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Department of Family Medicine and Community Health, Duke University School of Medicine, USADepartment of Population Health Sciences, Duke University School of Medicine, USAPre-hospital and Emergency Research Center, Duke-NUS Medical School, Singapore
Out-of-hospital cardiac arrest exerts a large disease burden, which may be mitigated by bystander cardiopulmonary resuscitation and automated external defibrillation. We aimed to estimate the global prevalence and distribution of bystander training among laypersons, which are poorly understood, and to identify their determinants.
Methods
We searched electronic databases for cross-sectional studies reporting the prevalence of bystander training from representative population samples. Pooled prevalence was calculated using random-effects models. Key outcome was cardiopulmonary resuscitation training (training within two-years and those who were ever trained). We explored determinants of interest using subgroup analysis and meta-regression.
Results
28 studies were included, representing 53,397 laypersons. Among national studies, the prevalence of cardiopulmonary resuscitation training within two-years and among those who were ever trained, and automated external defibrillator training was 10.02% (95% CI 6.60–14.05) and 39.64% (95%CI 29.11–50.67), and 15.70% (95% CI 10.17–22.18) respectively.
Subgroup analyses by continent revealed pooled prevalence estimates of 31.58% (95%CI 18.70–46.09), 52.62% (95%CI 38.40–66.63), 18.93 (95%CI 0.00–62.94), 64.97% (95%CI 64.00–65.93), and 50.56% (95%CI 47.57–53.54) in Asia, Europe, Middle East, North America, and Oceania respectively, with significant subgroup differences (p < 0.01). A country’s income and cardiopulmonary resuscitation training (ever trained) (p = 0.033) were positively correlated. Similarly, this prevalence was higher among the employed (p < 0.00001) and highly educated (p < 0.00001).
Conclusions
Large regional variation exists in data availability and bystander training prevalence. Socioeconomic status correlated with prevalence of bystander training, and regional disparities were apparent between continents. Bystander training should be promoted, particularly in Asia, Middle East, and low-income regions. Data availability should be encouraged from under-represented regions.
Out-of-hospital cardiac arrest (OHCA) is the loss of functional cardiac mechanical activity in association with an absence of systemic circulation, occurring at a setting outside of the hospital.
Despite advances in healthcare, mortality in OHCA remains high, with the pooled incidence of return of spontaneous circulation at 29.7%, and survival to admission at 22.0%.
The global survival rate among adult out-of-hospital cardiac arrest patients who received cardiopulmonary resuscitation: a systematic review and meta-analysis.
Observed variations in OHCA outcomes are multifactorial. Contributors to OHCA outcomes include factors such as local differences in the community aspects of the chain of survival
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.
including early bystander cardiopulmonary resuscitation (CPR) and defibrillation with an automated external defibrillator (AED). A study Sweden has showed that survival rates are proportional to the rates of bystander CPR, which are linked to the percentage of the population who are CPR trained.
Association of national initiatives to improve cardiac arrest management with rates of bystander intervention and patient survival after out-of-hospital cardiac arrest.
However, the prevalence of the population trained in CPR or AED training is likely to vary by geographical region and has been reported to be as low as 2.4%.
Worldwide, efforts have been made to improve access to CPR or AED training by various organizations, such as the American Heart Association, the Red Cross societies and the Laerdal Foundation,
These may include strategies such as incorporating basic life support (BLS) training into educational curriculum in public schools and training BLS skills at community institutions such as religious institutions or sports clubs, among other interventions.
Beyond in-person courses, BLS training may be offered on online platforms as well, such as an interactive website by the Resuscitation Council UK. Data regarding the prevalence of CPR or AED training across the globe and which subpopulations have poorest access to BLS training is hence urgently needed to guide targeted public health and educational initiatives that promote BLS training among laypersons.
Although various communities have individually reported the prevalence of BLS training both at the national level and for school-going populations, there has been no previous systematic review done to consolidate these. Hence, we performed a systematic review and meta-analysis to investigate the global prevalence of CPR and AED training and their determinants.
Methods
This systematic review and meta-analysis adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines,
The study protocol had been published in the International Prospective Register of Systematic Reviews (PROSPERO CRD: 42022300559).
Search strategy and study selection
We conducted a systematic literature search in Medline, Embase and Cochrane Library from database inception to October 24th 2021. The search strategy was developed in consultation with a medical information specialist (Medical Library, National University of Singapore). The search terms included medical subject heading (MeSH) terms such as “Out-of-Hospital Cardiac Arrest”, “Cardiopulmonary Resuscitation”, “Automated External Defibrillator”, “Basic Life Support” and related synonyms. The reference lists of relevant sources were hand-searched, and this process surfaced three more studies which were included in the final analysis.
