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Original Research

Open Access

Effect of population-based training programs on bystander willingness to perform cardiopulmonary resuscitation


1 Department of Emergency Medicine, Chang Gung Memorial Hospital, Keelung, Taiwan

2 Department of Emergency Medicine, Chang Gung Memorial Hospital, Linkou, Taiwan

3 Department of Emergency Medicine and Medical Education, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan

DOI: 10.22514/SV121.102016.11 Vol.12,Issue S1,October 2016 pp.63-69

Published: 10 October 2016

*Corresponding Author(s): CHAOU CHUNG-HSIEN E-mail:


Objective. This study was performed to determine the factors related to unwilling-ness of bystanders to perform cardiopul-monary resuscitation (CPR), and improve-ment of willingness among the lay public after CPR training.

Design. Retrospective design

Methods. We collected questionnaires received from laypersons attending CPR training courses implemented by the CPR Improvement Program of Chang Gung Memorial Foundation. Pre- and post-training questionnaires were given to par-ticipants attending CPR training courses between September 2013 and January 2014.

Results. Among the 401 respondents at pre-training, higher educational level (odds ratio, 3.605; 95% confidence in-terval [CI], 3.055 – 8.284) and previous CPR training (odds ratio, 1.754; 95% CI, 1.049 – 2.932) were significantly associ-ated with willingness to perform bystander CPR. Significant improvements in will-ingness to perform conventional CPR and hands-only CPR on a stranger were observed after training (P = 0.016 and P < 0.0001, respectively). Approximately half of the respondents claimed that fear of doing further harm was the primary rea-son for their lack of willingness to admin-ister conventional CPR on a stranger.

Conclusions. We showed that CPR train-ing significantly increased the rate of will-ingness to perform CPR on strangers as well as acquaintances among the lay pub-lic. This study also showed that fear of do-ing further harm was the most significant barrier after training. This concern should be addressed in future training programs.


cardiopulmonary resuscitation, cardiopulmonary resuscitation training, by-stander willingness

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CHIEN CHENG-YU,WENG YI-MING,HSU SHOU-CHIEN,KUO CHAN-WEI,CHAOU CHUNG-HSIEN. Effect of population-based training programs on bystander willingness to perform cardiopulmonary resuscitation. Signa Vitae. 2016. 12(S1);63-69.


1. Berdowski J, Berg RA, Tijssen JG, Koster RW. Global incidences of out-of-hospital cardiac arrest and survival rates: Systematic review of 67 prospective studies. Resuscitation 2010;81(11):1479-87.

2. Nichol G, Thomas E, Callaway CW, Hedges J, Powell JL, Aufderheide TP, et al. Regional variation in out-of-hospital cardiac arrest incidence and outcome. JAMA 2008;300(12):1423-31.

3. Atwood C, Eisenberg MS, Herlitz J, Rea TD. Incidence of EMS- treated out-of-hospital cardiac arrest in Europe. Resuscitation 2005;67(1):75-80.

4. Rea TD, Eisenberg MS, Sinibaldi G, White RD. Incidence of EMS treated out of-hospital cardiac arrest in the United States. Resus-citation 2004;63(1):17-24.

5. Wang CY, Wang JY, Teng NC, Chao TT, Tsai SL, et al. The Secular Trends in the Incidence Rate and Outcomes of Out-of-Hospital Cardiac Arrest in Taiwan—A Nationwide Population-Based Study. PLoS One 2015;10(4):e0122675.

6. Ritter G, Wolfe RA, Goldstein S, Landis JR, Vasu M, Acheson A, Leighton R, VanderBrug S. The effect of bystander CPR on survival of out-of-hospital cardiac arrest victims. Am Heart J 1985;110(5):932-7.

7. Gallagher EJ, Lombardi G, Gennis P. Effectiveness of bystander cardiopulmonary resuscitation and survival following out-of-hospital cardiac arrest. JAMA 1995;274(24):1922-5.

8. Weston CF, Wilson RJ, Jones SD. Predicting survival from out-of-hospital cardiac arrest: a multivariate analysis. Resuscitation 1997;34(1):27-34.

9. Kida M, Kawamura T, Fukuoka T, Tamakoshi A, Wakai K, Ohno Y, et al. Out-of-hospital cardiac arrest and survival: An epidemio-logical analysis of emergency service reports in a large city in Japan. Circ J 2004;68(7):603-9.

10. Nichol G, Thomas E, Callaway CW, Hedges J, Powell JL, Aufderheide TP, et al. Regional variation in out-of-hospital cardiac arrest incidence and outcome. JAMA 2008;300(12):1423–31.

