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Barriers to bystander CPR: Evaluating socio-economic and cultural factors influencing students attending community CPR training

      Out-of-hospital cardiac arrest (OHCA) remains a leading cause of death in the United States, affecting over 350,000 people annually [

      Cardiac Arrest Statistics [Internet]. [cited 2018 May 6]; available from: http://cpr.heart.org/AHAECC/CPRAndECC/General/UCM_477263_Cardiac-Arrest-Statistics.jsp

      ]. Research repeatedly demonstrates that prompt bystander initiated cardiopulmonary resuscitation (CPR) improves both the overall survival rate and nearly every objective measures of surviving an OHCA [
      • Coons S.J.
      • Guy M.C.
      Performing bystander CPR for sudden cardiac arrest: behavioral intentions among the general adult population in Arizona.
      ,
      • Urban J.
      • Thode H.
      • Stapleton E.
      • Singer A.J.
      Current knowledge of and willingness to perform Hands-Only CPR in laypersons.
      ,
      • Lee M.J.
      • Hwang S.O.
      • Cha K.C.
      • Cho G.C.
      • Yang H.J.
      • Rho T.H.
      Influence of nationwide policy on citizens' awareness and willingness to perform bystander cardiopulmonary resuscitation.
      ,
      • Wissenberg M.
      • Lippert F.K.
      • Folke F.
      • Weeke P.
      • Hansen C.M.
      • Christensen E.F.
      • et al.
      Association of national initiatives to improve cardiac arrest management with rates of bystander intervention and patient survival after out-of-hospital cardiac arrest.
      ,
      • Sasson C.
      • Rogers M.A.M.
      • Dahl J.
      • Kellermann A.L.
      Predictors of survival from out-of-hospital cardiac arrest: a systematic review and meta-analysis.
      ,
      • Kragholm K.
      • Wissenberg M.
      • Mortensen R.N.
      • Hansen S.M.
      • Malta Hansen C.
      • Thorsteinsson K.
      • et al.
      Bystander efforts and 1-year outcomes in out-of-hospital cardiac arrest.
      ,
      • Stiell I.
      • Nichol G.
      • Wells G.
      • De Maio V.
      • Nesbitt L.
      • Blackburn J.
      • et al.
      Health-related quality of life is better for cardiac arrest survivors who received citizen cardiopulmonary resuscitation.
      ,
      • Park G.J.
      • Song K.J.
      • Shin S.D.
      • Lee K.W.
      • Ahn K.O.
      • Lee E.J.
      • et al.
      Timely bystander CPR improves outcomes despite longer EMS times.
      ]. Yet the rate at which bystander initiated CPR is administered varies considerably and is dependent on the location of the arrest [
      • Sasson C.
      • Rogers M.A.M.
      • Dahl J.
      • Kellermann A.L.
      Predictors of survival from out-of-hospital cardiac arrest: a systematic review and meta-analysis.
      ,
      • Nassel A.F.
      • Root E.D.
      • Haukoos J.S.
      • McVaney K.
      • Colwell C.
      • Robinson J.
      • et al.
      Multiple cluster analysis for the identification of high-risk census tracts for out-of-hospital cardiac arrest (OHCA) in Denver, Colorado.
      ,
      • Mitchell M.J.
      • Stubbs B.A.
      • Eisenberg M.S.
      Socioeconomic status is associated with provision of bystander cardiopulmonary resuscitation.
      ,
      • Vaillancourt C.
      • Lui A.
      • De Maio V.J.
      • Wells G.A.
      • Stiell I.G.
      Socioeconomic status influences bystander CPR and survival rates for out-of-hospital cardiac arrest victims.
      ,
      • Sasson C.
      • Keirns C.C.
      • Smith D.
      • Sayre M.
      • Macy M.
      • Meurer W.
      • et al.
      CARES (Cardiac Arrest Registry to Enhance Survival) Study Group. Small area variations in out-of-hospital cardiac arrest: does the neighborhood matter?.
      ,
      • Sasson C.
      • Magid D.J.
      • Chan P.
      • Root E.D.
      • McNally B.F.
      • Kellermann A.L.
      • et al.
      CARES Surveillance Group. Association of neighborhood characteristics with bystander-initiated CPR.
      ]. With the overwhelming evidence in support of bystander CPR, public health organizations have implemented widespread educational initiatives to train laypeople in compression-only CPR over the past decade. Correspondingly, an increase in the proportion of patients receiving bystander CPR in large national registries has been reported [
      • Wissenberg M.
      • Lippert F.K.
      • Folke F.
      • Weeke P.
      • Hansen C.M.
      • Christensen E.F.
      • et al.
      Association of national initiatives to improve cardiac arrest management with rates of bystander intervention and patient survival after out-of-hospital cardiac arrest.
      ,
      • Yamaguchi Y.
      • Woodin J.A.
      • Gibo K.
      • Zive D.M.
      • Daya M.R.
      Improvements in out-of-hospital cardiac arrest survival from 1998 to 2013.
      ,
      • Chan P.S.
      • McNally B.
      • Tang F.
      • Kellermann A.
      Recent trends in survival from out-of-hospital cardiac arrest in the United States.
      ]. Despite overall increases in bystander rates, specific populations such as the socio-economically disadvantaged and the under-educated, still lag behind in this critical link in the chain of survival [
      • Sasson C.
      • Haukoos J.S.
      • Bond C.
      • Rabe M.
      • Colbert S.H.
      • King R.
      • et al.
      Barriers and facilitators to learning and performing cardiopulmonary resuscitation in neighborhoods with low bystander cardiopulmonary resuscitation prevalence and high rates of cardiac arrest in Columbus, OH.
      ,
      • Lee S.Y.
      • Ro Y.S.
      • Shin S.D.
      • Song K.J.
      • Ahn K.O.
      • Kim M.J.
      • et al.
      Interaction effects between highly-educated neighborhoods and dispatcher-provided instructions on provision of bystander cardiopulmonary resuscitation.
      ]. Several barriers to bystander intervention have been identified in recent years including panic, general anxiety, fear of not performing CPR properly, fear of hurting the victim, fear of litigation, and fear of transmittable diseases [
      • Coons S.J.
      • Guy M.C.
      Performing bystander CPR for sudden cardiac arrest: behavioral intentions among the general adult population in Arizona.
      ,
      • Swor R.
      • Khan I.
      • Domeier R.
      • Honeycutt L.
      • Chu K.
      • Compton S.
      CPR training and CPR performance: do CPR-trained bystanders perform CPR?.
      ,
      • Bouland A.
      • Halliday M.
      • Comer A.
      • Levy M.
      • Seaman K.
      • Lawner B.
      • et al.
      ]. The purpose of this study is to identify how social and educational factors impact reported barriers to bystander CPR.

      Keywords

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