European Journal of Cardiovascular Medicine

Cardiopulmonary Resuscitation (CPR) is a life-saving procedure performed in emergencies such as sudden cardiac arrest (SCA), where immediate intervention can significantly improve survival outcomes1. The procedure involves chest compressions and artificial ventilation to restore blood circulation and oxygenation in patients experiencing cardiac or respiratory arrest. Early and effective CPR is crucial, as it increases the chances of survival before professional medical assistance arrives2,3. Despite its importance, CPR awareness and competency among the general public, particularly non-medical individuals, remain limited4.

Sudden cardiac arrest is a major public health concern worldwide. In India, approximately 500,000–600,000 people die from sudden cardiac arrest each year, with many deaths occurring due to a lack of timely CPR intervention5. Studies indicate that bystander CPR can double or even triple survival rates, yet its application is often hindered by inadequate training, fear of performing CPR incorrectly, and limited awareness of emergency response protocols6. Several countries, such as Denmark, have made CPR training mandatory in school curricula, recognizing its importance in increasing the rate of bystander intervention7. However, such initiatives are not widely implemented in India.

This study aims to assess the knowledge, awareness, and preparedness of non-medical graduates in Ghaziabad City regarding CPR. By identifying knowledge gaps and evaluating the extent of CPR training among this demographic, the study seeks to highlight areas requiring targeted intervention. Additionally, the study explores participants' familiarity with Automated External Defibrillators (AEDs), which are crucial in cases of cardiac arrest but remain underutilized due to a lack of public awareness.

The primary objectives of this study are: To evaluate the level of CPR knowledge and training among non-medical graduates in Ghaziabad City. To assess their understanding of the correct steps in CPR administration. To examine their practical experience with CPR, including real-life application. To analyze awareness and knowledge regarding AED use.

Study Design

This study conducted from January 2023 to December 2023, employed a quantitative research design with an observational approach to evaluate the knowledge, awareness, and preparedness of non-medical graduates regarding Cardiopulmonary Resuscitation (CPR). A structured questionnaire was used to collect data, focusing on respondents' CPR training history, theoretical knowledge, practical experience, and familiarity with Automated External Defibrillators (AEDs).

Study Setting and Participants

The study was conducted in Ghaziabad City, India, targeting non-medical graduates. A purposive sampling technique was applied to select 101 participants who met the inclusion criteria.

Inclusion Criteria:

Individuals with a graduate degree (except those from medical or paramedical fields).

Residents of Ghaziabad City.

Individuals aged 21 years and above.

Exclusion Criteria:

Medical, paramedical, or healthcare professionals.

Individuals below 21 years of age.

Those unwilling to participate in the survey.

Data Collection Method

A structured questionnaire was designed using Google Forms and distributed electronically. The questionnaire included demographic information, CPR training history, knowledge of CPR procedures, experience in administering CPR, and awareness of AEDs. The survey comprised 15 questions, with 2 demographic-based questions and 13 questions based on CPR knowledge, training, and experience. A Likert scale was used for some responses to assess the level of agreement with key CPR concepts.

Study Variables

The study utilized dependent and independent variables to assess CPR knowledge and training.

Dependent Variable: Knowledge about CPR.

Independent Variables: Source of CPR information., CPR training experience., Educational background.

Statistical Analysis

The collected data was screened and cleaned to ensure consistency before analysis. The statistical analysis was performed using IBM SPSS software, applying descriptive statistics and regression analysis. Descriptive Statistics: Used to summarize demographic characteristics, training status, and CPR knowledge levels. Regression Analysis: Performed to identify associations between educational background, CPR training, and knowledge levels. Mean and Standard Deviation (SD): Used to assess variations in CPR knowledge and training experiences among respondents.

Ethical Approval

This study was conducted in accordance with ethical guidelines for human participant research. Ethical approval was obtained from the Institutional Ethics Committee prior to data collection. Informed consent was obtained from all participants, ensuring voluntary participation. Data confidentiality was strictly maintained, and all responses remained anonymous. The study adhered to public health research standards, ensuring compliance with ethical principles related to human subject research.

Demographic Characteristics

A total of 101 non-medical graduates from Ghaziabad City participated in the study. The majority of respondents (60.4%) were female, while 39.6% were male (Table 1). The age distribution showed that most participants belonged to the 31–40 age group (47.52%), followed by those aged 41–50 (30.69%). Only a small proportion of respondents were above 50 years (5.0%). In terms of educational background, 50.50% were university students, 31.68% were graduates from non-medical disciplines, and 17.82% were employed professionals.

