Clinical paperPerforming bystander CPR for sudden cardiac arrest: Behavioral intentions among the general adult population in Arizona☆
Introduction
Out-of-hospital cardiac arrest (OHCA) remains a significant public health issue in the United States1 and the industrialized world. A person who has an out-of-hospital cardiac arrest has little chance of survival unless bystanders take immediate action by calling 911 and beginning resuscitation efforts. Numerous studies have provided evidence that the odds of surviving an out-of-hospital cardiac arrest are significantly improved by the provision of bystander cardiopulmonary resuscitation (CPR).2, 3, 4, 5 Although quite variable, a rough average would be that only about a third of out-of-hospital cardiac arrest victims receive bystander resuscitation prior to the arrival of emergency personnel.3, 6, 7, 8, 9, 10
Why is this? What are the key barriers to performing bystander CPR? The answers to these questions are far from clear-cut. There are many inconsistencies in the published research literature due to differences in study designs, target populations, data collection methods, and the specific questions asked. For example, Swor et al., among CPR-trained bystanders who had called 911 at the time of a cardiac arrest, found that the most common reason given for why bystanders had not performed CPR was that they had panicked.9 Other reasons were concern about not performing CPR properly, physically unable to perform CPR, fear of harming the individual, and belief that the person was dead. Concern about mouth-to-mouth contact was mentioned by only four (1.4%) of the 279 respondents. However, many other researchers have found that mouth-to-mouth contact is an important determinant of the public's willingness to perform bystander CPR, particularly on a stranger.11, 12, 13, 14, 15, 16, 17 In fact, a number of studies have documented that mouth-to-mouth contact was a significant barrier to initiating CPR by trained health care workers.12, 18, 19 In addition, although not even mentioned in many studies, fear of legal consequences has been reported as a factor making respondents less likely to perform bystander CPR on strangers.15, 16, 20
The existing literature remains equivocal as to the reasons why members of the general public are not likely to engage in traditional CPR (e.g., a combination of chest compression and mouth-to-mouth ventilation). Hence, in order to inform the development of initiatives aimed at increasing the number of individuals willing and able to perform CPR for out-of-hospital cardiac arrests, we conducted a study to identify the barriers to bystander CPR in the state of Arizona. Specifically, the objectives of this research were (1) to determine the behavioral intentions of the general adult population regarding performing bystander CPR; and (2) to assess the reasons why people in the general population are unwilling to perform bystander CPR.
Section snippets
Methods
This study (Arizona CPR Survey) was a general population survey that used a mailed, self-administered questionnaire as the data collection tool. The Tailored Design Method developed by Dillman21 for survey research guided the survey methodology used in this study.
Respondents (i.e., completed sample)
Completed and usable questionnaires were received from 370 and 385 respondents from the urban (MC) and rural (SCC) areas, respectively. Fig. 1 provides a flow diagram for the calculation of the response rates for each of the two target subpopulations. The response rates were remarkably similar (49.5% for MC and 49.6% for SCC). As can be seen, there were substantially more undeliverable addresses in the urban area.
Table 1 provides demographic information and other characteristics for the
Discussion
A substantial number (∼45%) of the respondents would not perform CPR on a stranger for a variety of reasons. Although the over 55% of respondents with CPR training were more likely to report being willing to perform CPR, many of them indicated they would not perform it on a stranger. While this unwillingness within the general public may be attributed to a lack of training or a significant lapse of time since being trained, other factors must be considered.
A large number of respondents
Conclusions
These findings demonstrate a need for enhancing the general public's CPR knowledge and skill level as well as changing the public's CPR-related attitudes and beliefs. Our results provide further evidence for the assertion by Vadeboncoeur and colleagues in 2007, that “Public health officials should re-evaluate current models of public education on CPR.”5 It is readily apparent that much more could and should be done to increase the number of people willing and able to perform CPR in Arizona and
Conflict of interest
There are no conflicts of interest to declare.
Role of the funding source
Members of the Sarver Heart Center's Resuscitation Research Group provided input regarding the study design, but had no substantive involvement in the collection, analysis, or interpretation of the study data. The Arizona Department of Health Services Health Crisis Fund had no involvement in any aspect of the study. The funding sources placed no restrictions on the decision to submit the manuscript for publication.
Acknowledgements
Funding for this study was provided by the Sarver Heart Center at the University of Arizona and the Arizona Department of Health Services Health Crisis Fund. The insight and constructive input from the Sarver Heart Center's Resuscitation Research Group during the development of this study was invaluable and greatly appreciated.
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A Spanish translated version of the summary of this article appears as Appendix in the final online version at doi:10.1016/j.resuscitation.2008.11.024.