11. Atkins DL. Realistic expectations for public access defibrillation programs. Curr Opin Crit Care 2010;16(3):191-5.

12. Nolan RP, Wilson E, Shuster M, Rowe BH, Stewart D, Zambon S. Readiness to perform cardiopulmonary resuscitation: an emerging strategy against sudden cardiac death. Psychosom Med;61(4):546-51.

13. Axelsson A. Bystander cardiopulmonary resuscitation: would they do it again? J Cardiovasc Nurs 2001;16(1):15-20; quiz 73-4.

14. Jelinek GA, Gennat H, Celenza T, O’Brien D, Jacobs I, Lynch D. Community attitudes toward performing cardiopulmonary resusci-tation in Western Australia. Resuscitation 2001;51(3):239-46.

15. Johnston TC, Clark MJ, Dingle GA, FitzGerald G. Factors influencing Queenslanders’ willingness to perform bystander cardiopul-monary resuscitation. Resuscitation 2003;56(1):67–75.

16. Hamasu S, Morimoto T, Kuramoto N, Horiguchi M, Iwami T, Nishiyama C, et al. Effects of BLS training on factors associated with attitude toward CPR in college students. Resuscitation 2009;80(3):359-64.

17. Kuramoto N, Morimoto T, Kubota Y, Maeda Y, Seki S, Takada K, et al. Public perception of and willingness to perform bystander CPR in Japan. Resuscitation 2008;79(3):475-81.

18. Swor R, Khan I, Domeier R, Honeycutt L, Chu K, Compton S. CPR training and CPR performance: do CPR-trained bystander per-form CPR? Acad Emerg Med 2006;13(6):596-601.

19. Cho GC, Sohn YD, Kang KH, Lee WW, Lim KS, Kim W, et al. The effect of basic life support education on laypersons’ willingness in performing bystander hands only cardiopulmonary resuscitation. Resuscitation 2010;81(6):691-4.

20. Nielsen AM, Isbye DL, Lippert FK, Rasmussen LS. Can mass education and a television campaign change the attitudes toward car-diopulmonary resuscitation in a rural community? Scand J Trauma Resusc Emerg Med 2013;21:39.

21. Taniguchi T, Sato K, Fujita T, Okajima M, Takamura M. Attitudes to bystander cardiopulmonary resuscitation in Japan in 2010. Circ J 2012;76(5):1130-5.

22. Chew KS, Yazid MN, Kamarul BA, Rashidi A. Translating knowledge to attitude: a survey on the perception of bystander cardio-pulmonary resuscitation among dental students in Universiti Sains Malaysia and school teachers in Kota Bharu, Kelantan. Med J Malaysia 2009;64(3):205-9.

23. Chew KS, Yazid MN. The willingness of final year medical and dental students to perform bystander cardiopulmonary resuscitation in an Asian community. Int J Emerg Med 2008;1(4):301-9.

24. Shibata K, Taniguchi T, Yoshida M, Yamamoto K. Obstacles to bystander cardiopulmonary resuscitation in Japan. Resuscitation 2000;44(3):187-93.

25. Coons SJ, Guy MC. Performing bystander CPR for sudden cardiac arrest: behavioral intentions among the general adult population in Arizona. Resuscitation 2009;80(3):334-40.

26. Omi W, Taniguchi T, Kaburaki T, Okajima M, Takamura M, Noda T, Ohta K, Itoh H, Goto Y, Kaneko S, Inaba H. The attitudes of Japanese high school students toward cardiopulmonary resuscitation. Resuscitation 2008;78(3):340-5.

27. Swor RA, Jackson RE, Compton S, Domeier R, Zalenski R, Honeycutt L, Kuhn GJ, Frederiksen S, Pascual RG. Cardiac arrest in pri-vate locations: different strategies are needed to improve outcome. Resuscitation 2003;58(2):171-6.

28. Iwashyna TJ, Christakis NA, Becker LB. Neighborhoods matter: a population-based study of provision of cardiopulmonary resuscita-tion. Ann Emerg Med 1999;34(4 Pt 1):459-468.

29. Ong ME, Quah JL, Ho AF, Yap S, Edwin N, Ng YY, et al. National population based survey on the prevalence of first aid, cardiopul-monary resuscitation and automated external defibrillator skills in Singapore. Resuscitation 2013;84(11):1633-6.

30. Locke CJ, Berg RA, Sanders AB, Davis MF, Milander MM, Kern KB, et al. Bystander cardiopulmonary resuscitation. Concerns about mouth-to-mouth contact. Arch Intern Med 1995;155(9):938-43.

31. Axelsson A, Thorén A, Holmberg S, Herlitz J. Attitudes of trained Swedish lay rescuers toward CPR performance in an emergency. A survey of 1012 recently trained CPR rescuers. Resuscitation 2000;44(1):27-36.

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