Elsevier

Resuscitation

Volume 82, Issue 8, August 2011, Pages 1053-1059
Resuscitation

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

https://doi.org/10.1016/j.resuscitation.2011.03.033Get rights and content

Abstract

Background

Early bystander cardiopulmonary resuscitation (CPR) is essential for survival from out-of-hospital cardiac arrest (OHCA). Young people are potentially important bystander CPR providers, as basic life support (BLS) training can be distributed widely as part of the school curriculum.

Methods

Questionnaires were distributed to nine secondary schools in North Norway, and 376 respondents (age 16–19 years) were included. The completed questionnaires were statistically analysed to assess CPR knowledge and attitude to performing bystander CPR.

Results

Theoretical knowledge of handling an apparently unresponsive adult person was high, and 90% knew the national medical emergency telephone number (113). The majority (83%) was willing to perform bystander CPR in a given situation with cardiac arrest. However, when presented with realistic hypothetical cardiac arrest scenarios, the option to provide full BLS was less frequently chosen, to e.g. a family member (74%), a child (67%) or an intravenous drug user (18%). Students with BLS training in school and self-reported confidence in their own BLS skills reported stronger willingness to perform BLS. 8% had personally witnessed a cardiac arrest, and among these 16% had performed full BLS. Most students (86%) supported mandatory BLS training in school, and three out of four wanted to receive additional training.

Conclusion

Young Norwegians are motivated to perform bystander CPR, but barriers are still seen when more detailed cardiac arrest scenarios are presented. By providing students with good quality BLS training in school, the upcoming generation in Norway may strengthen the first part of the chain of survival in OHCA.

Introduction

Survival from out-of-hospital cardiac arrest (OHCA) depends on all the individual parts of the chain of survival,1, 2, 3 and immediate bystander cardiopulmonary resuscitation (CPR) is a major contributor to survival from OHCA,4, 5, 6, 7, 8 probably increasing survival fourfold.9 However, bystander CPR rates vary between 15 and 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. Both factors also differ between different age groups. In recent studies, the willingness to perform CPR varies considerably among high school students in e.g. Japan20 and New Zealand.21

To investigate knowledge of CPR and attitude to performing bystander CPR among young Norwegians, we questioned secondary school students about CPR training, self-reported experience with cardiac arrest situations, and how they think they would react in given cardiac arrest situations.

Section snippets

Materials and methods

800 questionnaires were distributed to second year students from the Specialization in General Studies Programme of nine secondary schools in the counties of Nordland and Troms (Norway). Approval was given by the Chief County Education Officers and the headmasters of the selected schools. Participation was voluntary and the form teachers were kindly asked to motivate the students to respond to the questionnaire. One reminder was given six weeks after the initial contact. Students outside the

The respondents

A total of 404 completed questionnaires were returned, but 28 of these did not fulfil the inclusion criteria, leaving 376 participants. The main characteristics of the respondents are shown in Table 1. Fifty-nine percent were female, and the predominant age was 17 years (63.5%).

Previous BLS training was common (89%) in both genders, and 73% had obtained this at school. More than half of the respondents had attended BLS courses through organizations, work, or other providers. The majority (75%)

Discussion

Early bystander CPR is one of the most significant factors for survival from OHCA.4, 22, 23 Although some recent studies have shown increased rates,24 most authors report bystander CPR rates below 50%, and the rates vary between different countries.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

Conclusions

These findings confirm that secondary school students are an important target for efforts to increase the bystander CPR rate, at least in Norway. The motivation to help is good in this population, but barriers to start CPR become evident when the students are exposed to realistic details in potential CPR scenarios. Sufficient BLS training in school, including appropriate refresher courses and focus on known barriers to bystander CPR could strengthen the chain of survival and contribute to

Study limitations

We believe it is unlikely that the respondents differ very much from the general student population with regard to BLS training and attitude. We can, however, not rule out that the findings would have been slightly different with a higher response rate. Our study includes only students of the academically oriented “Specialisation in general studies” programme, and thus describes a subset of the population. However, this subset is representative of the majority of secondary school students in

Conflicts of interest statement

There are no conflicts of interest.

Funding sources

None.

References (37)

  • T.C. Johnston et al.

    Factors influencing Queenslanders ‘willingness to perform bystander cardiopulmonary resuscitation

    Resuscitation

    (2003)
  • A.J. Handley et al.

    European Resuscitation Guidelines for Resuscitation 2005 Section 2. Adult basic life support and use of automated external defibrillators

    Resuscitation

    (2005)
  • R.O. Cummins et al.

    Improving survival from sudden cardiac arrest: the “chain of survival” concept. A statement for health professionals from the Advanced Cardiac Life Support Subcommittee and the Emergency Cardiac Care Committee, American Heart Association

    Circulation

    (1991)
  • European Resuscitation Council. European Resuscitation Council Guidelines for Resuscitation 2005. Resuscitation...
  • T. Iwami et al.

    Continuous improvements in “chain of survival” increased survival after out-of-hospital cardiac arrest

    Circulation

    (2009)
  • E.J. Gallagher et al.

    Effectiveness of bystander cardiopulmonary resuscitation and survival following out-of-hospital cardiac arrest

    JAMA

    (1995)
  • T.D. Valenzuela et al.

    Estimating effectiveness of cardiac arrest interventions: a logistic regression survival model

    Circulation

    (1997)
  • I.G. Stiell et al.

    Advanced cardiac life support in out-of-hospital cardiac arrest

    N Engl J Med

    (2004)
  • Cited by (156)

    View all citing articles on Scopus

    A Spanish translated version of the abstract of this article appears as Appendix in the online version at doi:10.1016/j.resuscitation.2011.03.033.

    d

    These authors have contributed equally to the study, and submitted an unpublished thesis based on this manuscript for the partial fulfilment of the MD degree at the University of Tromsø in September 2010.

    View full text