Table 1: Demographic Characteristics of Participants

CPR Training and Knowledge

Among the participants, 88.12% had received CPR training in the past five years, while 11.88% had never undergone any training (Table 2). Regarding the role of mental preparedness in CPR administration, 74.26% of participants agreed that mental strength is crucial for performing CPR, whereas 11.88% strongly agreed, and 13.86% disagreed.

When assessing knowledge of the correct initial step in CPR, only 25.74% correctly identified “checking for breathing” as the first step, whereas the majority (74.26%) incorrectly believed that CPR should start with “30 chest compressions” (Table 2). These findings indicate gaps in fundamental CPR knowledge among non-medical graduates.

Table 2: CPR Training and Knowledge Among Participants

Experience with CPR Administration

Participants were asked whether they had ever encountered a situation requiring CPR, and 86.14% reported having experienced such an event, while 7.92% had never been in such a situation, and 5.94% could not recall (Table 3). Among those who had faced a CPR situation, 89.11% confirmed that they had performed CPR, while 10.89% had not (Table 3).

Table 3: Experience with CPR Administration

Reasons for Not Performing CPR

Among the 10.89% of respondents who did not administer CPR, 27.72% cited discomfort as the primary reason, 25.74% stated they lacked knowledge of CPR techniques, and 22.77% reported that someone else was already performing the procedure. Additionally, 23.76% of respondents indicated that they did attempt CPR when required (Table 4 & Figure No.1).

Table 4: Reasons for Not Performing CPR

Figure No:1. Reasons for Not Performing CPR

Motivations for Performing CPR

For those who did perform CPR, 36.63% reported that they stepped in because no one else attempted to help, while 35.64% were guided by a medical dispatcher. A smaller proportion (16.83%) stated they had the confidence to perform CPR, whereas 10.89% did not perform CPR despite recognizing the need (Table 5& Figure No:2).

Table 5: Reasons for Performing CPR

Figure No:2. Reasons for Performing CPR

Knowledge of AED Usage

A significant gap was observed in participants' knowledge of Automated External Defibrillators (AEDs). While 53.47% reported being familiar with AEDs, 46.53% either had never heard of them or did not remember (Table 6). This finding suggests a critical need for awareness programs on AED functionality and accessibility.

Table 6: Knowledge of AED (Automated External Defibrillator)

Statistical Analysis of CPR-Related Knowledge and Experience

The mean score for CPR workshop attendance was 0.12, with a standard deviation (SD) of 0.325, indicating that most participants had attended training within the past five years (Table 7). The mean value for CPR initiation knowledge was 2.15 (SD = 1.152), highlighting variability in participants’ understanding of the initial steps of CPR. The mean score for experience in performing CPR was 0.20 (SD = 0.530), while learning CPR through video demonstrations had a mean value of 0.26 (SD = 0.439). Lastly, knowledge of AEDs had a mean value of 1.45 (SD = 0.911), confirming a lack of awareness regarding AED usage (Table 7).

Table 7: Statistical Analysis of Key Variables

Figure No:3. Statistical Analysis of Key Variables

The findings of this study reveal significant knowledge gaps in Cardiopulmonary Resuscitation (CPR) awareness and preparedness among non-medical graduates in Ghaziabad City. While a large proportion (88.12%) of participants reported prior CPR training (Table 2), misconceptions regarding critical procedural steps and Automated External Defibrillator (AED) usage persist. These findings align with previous studies that highlight the inadequacy of CPR knowledge retention over time, particularly among individuals without frequent refresher courses (Tabata et al9., 2024).

Knowledge and Training Deficiencies

One of the most concerning findings was that only 25.74% of participants correctly identified "checking for breathing" as the first step in CPR, while the majority (74.26%) mistakenly believed that CPR begins with 30 chest compressions (Table 2). This incorrect understanding could lead to delayed intervention and ineffective resuscitation efforts, a common issue identified in previous research (Milenkovic et al7., 2023). Studies have consistently demonstrated that without regular reinforcement, CPR knowledge deteriorates, even among trained individuals (Greif et al13., 2021).

Additionally, awareness of AEDs was alarmingly low, with 46.53% of respondents unfamiliar with their function (Table 6). This trend is concerning given that AEDs significantly improve survival rates in out-of-hospital cardiac arrests (OHCA) (Nolan et al10., 2020). Countries such as Denmark and the United States have successfully integrated AED training into school and community education programs, leading to higher bystander intervention rates (Perkins et al11., 2021).

