The initiation of CPR before the arrival of professional help doubles the 30-day survival rate, which indicates the need for community involvement in understanding the practical application of CPR to provide resuscitation effectively and safely [19, 20]. We aimed to assess the CPR-related knowledge of individuals not involved in health care and their willingness to perform it and to uncover the barriers preventing them from performing CPR. Compared to other studies on this topic, our study is unique, as it sub-grouped the aware participants and compared them depending on the sources from which they received their knowledge. Other studies were limited to specific regions, conducted their surveys by email or social media or included health care individuals.
In our study, we found a poor level of awareness of CPR based on participant reports; 51.8% had no awareness of CPR. In comparison, only 10% of Australian and Chinese populations had never heard of CPR [9, 12]. However, the other half of our participants (48.2%) acquired their knowledge through different sources. Based on the subgroup analysis, 4.4% received their training through a formal CPR course, 5.1% through campaigns, and 38.7% through the media. The training rate in Riyadh City seemed higher than that in Hong Kong (21%), Jeddah (28.7%), Jordan (29%), and Izmir (40.3%) [8, 10, 11, 21]. In contrast, our rate of training was lower than that of countries where CPR courses are a mandatory requirement. In Slovenia, 69.4% of the respondents had received previous CPR training, which was associated with mandatory training during the acquisition of driver’s licenses . In Denmark, multinational initiatives were taken to increase the rate of bystander CPR, and after implementing different strategies, the rate of bystander CPR increased significantly from 21.1% in 2001 to 44.9% in 2010 . High percentages of trained individuals were also reported in Scotland (52%) , Australia (56%) , the UK (59%) , Canada (64%) , and the USA (65%) .
Participants showed some logical awareness of the signs of SCA. A high proportion of the participants stated that the absence of a pulse, breathing, and the loss of consciousness were the most common signs of SCA (51.8%, 48.1%, and 44.9%, respectively). Our findings were consistent with those of Özbilgin et al., as 60.7% selected the absence of a pulse, 49.3% selected the absence of breathing, and 40.7% selected the loss of consciousness . On the other hand, our results were higher than those reported in Jeddah, as 24.7%, 36.8%, and 40.7% of their respondents could properly identify signs of SCA, absence of pulse, breathing, and loss of consciousness, respectively . When participants were asked about their recognition of an SCA victim, among all of the aware participants, 27.6% and 29% could correctly assess consciousness and breathing, respectively. Overall, our findings were higher than those of Jeddah City, where among those who received training, only 12.8% and 20.2% could correctly assess consciousness and breathing, respectively . Similarly, poor results were reported in Izmir and Jordan as well [10, 11]. However, those who acquired their training through campaigns had a higher set of skills in recognizing an unconscious victim (31.8%) and identifying the correct way to assess breathing (43.2%). The results may reflect the quality of campaigns and the importance of refresher training courses for those who had previously attended a CPR course.
The participants were asked how to approach someone with SCA; the majority of participants (76.3%) who had taken a formal CPR course and 70.5% who were campaign attendees, respectively; (p < 0.001) stated that they would start CPR. In contrast, 34.1% of the participants who gained their CPR experience through the media and 54% of those who were totally unaware of CPR stated that they would only watch without intervening (p < 0.001). In our study, 14.3% of all participants had encountered a situation that required CPR, with most of those victims being a family member. Among those, only 6.5% started CPR. The results indicate the importance of training programmes that encourage individuals not involved in health care to perform CPR in a real-life situation when it is indicated. Among Turkish participants, 18.6% stated that they had previously witnessed SCA, and only 3.6% performed CPR . A lower rate of CPR was also reported in Jordan and Jeddah [8, 10]
With regard to the practical application of CPR according to the American Heart Association guidelines, self-reported answers revealed poor knowledge among aware participants regarding the application of CPR. Among all aware participants, only 15.7% stated that they would perform both chest compression and mouth-to-mouth breathing. However, 10.6% stated that they would perform all 3 procedures. Overall, only 12.8% knew the correct location of compression, and 7% knew the ratio of compressions to ventilation. The percentages of correct responses for rate and depth were 8.4% and 16.2%, respectively. Our participants had the same level of poor knowledge shown in previous studies [10, 11]. However, the rates of correct answers were found to be significantly higher among the formal CPR course attendees group (p < 0.001). Our findings revealed discrepancies among those who gained their experience through the media. This is justified by their different perceptions of having sufficient knowledge based on what they demonstrated from the media. In addition, these devastating results reflect the quality of the theoretical details given in different sources and the necessity of regular high-quality CPR training and refresher courses.
In the case of SCA, numerous studies reported that high percentages of their respondents would begin CPR for their family members [8, 10, 11]. Among all our aware participants, 36% showed no hesitation to perform CPR for their family members, followed by for a friend, neighbor, and finally a stranger. The main reason for a lack of willingness to conduct CPR among those who gained their experience through the media was being unconfident in performing CPR on any of the aforementioned individuals (p < 0.001), reflecting the significance of hands-on training in the other groups. However, 4.6% stated that they knew how to perform CPR but would not perform it (p < 0.001). There are certain barriers that may affect the willingness of the aware participants to begin CPR. With regard to family members, 11.6% stated that nothing would prevent them from performing CPR (p < 0.001), whereas 26.1% had a fear of breaking a rib bone (p = 0.002). The most common reason for not conducting CPR on a stranger among formal CPR course attendees and campaign attendees was legal issues 42.1% and 34.1%, respectively. This raises our appeal to local authorities to create a law to encourage the public to step in when indicated, such as the ‘good Samaritan law’, which is enacted in a number of countries, such as the USA and Korea. The law is enacted to protect individuals from any consequences and offer legal protection when they assist in good faith and deliver medical assistance for strangers in emergencies [26, 27].
A total of 54.8% of all participants were unaware of the current emergency contact number (Saudi Red Crescent number 997). Among the participants, 77.3% of campaign attendees selected the correct answer, 57.9% of formal CPR course attendees, 52.6% of media-obtained participants, and 35.4% of those unaware of CPR. The results revealed that the campaign attendees group were the most aware of the correct number, which might reflect that local campaigns focus on giving the correct Saudi Red Crescent number, while CPR course materials are developed abroad, where the universal emergency service number (911) differs from that used in Saudi Arabia.
This study has some limitations. The status of knowledge of CPR and training skills was based on participants’ self-report. In addition, CPR training skills were only tested theoretically, not practically, as the latter was not feasible for our study participants. Lastly, we did not ask whether the formal CPR course attendees training was recent or not.