Bystander cardiopulmonary resuscitation (CPR) is an important factor associated with improved survival rates and neurologic prognoses in cases of out-of-hospital cardiac arrest. We assessed how factors related to CPR education including timing of education, period from the most recent education session, and content, affected CPR willingness.
In February 2012, trained interviewers conducted an interview survey of 1,000 Daegu citizens through an organized questionnaire. The subjects were aged ≥19 years and were selected by quota sampling. Their social and demographic characteristics, as well as CPR and factors related to CPR education, were investigated. Chi-square tests and multivariate logistic regression analyses were used to evaluate how education-related factors affected the willingness to perform CPR.
Of total 1,000 cases, 48.0% were male. The multivariate analyses revealed several factors significantly associated with CPR willingness: didactic plus practice group (adjusted odds ratio [AOR], 3.38; 95% confidence interval [CI], 2.3 to 5.0), group with more than four CPR education session (AOR, 7.68; 95% CI, 3.21 to 18.35), interval of less than 6 months from the last CPR education (AOR, 4.47; 95% CI 1.29 to 15.52), and education with automated external defibrillator (AOR, 5.98; 95% CI 2.30 to 15.53).
The following were associated with increased willingness to perform CPR: practice sessions and automated electrical defibrillator training in public CPR education, more frequent CPR training, and shorter time period from the most recent CPR education sessions.
Bystander cardiopulmonary resuscitation (CPR) is critical in improving the survival rate of out of hospital cardiac arrest, and CPR training is important in improving bystander CPR rates.
Training practice, including automated external defibrillator training, frequent reeducation, and short interval from last training are important factors associated with the willingness to perform bystander CPR.
In 2010, the prevalence of sudden cardiac arrest (SCA) was 46.8 per 100,000 people in Korea; the survival to hospital discharge rate was 3.0%, which was lower than that in major developed countries [
Public CPR education is imperative to increase the rate of bystander CPR. Sipsma et al. [
This study aimed to determine how bystander CPR willingness is affected by factors related to CPR education, such as the methodology and number of bystander CPR education sessions, the time period from the last education session, and whether automated electrical defibrillator (AED) training was included.
The study population was selected among adults aged 19 years or above living in Daegu metropolitan city. In 2012, the population of Daegu metropolitan city was 2,528,000, with an incidence rate of SCA of 40.2 per 100,000. In the same period, the bystander CPR and survival-to-discharge rates were 12.1% and 4.7%, respectively [
The questionnaire items included social and population factors, factors related to CPR, and factors related to CPR education. The social and population factors included age, sex, education level (middle school graduate or under, high school graduate, and college graduate or higher), average monthly income (<1 million [M] South Korean won [KRW], 1 M to less than 2 M KRW, 2 M to less than 3 M KRW, 3 M to less than 4 M KRW, 4 M to less than 5 M KRW, or >5 M KRW), and legal obligation under EMS laws to receive CPR education (yes or no). The factors related to CPR included CPR recognition, AED recognition, confidence in performing CPR, and willingness to perform CPR. All factors were measured using a five-point score (1, not at all; 5, very likely). Results were dichotomized into two categories for analysis: ≤3 points and ≥4 points. The factors related to CPR education included prior experience (yes or no), frequency (1 time, 2 times, 3 times, or ≥4 times), period from the last CPR education session (<6 months, 6 months to 1 year, 1 to 2 years, 2 to 5 years, or ≥5 years), type of CPR education (didactic only or didactic with practice), and inclusion of AED training (yes or no).
Subjects were divided into groups according to their willingness to perform CPR. Chi-square tests were used for comparisons between groups based on social and population factors and factors related to CPR education. To investigate how factors related to CPR education affected CPR willingness, multivariate logistic regression analysis was performed using CPR education-related factors as independent variables and CPR willingness as an endpoint. Age, sex, education level, monthly income, and legal obligation to receive education were used as confounders. Statistical analysis was performed using IBM SPSS Statistics ver. 22.0 (IBM Corp., Armonk, NY, USA) and statistical significance was defined as P<0.05.
A total of 1,000 participants took part in the survey. Of these, 480 (48%) respondents were male and 520 (52%) were female. By age, respondents in their 40 s were most common. Most participants were educated through college or higher. A total of 57.3% of respondents reported a willingness to perform bystander CPR. The rate of willingness to perform CPR on family members or friends was 55.3% compared to 32.2% on strangers. Of the 480 male respondents, 67.5% reported a willingness to perform bystander CPR. The rate was 47.9% among the 520 female respondents, indicating that male respondents were more willing to perform CPR.
The rates of willingness to perform CPR decreased with age as follows: 64.6% amongst respondents aged 20 to 29 years, 59.8% for respondents aged 50 to 59 years, and 38.6% for respondents aged 60 years or above. The rates of willingness to perform CPR according to grade of education were 34.1% of 135 middle school graduates or respondents with a lower level of education, 55.5% of 292 high school graduates, and 68.9% of 560 college graduates or respondents with a higher level of education. These findings indicate that increased willingness to perform CPR was associated with higher levels of education. Monthly income had no significant impact on CPR willingness. Among respondents legally obligated to perform CPR under Korean EMS laws, 66.9% of 130 respondents reported their willingness.
