.8%, 95%CI:25.9–33.9%), and forgetting first aid steps (23.0%, 95%CI:15.8–32.2%). By employing the multivariable linear regression model, it was identified that students with high (β = 0.614, 95%CI:0.009–1.219) or very high (β = 1.64, 95%CI:0.857–2.422) levels of self-efficacy appeared to be more willing to perform first aid. Similarly, in the Poisson regression models, compared to neutral students, students who reported high (PR = 1.214, 95%CI:1.048–1.407) or very high (PR = 1.871, 95%CI:1.049–3.337) levels of self-efficacy were more willing to perform first aid.

Conclusions

The level of willingness to perform first aid among high school students in this study population was found to be moderate. Therefore, integrating activities to promote self-efficacy in first aid training could be considered a progressive step towards improving a student’s willingness to provide such life-saving procedures.

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.

Understanding the Importance of the Lay Responder Experience in Out-of-Hospital Cardiac Arrest: A Scientific Statement From the American Heart Association

Bystander cardiopulmonary resuscitation (CPR) is critical to increasing survival from out-of-hospital cardiac arrest. However, the percentage of cases in which an individual receives bystander CPR is actually low, at only 35% to 40% globally. Preparing lay responders to recognize the signs of sudden cardiac arrest, call 9-1-1, and perform CPR in public and private locations is crucial to increasing survival from this public health problem. The objective of this scientific statement is to summarize the most recent published evidence about the lay responder experience of training, responding, and dealing with the residual impact of witnessing an out-of-hospital cardiac arrest. The scientific statement focuses on the experience-based literature of actual responders, which includes barriers to responding, experiences of doing CPR, use of an automated external defibrillator, the impact of dispatcher-assisted CPR, and the potential for postevent psychological sequelae. The large body of qualitative and observational studies identifies several gaps in crucial knowledge that, if targeted, could increase the likelihood that those who are trained in CPR will act. We suggest using the experience of actual responders to inform more contextualized training, including the implications of performing CPR on a family member, dispelling myths about harm, training and litigation, and recognition of the potential for psychologic sequelae after the event.

Global prevalence of cardiopulmonary resuscitation training among the general public: a scoping review

A scoping review was conducted to identify, map, and analyze international evidence from studies investigating the prevalence of community cardiopulmonary resuscitation (CPR) training. We searched major bibliographic databases and grey literature for original studies evaluating the prevalence of CPR training in the general population. Studies published from January 2000 to October 2020 were included without language or publication type restrictions. Seventy-three eligible papers reported a total of 61 population-based surveys conducted in 29 countries. More than three-fourths of the surveys were conducted in countries with high-income economies, and none in low-income countries. Over half of the surveys were at a subnational level. Globally, the proportion of laypeople trained in CPR varied greatly (median, 40%). For high-income countries, the median percentage was twice as high as that of upper middle-income countries (50% vs. 23%). The studies used heterogeneous survey methods and reporting patterns. Key methodological aspects were frequently not described. In summary, few studies have assessed CPR training prevalence among the general public. The rates of resuscitation training for the vast majority of countries remain unknown. High heterogeneity of studies precludes a reliable interpretation of the research. International Utstein-style consensus guidelines are needed to inform future research and reporting of public resuscitation training worldwide.

Awareness, knowledge and attitudes towards cardiopulmonary resuscitation among people with and without heart disease relatives in South China: a cross-sectional survey

OBJECTIVES

To assess the awareness, knowledge and attitudes towards cardiopulmonary resuscitation (CPR) among relatives of people with and without heart disease and their influence in South China.

DESIGN

This is a cross-sectional survey. Logistic regression was used to evaluate the demographic factors associated with CPR training, learning and knowledge.

SETTING

The study was conducted in two hospitals, the largest cardiovascular institute and the largest eye care centre in South China.

PARTICIPANTS

Healthy individuals who accompanied their relatives with heart disease to the outpatient department of cardiovascular disease and systemically healthy patients who came for regular ophthalmic examination and had no relatives with heart disease were consecutively recruited for the study. A total of 1644 respondents with heart disease relatives and 813 respondents without heart disease relatives completed the survey.

RESULTS

Thirty three per cent of respondents never heard of CPR and only 11% had received CPR training. Factors associated with a higher rate of CPR training were higher level of education and income (p<0.001). Most respondents stated that CPR training was necessary and would like to learn CPR. However, only one-third considered it beneficial to perform CPR as a layperson. In addition, healthcare respondents (p<0.001), younger (p<0.05) and more educated respondents (p<0.001) earned higher scores on the knowledge of CPR skills. Only 5.3% had perfect scores on a CPR skills test. Notably, respondents with relatives suffering from heart disease had significantly less training experience and CPR knowledge than those without (p<0.001).

CONCLUSIONS

Although the attitudes towards learning CPR are very positive, there was a lack of knowledge on this topic among the general public. This study demonstrates an urgent need to boost awareness and training in CPR in South China, especially among people whose relatives have heart disease.

