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The impact of COVID-19 on the Australian public’s willingness to perform hands-only CPR

      To the Editor,
      The provision of bystander CPR in public places relies on the public’s willingness to intervene and provide first aid to a stranger. Recent surveys suggest approximately half of members of the public are willing to provide CPR to a stranger,
      • Cartledge S.
      • Saxton D.
      • Finn J.
      • Bray J.E.
      Australia's awareness of cardiac arrest and rates of CPR training: results from the Heart Foundation's HeartWatch survey.
      with fear of infection rarely reported as a barrier.
      • Cartledge S.
      • Saxton D.
      • Finn J.
      • Bray J.E.
      Australia's awareness of cardiac arrest and rates of CPR training: results from the Heart Foundation's HeartWatch survey.
      • Matsuyama T.
      • Scapigliati A.
      • Pellis T.
      • Greif R.
      • Iwami T.
      Willingness to perform bystander cardiopulmonary resuscitation: a scoping review.
      However, this may have changed in the current era of the highly infectious COVID-19 pandemic.
      Data is emerging about the variable effects of the current COVID-19 pandemic on rates of bystander CPR.
      • Bray J.
      • Cartledge S.
      • Scapigliati A.
      Bystander CPR in the COVID-19 pandemic.
      Of importance, an international social media survey conducted in June 2020 suggests willingness to perform bystander CPR had decreased.
      • Grunau B.
      • Bal J.
      • Scheuermeyer F.
      • et al.
      Bystanders are less willing to resuscitate out-of-hospital cardiac arrest victims during the COVID-19 pandemic.
      However, this study asked participants to reflect on their prior willingness to intervene and was conducted relatively early in the pandemic. We decided to investigate whether this was an issue at the peak of the pandemic in Australia.
      The National Heart Foundation of Australia commissions quarterly online surveys of Australian adults.
      • Cartledge S.
      • Saxton D.
      • Finn J.
      • Bray J.E.
      Australia's awareness of cardiac arrest and rates of CPR training: results from the Heart Foundation's HeartWatch survey.
      In two of these quarters, July to September 2017 (n = 1076) and the same period in 2020 (n = 3607), questions were added about willingness to provide hands-only CPR to a stranger. We explored this data to examine whether the pandemic had changed the Australian public’s willingness to provide CPR to a stranger, and conducted a logistic regression analysis to the determine whether subgroups of the population were more willing.
      Our data suggests the Australian public’s willingness to perform bystander CPR on a stranger did not changed at the peak of the pandemic (54% in 2017 to 55% in 2020, p = 0.70). Compared to younger participants surveyed, those aged over 55 years were more willing to provide CPR (Fig. 1), as were those who were living in states and territories with smaller population numbers (vs Victoria) and in outer regional, remote and very remote locations (vs major cities).
      Fig. 1
      Fig. 1Multivariable analysis of willingness to perform CPR.
      Rates of COVID-19 varied widely between states and territories, and were greatest at the time of the survey in the state of Victoria. However, our data showed no change in willingness to perform CPR by Victorians (52% in 2017 and 48% in 2020, p = 0.28). This finding is consistent with OHCA registry data from this region which suggest no changes to bystander CPR rates in public places during the pandemic.
      • Ball J.
      • Nehme Z.
      • Bernard S.
      • et al.
      Collateral damage: hidden impact of the COVID-19 pandemic on the out-of-hospital cardiac arrest system-of-care.
      Our data does highlight the relatively low willingness of Australians to provide bystander CPR to a stranger, and also provides important information about whom to target with education highlighting the importance of CPR and the need to intervene. Targeting and tailoring CPR education specifically by age may be warranted.

      Conflicts of interest

      No conflicts of interest.

      Funding

      SH is supported by a National Health and Medical Research Council (NHMRC) Centre of Research Excellence (Prehospital Emergency Care, #1029983 ). ZN is supported by a NHMRC Early Career Fellowship ( #1146809 ). JB is supported by a Heart Foundation Fellowship ( #101171 ).

      References

        • Cartledge S.
        • Saxton D.
        • Finn J.
        • Bray J.E.
        Australia's awareness of cardiac arrest and rates of CPR training: results from the Heart Foundation's HeartWatch survey.
        BMJ Open. 2020; 10e033722
        • Matsuyama T.
        • Scapigliati A.
        • Pellis T.
        • Greif R.
        • Iwami T.
        Willingness to perform bystander cardiopulmonary resuscitation: a scoping review.
        Resusc Plus. 2020; 4100043
        • Bray J.
        • Cartledge S.
        • Scapigliati A.
        Bystander CPR in the COVID-19 pandemic.
        Resusc Plus. 2020; 4100041
        • Grunau B.
        • Bal J.
        • Scheuermeyer F.
        • et al.
        Bystanders are less willing to resuscitate out-of-hospital cardiac arrest victims during the COVID-19 pandemic.
        Resusc Plus. 2020; 4100034
        • Ball J.
        • Nehme Z.
        • Bernard S.
        • et al.
        Collateral damage: hidden impact of the COVID-19 pandemic on the out-of-hospital cardiac arrest system-of-care.
        Resuscitation. 2020; 156: 157-163