Experience with Real-Life CPR Situations

A high proportion (86.14%) of respondents had encountered situations requiring CPR, and 89.11% reported performing CPR (Table 3). However, among those who did not intervene, 27.72% cited discomfort, and 25.74% stated a lack of knowledge as reasons for inaction (Table 4). These findings support prior research that theoretical knowledge alone does not translate into practical confidence, emphasizing the importance of hands-on training (Dinberu & Yemane8, 2024).

Factors Influencing CPR Performance

Among those who performed CPR, 36.63% intervened because no one else attempted to help, while 35.64% received guidance from a medical dispatcher (Table 5). This reliance on external guidance indicates a lack of confidence in independently performing CPR, consistent with studies showing that bystanders often hesitate due to fear of causing harm or legal repercussions (Baldi et al12., 2019). Similar findings were reported among final-year medical students, suggesting that even those with prior CPR training may struggle with confidence in high-stress situations (Milenkovic et al7., 2023).

Public Health Implications and the Need for Structured CPR Training

The study findings emphasize the need for structured, practical, and periodic CPR training programs. Research suggests that one-time training is insufficient, as knowledge retention declines significantly within six months to a year (Böttiger & Van Aken14, 2015). Mandatory refresher courses and skill-based simulations should be integrated into higher education curricula and workplace settings to reinforce CPR competency (Greif et al13., 2021).

Additionally, AED training should be incorporated into public health awareness programs to enhance confidence in using life-saving devices during cardiac emergencies (Tabata et al9., 2024). Countries with high bystander CPR rates, such as Sweden and Norway, have successfully implemented community-based training programs that significantly increase survival rates in OHCA cases (Perkins et al11., 2021).

Limitations

This study has certain limitations. First, the sample size (N=101) was relatively small, and the findings may not be fully representative of the entire non-medical graduate population in India. Additionally, the study relied on self-reported data, which may be subject to recall bias. Future research should consider larger sample sizes and objective skill assessments to validate CPR competency levels.

The findings of this study indicate that while non-medical graduates in Ghaziabad City have some exposure to CPR training, significant knowledge gaps persist, particularly in the correct initiation of CPR and the use of Automated External Defibrillators (AEDs). A substantial proportion of participants demonstrated misconceptions about the initial steps of CPR, and many lacked confidence in performing CPR in real-life situations. Given the high number of respondents who have encountered cardiac emergencies, structured and mandatory CPR training programs, hands-on skill development, and increased public awareness initiatives are essential. Enhancing CPR education and AED training can significantly improve bystander response rates, thereby increasing survival chances for individuals experiencing sudden cardiac arrest. Future policies should prioritize regular refresher courses and practical CPR simulations to ensure long-term competency.