Regarding questions about their recognition of CPR and CPR procedures, 893 and 349 respondents, respectively, answered affirmatively. The rates of willingness were 60.6% in the group recognizing CPR and 79.1% in the group recognizing CPR procedures.
A total of 362 respondents had attended CPR education sessions at least once; of these, 74.0% were willing to perform CPR, compared to 47.8% in the non-educated group (
Of these 362 respondents, 229 indicated that they had also undergone practical education sessions. The rate of CPR willingness (79.9%) in the didactic plus practice group was significantly higher than that in the didactic only group (63.9%). The CPR willingness rates, according to the total number of CPR education sessions attended, were 62.5% for the group attending one session, 74.8% for the group attending 2 sessions, 74.5% for the group attending 3 sessions, and 91.5% for the group attending 4 or more sessions. The willingness to perform CPR, according to the time interval between the last CPR session and the study period, was 72.6% with an interval of 5 years or more, 68.1% with an interval between 2 and 5 years, and 70.0% with an interval between 1 and 2 years. Of note, willingness rates were 81.6% and 87% for intervals between 6 months and 1 year, and intervals under 6 months, respectively. These findings indicate that more respondents were willing to perform CPR if the interval was under 1 year than those who received CPR education more than 1 year earlier. Moreover, as respondents attended CPR education more frequently or more recently, they tended to be more confident in performing CPR (
Only 13.8% of respondents reported that AED training was included in the CPR education sessions that they had attended. However, the willingness to perform CPR was 90.0% in the AED-trained group, which indicates a greater willingness compared to subjects who did not receive AED training (
Multivariate analysis was performed to identify how discrepancies in CPR education experience, such as type of CPR education, period from the most recent CPR education session, and frequency of sessions, affect CPR willingness. The adjusted odds ratio (OR) was 3.38 (95% confidence interval [CI], 2.26 to 5.04) for didactic plus practice group. In the group receiving CPR education on 4 or more occasions, the adjusted OR for CPR willingness was 7.68 (95% CI, 3.21 to 18.35). This was higher than the adjusted OR of 2.17 (95% CI, 1.08 to 4.36) for groups receiving CPR education on 3 occasions or less. The adjusted OR for CPR willingness according to the period from the latest CPR education session was 4.47 (95% CI, 1.29 to 15.52) for intervals shorter than 6 months, 3.80 (95% CI, 1.91 to 7.56) for intervals between 6 months and 1 year, and 1.91 (95% CI, 1.02 to 3.20) for intervals between 1 and 2 years. If AED training was included in CPR education, the adjusted OR for CPR willingness was 5.98 (95% CI, 2.30 to 15.53) (
Prompt CPR synchronous to cardiac arrest increases survival rates two to four-fold [
Previous studies reported community EMS response intervals of approximately 5 to 8 minutes [
Hamasu et al. [
Few studies have evaluated the impact of social and population factors and CPR education on bystander CPR [
In this study, we investigated how the details of the effect of CPR education, including the type, frequency, and timing of education sessions, as well as the inclusion of AED on subsequent willingness to perform CPR. We found that the willingness was greater when practical sessions and AED training were included, with more frequent education sessions, and with intervals from the most recent CPR education session between 6 months and 1 year.
In a community-based study, Sipsma et al. [
Reeducation within a certain timeframe following CPR education appears to be necessary, as bystander CPR willingness tends to decrease over time. In a survey of the general Australian population, Johnston et al. [
CPR knowledge acquired during education sessions diminishes over time. Previous studies involving health care providers report that the knowledge declines after approximately 6 to 12 months [
The findings of this study indicate that, in order to maintain an adequate level of bystander willingness to perform CPR, it is necessary to repeat CPR education sessions over time. However, this is a challenging goal, in terms of both time and resources. Bobrow et al. [
Therefore, bystander CPR willingness is affected by the frequency of education sessions and the period from the most recent session. We believe that it is essential to establish a community dispatch center system and incorporate DA-CPR in bystander CPR education programs, in order to effectively perform DA-CPR alongside public CPR education.
The current study has a number of limitations. First, the timing and frequency of previous education sessions were identified through a survey; therefore, we cannot exclude the possibility of errors in recall, particularly regarding the point in time when CPR education was received. Second, as the investigation was conducted using a survey, it is difficult to reliably predict whether a respondent will actually perform CPR when witnessing a cardiac arrest.
In summary, it is imperative to include practice sessions and AED education in CPR education. As CPR willingness is greater with a shorter period from the most recent CPR education and with increased reeducation sessions, systematic planning and management of CPR reeducation are required for first-aid responders.
No potential conflict of interest relevant to this article was reported.
Trends in the percentages of participants willing to perform cardiopulmonary resuscitation (CPR) and percentages of confidence in performing CPR according to CPR education characteristics.