Grey literature and non-English language articles were excluded. Abstracts retrieved from the search were imported into EndNote X9 (Clarivate, Philadelphia, PA) for the removal of duplicates.
Inclusion criteria
After deduplication of entries, three reviewers (TPN, SE, JT) independently screened all the abstracts using pre-defined inclusion and exclusion criteria. Article sieve was conducted using Google Sheets (Google LLC, Mountain View, CA). After identifying potentially relevant studies, the full-text articles were retrieved. Three reviewers (TPN, SE, JT) independently screened the full-texts and the reasons for exclusion were recorded. Discrepancies at any stage of the screening were resolved by discussion between the three reviewers and consensus with the senior author (AFWH).
The inclusion criteria were: (1) Studies with a primary or secondary aim of reporting the proportion of laypersons who have undergone CPR or AED training, (2) Studies representing a sample of a well-defined population. We considered laypersons among the general population or school-going population (students enrolled in educational institutions). A small number of off-duty healthcare workers who were part of the sample may be included in this population. We did not consider self-reported knowledge on CPR or willingness to provide bystander CPR as an indication of CPR training, and likewise for AED training. Exclusion criteria were: (1) Studies with no numerical data, (2) Studies only including healthcare workers (3) Unpublished or unfinished studies, (4) Conference abstracts, (5) Articles with small sample sizes (n < 5), (6) Case reports or series, (7) Narrative reviews or systematic reviews (8) Non-English language studies.
Data extraction and outcomes
Data were extracted from the studies using a case record form by three independent investigators (TPN, SE, JT). The data extraction process was blinded, and discrepancies were resolved through discussion and consensus with the senior author (AFWH). In this study, the main variables of interest were the proportion of laypersons who had ever undergone CPR (CPR-E) or AED (AED-E) training and the proportion of laypersons who had valid CPR (CPR-V) or AED (AED-V) training, defined as possession of a valid certificate in AED and CPR administration within two years of training. We also extracted variables such as gender, age, location (population density, rural or metropolitan residents), educational level, occupation, socioeconomical status (SES), race, marital status, population who received AED and CPR training, training location, and whether the training was mandatory from the included studies.
Statistical analysis
Data analyses were performed using the meta 4.18–0 package in R 3.6.3 (R Foundation for Statistical Computing, Vienna, Austria).
We conducted a single-arm meta-analysis of proportions for the primary outcomes. Nationally representative studies were selected if they fit the had a study aim was to ascertain training prevalence in a particular geographic area with the largest possible sample size. Data was transformed using the Freeman-Tukey double arcsine method
to stabilise variance before the calculation of pooled prevalence estimates using Clopper-Pearson intervals. Random effects models were used given expected heterogeneity between communities studied and the restricted maximum likelihood estimator was applied for between-study variance. Statistical heterogeneity was evaluated through the I2 statistic, τ2, and Cochran Q test values. I2 values of 25%, 50%, and 75% were taken as thresholds for low, moderate, and high heterogeneity, respectively. We opted to use multiple measures of statistical heterogeneity because recent studies showed that in meta-analyses of prevalence (single-arm meta-analysis), I2 alone is unreliable and may be misleading.
Comparative data exploring the effect of variables on CPR or AED training were extracted as crude odds ratios. Where possible, odds ratios were calculated using 2x2 contingency tables for binary variables of interest.
To further explore the heterogeneity between studies, we performed pre-defined subgroup analyses according to study-level variables including region (continent) and Gross National Income (GNI). Countries were categorised into subgroups based on their GNI per capita according to classification by the World Bank in the year 2021.
Bank TW. Health nutrition and population statistics [Available from: https://databank.worldbank.org/metadataglossary/health-nutrition-and-population-statistics/series/NY.GNP.PCAP.CD.
According to the World Bank, GNI per capita is defined as the gross national income divided by the midyear population, converted to United States Dollars at official exchange rates. We then performed univariate meta-regression to test a priori hypotheses that CPR or AED training would vary with the GNI per capita and mean age of study population. Finally, we performed conventional pairwise meta-analysis comparing the effects of binary variables (sex, education level, employment status) on CPR or AED training using Review Manager (RevMan 5.4, The Cochrane Collaboration). We used a Dersimonian-Laird random effects model and the Mantel-Haenszel method to pool the log odds ratios. Two-tailed statistical significance was set at p < 0.05. Quality assessment of the prevalence studies were assessed on 10 domains using the tool by Hoy et al.
whereas for comparative meta-analysis, a funnel plot was plotted and inspected for asymmetry whenever there are at least ten data-points.
Specific ethics review was not required for this review.