1. Jarghon S, Molokoane K, Laher AE, Motara F. Knowledge, Attitudes, and Perceptions Regarding CPR Among Non-medical Staff at a Medical School in South Africa. Cureus. 2023 Jan 8;15(1):e33506. doi: 10.7759/cureus.33506. PMID: 36756028; PMCID: PMC9904421.
2. Bilal MM, Shah SB, Rehman TU, Sadiq N, Lakho GR. Knowledge, attitude, and awareness of cardiopulmonary resuscitation among university enrolled medical and non-medical students of Pakistan: An online study. Pak J Med Sci. 2024 Mar-Apr;40(4):767-772. doi: 10.12669/pjms.40.4.7933. PMID: 38544997; PMCID: PMC10963979.
3. Alnajjar H, Hilal RM, Alharbi AJ, Alharthi OH, Batwie RA, AlShehri RM, Algethami MR. Evaluation of Awareness, Knowledge, and Attitudes Towards Basic Life Support Among Non-Medical Students at Two Academic Institutions in Jeddah, Saudi Arabia. Adv Med Educ Pract. 2020 Dec 23;11:1015-1021. doi: 10.2147/AMEP.S271130. PMID: 33380857; PMCID: PMC7767641.
4. Iqbal A, Nisar I, Arshad I, Butt UI, Umar M, Ayyaz M, Farooka MW. Cardiopulmonary resuscitation: Knowledge and Attitude of doctors from Lahore. Ann Med Surg (Lond). 2021 Aug 17;69:102600. doi: 10.1016/j.amsu.2021.102600. PMID: 34457248; PMCID: PMC8379428.
5. Shams A, Raad M, Chams N, Chams S, Bachir R, El Sayed MJ. Community involvement in out of hospital cardiac arrest: A cross-sectional study assessing cardiopulmonary resuscitation awareness and barriers among the Lebanese youth. Medicine (Baltimore). 2016 Oct;95(43):e5091. doi: 10.1097/MD.0000000000005091. PMID: 27787361; PMCID: PMC5089090.
6. Robak O, Kulnig J, Sterz F, Uray T, Haugk M, Kliegel A, Holzer M, Herkner H, Laggner AN, Domanovits H. CPR in medical schools: learning by teaching BLS to sudden cardiac death survivors--a promising strategy for medical students? BMC Med Educ. 2006 Apr 28;6:27. doi: 10.1186/1472-6920-6-27. PMID: 16646966; PMCID: PMC1479344.
7. Milenkovic M, Tesic M, Hadzibegovic A, Palibrk I, Djukanovic M, Rovic I, Sijan D, Stanisavljevic J, Tvrtkovic M, Petrovic K, Jovanovic V, Stevanovic P. Evaluation of the self-assessment knowledge regarding cardiopulmonary resuscitation in medical students at the University of Belgrade. Eur Rev Med Pharmacol Sci. 2023 Aug;27(15):7081-7091. doi: 10.26355/eurrev_202308_33281. PMID: 37606118.
8. Dinberu MT, Yemane DH. Assessment of Cardiopulmonary Resuscitation Knowledge Among Physicians in the Pediatrics Department of an Urban Tertiary Referral Hospital in Ethiopia: A Cross-Sectional Study. Emerg Med Int. 2024 Oct 28;2024:8815197. doi: 10.1155/2024/8815197. PMID: 39502495; PMCID: PMC11535191.
9. Tabata R, Tagami T, Suzuki K, Amano T, Takahashi H, Numata H, et al. Effect of cardiopulmonary resuscitation training for layperson bystanders on outcomes of out-of-hospital cardiac arrest: A prospective multicenter observational study. Resuscitation. 2024 Aug;201:110314. doi: 10.1016/j.resuscitation.2024.110314. Epub 2024 Jul 9. PMID: 38992559.
10. Nolan JP, Monsieurs KG, Bossaert L, Böttiger BW, Greif R, Lott C, et al; European Resuscitation Council COVID-Guideline Writing Groups. European Resuscitation Council COVID-19 guidelines executive summary. Resuscitation. 2020 Aug;153:45-55. doi: 10.1016/j.resuscitation.2020.06.001. Epub 2020 Jun 7. PMID: 32525022; PMCID: PMC7276132.
11. Perkins GD, Graesner JT, Semeraro F, Olasveengen T, Soar J, Lott C,et al; European Resuscitation Council Guideline Collaborators. European Resuscitation Council Guidelines 2021: Executive summary. Resuscitation. 2021 Apr;161:1-60. doi: 10.1016/j.resuscitation.2021.02.003. Epub 2021 Mar 24. Erratum in: Resuscitation. 2021 May 4;163:97-98. doi: 10.1016/j.resuscitation.2021.04.012. PMID: 33773824.
12. Baldi E, Contri E, Bailoni A, Rendic K, Turcan V, Donchev N, et al. Final-year medical students' knowledge of cardiac arrest and CPR: We must do more! Int J Cardiol. 2019 Dec 1;296:76-80. doi: 10.1016/j.ijcard.2019.07.016. Epub 2019 Jul 8. PMID: 31375334.
13. Greif R, Lockey A, Breckwoldt J, Carmona F, Conaghan P, Kuzovlev A, Pflanzl-Knizacek L, Sari F, Shammet S, Scapigliati A, Turner N, Yeung J, Monsieurs KG. European Resuscitation Council Guidelines 2021: Education for resuscitation. Resuscitation. 2021 Apr;161:388-407. doi: 10.1016/j.resuscitation.2021.02.016. Epub 2021 Mar 24. PMID: 33773831.
14. Böttiger BW, Van Aken H. Kids save lives--Training school children in cardiopulmonary resuscitation worldwide is now endorsed by the World Health Organization (WHO). Resuscitation. 2015 Sep;94:A5-7. doi: 10.1016/j.resuscitation.2015.07.005. Epub 2015 Jul 21. PMID: 26209417.