General characteristics of respondents and their willingness to perform CPR
Total (n = 1,000) | Willingness to perform CPR | P-value | ||
---|---|---|---|---|
Sex | Male | 480 | 324 (67.5) | < 0.001 |
Female | 520 | 249 (47.9) | ||
Age (yr) | 20s | 178 | 115 (64.6) | < 0.001 |
30s | 203 | 124 (61.1) | ||
40s | 233 | 145 (62.2) | ||
50s | 189 | 113 (59.8) | ||
60s and above | 197 | 76 (38.6) | ||
CPR recognition (‘Do you know what CPR is?’) | Yes | 893 | 541 (60.6) | < 0.001 |
No | 104 | 32 (30.8) | ||
Unknown | 3 | |||
CPR procedure recognition (‘Do you know how to perform CPR?’) | Yes | 349 | 276 (79.1) | < 0.001 |
No | 651 | 297 (45.6) | ||
Prior experience with CPR training | Yes | 362 | 268 (74.0) | < 0.001 |
No | 630 | 305 (47.8) | ||
Unknown | 8 | |||
Confidence in performing CPR | Yes | 85 | 81 (95.3) | < 0.001 |
No | 914 | 492 (53.8) | ||
Legally obligated by EMS law | Yes | 130 | 87 (66.9) | 0.017 |
No | 870 | 486 (55.9) | ||
Education level | Middle school graduate or under | 135 | 46 (34.1) | < 0.001 |
High school graduate | 292 | 162 (55.5) | ||
College graduate or higher | 560 | 357 (68.9) | ||
Unknown | 13 | |||
Monthly income (KRW) | Less than 1 M | 153 | 74 (48.4) | 0.141 |
1 M–less than 2 M | 202 | 116 (57.4) | ||
2 M–less than 3 M | 238 | 149 (62.6) | ||
3 M–less than 4 M | 213 | 125 (58.7) | ||
4 M–less than 5 M | 98 | 54 (55.1) | ||
5 M or more | 53 | 32 (60.4) | ||
Unknown | 43 |
Values are presented as number or number (%).
CPR, cardiopulmonary resuscitation; EMS, emergency medical service; KRW, Korean won; M, million.
CPR training and willingness to perform CPR
Total (n = 362) | Willingness to perform CPR | P-value | ||
---|---|---|---|---|
Type of CPR education | Didactic only | 133 | 85 (63.9) | < 0.001 |
Didactic plus practice | 229 | 183 (79.9) | ||
Total no. of CPR education sessions attended | 1 | 112 | 70 (62.5) | < 0.001 |
2 | 119 | 89 (74.8) | ||
3 | 47 | 35 (74.5) | ||
4 Or more | 71 | 65 (91.5) | ||
Unknown | 13 | |||
Period from the last CPR education session | 6 Months or shorter | 23 | 20 (87.0) | 0.183 |
6 Months to 1 year | 76 | 62 (81.6) | ||
1 To 2 years | 70 | 49 (70.0) | ||
2 To 5 years | 69 | 47 (68.1) | ||
5 Years or longer | 113 | 82 (72.6) | ||
Unknown | 11 | |||
AED training included in CPR education | Yes | 50 | 45 (90.0) | 0.006 |
No | 277 | 198 (71.5) | ||
Unknown | 35 |
Values are presented as number or number (%).
CPR, cardiopulmonary resuscitation; AED, automated external defibrillator.
Factors associated with willingness to perform CPR
Unadjusted OR | 95% CI | Adjusted OR |
95% CI | ||
---|---|---|---|---|---|
Type of CPR education | Not trained | Reference | |||
Didactic only | 1.78 | 1.24–2.52 | 1.50 | 0.97–2.33 | |
Didactic plus practice | 2.98 | 2.88–5.50 | 3.38 | 2.26–5.04 | |
Total no. of CPR education sessions attended | Not trained | Reference | |||
1 | 1.67 | 1.14–2.44 | 1.51 | 0.96–2.37 | |
2 | 2.97 | 1.97–4.49 | 2.15 | 1.34–3.45 | |
3 | 2.92 | 1.51–5.62 | 2.17 | 1.08–4.36 | |
4 Or more | 10.83 | 4.69–25.00 | 7.68 | 3.21–18.35 | |
Period from the last CPR education session | Not trained | Reference | |||
5 Years or longer | 2.65 | 1.75–4.00 | 2.31 | 1.44–3.69 | |
2 To 5 years | 2.14 | 1.29–3.55 | 1.52 | 0.87–2.65 | |
1 To 2 years | 2.33 | 1.40–3.90 | 1.91 | 1.02–3.20 | |
6 Months-1 year | 4.43 | 2.48–7.10 | 3.80 | 1.91–7.56 | |
Shorter than 6 months | 6.67 | 1.98–22.44 | 4.47 | 1.29–15.52 | |
AED training included in CPR education | Not trained | Reference | |||
No | 2.51 | 1.93–3.25 | 1.90 | 1.36–2.67 | |
Yes | 9.00 | 3.57–22.67 | 5.98 | 2.30–15.53 |
CPR, cardiopulmonary resuscitation; OR, odds ratio; CI, confidence interval; AED, automated external defibrillator.
Adjusted for sex, age, education level, monthly income, and legal obligation under emergency medical service law.