Understanding and improving low bystander CPR rates: a systematic review of the literature

Abstract

Objectives: Cardiopulmonary resuscitation (CPR) is a crucial yet weak link in the chain of survival for out-of-hospital cardiac arrest. We sought to understand the determinants of bystander CPR and the factors associated with successful training. Methods: For this systematic review, we searched 11 electronic databases, 1 trial registry and 9 scientific websites. We performed hand searches and contacted 6 content experts. We reviewed without restriction all communications pertaining to who should learn CPR, what should be taught, when to repeat training, where to give CPR instructions and why people lack the motivation to learn and perform CPR. We used standardized forms to review papers for inclusion, quality and data extraction. We grouped publications by category and classified recommendations using a standardized classification system that was based on level of evidence. Results: We reviewed 2409 articles and selected 411 for complete evaluation. We included 252 of the 411 papers in this systematic review. Differences in their study design precluded a meta-analysis. We classified 22 recommendations; those with the highest scores were 1) 9-1-1 dispatchassisted CPR instructions, 2) teaching CPR to family members of cardiac patients, 3) Braslow's selftraining video, 4) maximizing time spent using manikins and 5) teaching the concepts of ambiguity and diffusion of responsibility. Recommendations not supported by evidence include mass training events, pulse taking prior to CPR by laymen and CPR using chest compressions alone. Conclusion:We evaluated and classified the potential impact of interventions that have been proposed to improve bystander CPR rates. Our results may help communities design interventions to improve their bystander CPR rates. RÉSUMÉ Objectifs : La réanimation cardio-respiratoire (RCR) est un maillon essentiel, quoique faible, de la chaîne de survie lors de la survenue d'un arrêt cardiaque hors de l'hôpital. Nous avons cherché à comprendre les déterminants du taux de passants pouvant administrer la RCR et les facteurs liés à une formation efficace. Méthodes : Dans le cadre de cette revue systématique, nous avons analysé 11 bases de données électroniques, un registre d'essais cliniques et neuf sites Web scientifiques. Nous avons réalisé des recherches manuelles et communiqué avec six experts du contenu. Nous avons examiné sans restriction toutes les communications portant sur les questions suivantes : qui devrait apprendre la RCR, ce qu'on devrait enseigner, QUAND la formation devrait être renouvelée, où les cours de

CPR knowledge and attitude to performing bystander CPR among secondary school students in Norway

“…However, they also reported the same barriers to taking extracurricular BLS courses as described elsewhere: lack of time and interest, and the inconvenience of leaving the house to attend a course. 12 Cost was not considered a problem by the respondents in the present study, but almost half of the students were not sure about where to find a BLS course.…”

“…11,14,25 As higher rates could increase survival, a focus on BLS training has been suggested, with a view to training those who live together with the elderly (and have the highest probability of encountering cardiac arrest), and trying to reduce psychological barriers to performing CPR. 11,12,14 Recently, the bystander CPR rate was reported as high as 70.7 % in a small OHCA study from Norway. 26 For this reason, we set out to investigate the level of training and attitudes to CPR among young Norwegians.…”

“…9 However, bystander CPR rates vary between 15 -50 % in OHCA. [9][10][11][12][13] Layperson training and attitude to actually performing CPR in a given cardiac arrest situation, are both important factors in order to increase bystander contribution to OHCA survival. 11,14 According to the literature, both basic life support (BLS) training, 10,15,16 and attitude to performing CPR, [17][18][19] varies between countries.…”

Basic Life Support and Cardiopulmonary Resuscitation Training for Pharmacy Students and the Community by a Pharmacy Student Committee

“…9 Student instructors were responsible for identifying and contacting community groups at greatest need for CPR training. 10 These groups focused on those individuals with a family member or acquaintance affected by cardiovascular disease, as these people are more likely to witness an out-of-hospital sudden cardiac arrest. The committee placed particular emphasis on identifying such groups, and also offered training courses at senior residential living facilities, as well as to those who may not have had other opportunities to attend basic life support training courses.…”

Are Canadians more willing to provide chest-compression-only cardiopulmonary resuscitation (CPR)?—a nation-wide public survey

“…20,21 However, these efforts have largely been unsuccessful, in that bystander CPR rates in OHCA remain unchanged. 22,23 Recently, international evidence-based guidelines have endorsed a simplified CCO approach for CPR. 20,21 The CCO-CPR approach emphasizes the importance of high-quality chest compressions and removes the requirement of mouth-to-mouth (MTM) ventilation.…”