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

OBJECTIVES

The incidence of bystander cardiopulmonary resuscitation (CPR) is low in China. CPR training could improve public attitudes and willingness, but at present, the attitudes of the public after online training are unclear. This study investigated individual attitudes towards CPR, the willingness to perform it in emergencies along with the main obstacles and the overall effects of online training.

DESIGN

Questionnaires were distributed to investigate the public attitudes and willingness towards performing bystander CPR.

SETTING

Questionnaires were accessible after the online course 'First Aid'.

PARTICIPANTS

1888 students who attended 'First Aid' from December 2019 to 1 January 2020 and then completed the questionnaire voluntarily.

RESULTS

The majority understood CPR (96.7%) and displayed a willingness to learn (98.4%) and to disseminate CPR knowledge (82.0%). Characteristics associated with more positive attitudes included women, the 26-35-year olds and those in medical-related occupations (p<0.05). Only 34.8% had CPR training before. Most people would willingly perform CPR on a close family member. Compared with the standard CPR (S-CPR), the public preferred chest compression-only CPR (CO-CPR) (p<0.01). The top three obstacles to performing CO-CPR were lack of confidence (26.7%), fear of harming the victim (23.4%) and causing legal trouble (20.7%), while regarding S-CPR, fear of disease transmission (22.9%) ranked second. Women, those in poor health and in medical-related occupations, were more likely to perform CPR (p<0.05). The confidence to perform CPR was improved remarkably after online training (p<0.05).

CONCLUSIONS

The overwhelming majority of respondents showed positive attitudes and willingness towards CPR. In some cases, there is still reluctance, especially towards S-CPR. Obstacles arise mainly due to lack of confidence in administering CPR, while online CPR training can markedly improve it. Therefore, we should focus on disseminating CPR knowledge, targeting those who are less willing to perform CPR and helping overcome their obstacles by online training.

Availability of basic life support courses for the general populations in India, Nigeria and the United Kingdom: An internet-based analysis

BACKGROUND

The number of lay people willing to attempt cardiopulmonary resuscitation (CPR) in real life is increased by effective education in basic life support (BLS). However, little is known about access of general public to BLS training across the globe. This study aimed to investigate availability and key features of BLS courses proposed for lay people in India, Nigeria and the United Kingdom (UK).

METHODS

A Google search was done in December 2018, using English keywords relevant for community resuscitation training. Ongoing courses addressing BLS and suitable for any adult layperson were included in the analysis. On-site training courses were limited to those provided within the country's territory.

RESULTS

A total of 53, 29 and 208 eligible courses were found for India, Nigeria and the UK, respectively. In the UK, the number of courses per 10 million population (31.5) is 79 and 21 times higher than that in India (0.4) and Nigeria (1.5). Course geography is limited to 28% states and one union territory in India, 30% states and the Federal Capital Territory in Nigeria. In the UK, the training is offered in all constituent countries, with the highest prevalence in England. Courses are predominantly classroom-based, highly variable in duration, group size and instructors' qualifications. For India and Nigeria, mean cost of participation is exceeding the monthly minimum wage.

CONCLUSION

In contrast to the UK, the availability and accessibility of BLS courses are critically limited in India and Nigeria, necessitating immediate interventions to optimize community CPR training and improve bystander CPR rates.

Observing the stages of bystander intervention in virtual reality simulation

BACKGROUND

Understanding bystander reactions to an emergency is an important component of effective training. Four stages of bystander intervention (BI) have been previously described: noticing the situation as a problem, interpreting when it is appropriate to intervene, recognizing personal responsibility to intervene, and knowing how to intervene. Using virtual reality (VR) to simulate emergencies such as sudden cardiac arrest (SCA) can be used to study these stages.

METHODS

In a secondary analysis of an observational cohort study, we analyzed bystander self-efficacy for stages of BI before and after simulated SCA. Each subject participated in a single-player, immersive, VR SCA scenario. Subjects interacted with simulated bystanders through voice commands ("call 911", "get an AED"). Actions taken in scenario, like performing CPR, were documented. Scenario BI actions were compared based on dichotomized comfort/discomfort.

RESULTS

From June 2016 to June 2017, 119 subjects participated. Average age was 37±14 years, 44% were female and 46% reported CPR training within 2 years. During the scenario, 98% "noticed the event" and "interpreted it as a problem", 78% "took responsibility", and 54% "possessed the necessary skills". Self-efficacy increased from pre- to post-scenario: noticing the event increased from 80% to 96%; interpreting as a problem increased from 86% to 97%; taking responsibility increased from 56% to 93%; possessing necessary skills increased from 47% to 63% (P<0.001).

CONCLUSION

Self-efficacy to respond to an SCA event increased pre- to post-scenario. Bystanders who reported feeling comfortable "taking responsibility to intervene" during an emergency were more likely to take action during a simulated emergency.