Results
Literature retrieval & summary of included studies
A total of 9,316 articles were retrieved from the initial search, of which 4,063 were duplicates. After the title and abstract sieve, the full texts of 209 articles were then evaluated for eligibility. 181 articles were excluded in the full text sieve. Finally, 28 studies qualified for synthesis,
National population based survey on the prevalence of first aid, cardiopulmonary resuscitation and automated external defibrillator skills in Singapore.
Knowledge of the national emergency telephone number and prevalence and characteristics of those trained in CPR in Queensland: baseline information for targeted training interventions.
A total of 16 studies representing a national population, and two studies representing a school going population were analysed. A summary of the search strategy is illustrated in Fig. 1.
Knowledge of the national emergency telephone number and prevalence and characteristics of those trained in CPR in Queensland: baseline information for targeted training interventions.
Association AH. Guidelines for Cardiopulmonary Resuscitation (CPR) and Emergency Cardiovascular Care (ECC). 2020 [Available from: https://cpr.heart.org/en/resuscitation-science/cpr-and-ecc-guidelines.
International multi-center real world implementation trial to increase out-of-hospital cardiac arrest survival with a dispatcher-assisted cardio-pulmonary resuscitation package (Pan-Asian resuscitation outcomes study phase 2).
National population based survey on the prevalence of first aid, cardiopulmonary resuscitation and automated external defibrillator skills in Singapore.
There were no studies appraised to be of high risk of bias. Three studies had a moderate risk of bias, and 25 studies were low-risk. The characteristics of included studies can be found in supplementary material 1.
The total at-risk population from all included studies consisted of 53,397 individuals.
Global prevalence of CPR training
A summary of pooled global prevalence results can be found in Table 1. The meta-regression and comparative analyses can be found in Table 2.
Table 1Summary of Pooled Global Prevalence Results.
Pooled Global Prevalence
Ever Trained
Valid Training
Studies representing national population
Studies representing school population
Studies representing national population
Studies representing school population
# of Studies (n)
% Prevalence (95% CI)
# of Studies (n)
% Prevalence (95% CI)
# of Studies (n)
% Prevalence (95% CI)
# of Studies (n)
% Prevalence (95% CI)
Overall prevalence of CPR training (all studies)
18 (40,066)
42.04% (30.98–52.52)
2 (2577)
12.60% (9.18–16.47)
6 (21,947)
10.02% (6.60–14.05)
1 (1407)
5.76% (4.60–7.04)
Overall prevalence of CPR training (low-risk studies only)
National population based survey on the prevalence of first aid, cardiopulmonary resuscitation and automated external defibrillator skills in Singapore.
Association AH. Guidelines for Cardiopulmonary Resuscitation (CPR) and Emergency Cardiovascular Care (ECC). 2020 [Available from: https://cpr.heart.org/en/resuscitation-science/cpr-and-ecc-guidelines.
International multi-center real world implementation trial to increase out-of-hospital cardiac arrest survival with a dispatcher-assisted cardio-pulmonary resuscitation package (Pan-Asian resuscitation outcomes study phase 2).
The pooled prevalence of CPR-E was 39.64% (95% confidence interval [95%CI] 29.11 to 50.67, Fig. 2) and when excluding 2 studies with a moderate risk of bias,
the pooled prevalence of CPR-E slightly decreased to 37.76% (95%CI 26.36 to 49.90, Fig. 2). Two studies reported the prevalence of CPR-E training among a total of 2,577 laypersons from a school-going population.
Subgroup analyses by GNI per capita (Fig. 3) revealed pooled prevalence of CPR-E estimates of 43.63% (95%CI 37.71 to 55.94), 40.13% (95%CI 25.88 to 55.29), and 3.00% (95%CI 2.35 to 3.72) for GNI per capita at high-, upper middle-, and lower middle-income levels respectively, with significant difference between the subgroups (p < 0.01).
Subgroup analyses by continent for CPR-E (Fig. 4) revealed pooled prevalence estimates of 64.97% (95%CI 64.00 to 65.93), 50.56% (95%CI 47.57 to 53.54), 31.58% (95%CI 18.70 to 46.09), 18.93 (95%CI 0.00 to 62.94), 52.62% (95%CI 38.40 to 66.63) for the continents of North America, Oceania, Asia, Middle East, and Europe respectively, with significant difference between them (p < 0.01).
National population based survey on the prevalence of first aid, cardiopulmonary resuscitation and automated external defibrillator skills in Singapore.
Association AH. Guidelines for Cardiopulmonary Resuscitation (CPR) and Emergency Cardiovascular Care (ECC). 2020 [Available from: https://cpr.heart.org/en/resuscitation-science/cpr-and-ecc-guidelines.
International multi-center real world implementation trial to increase out-of-hospital cardiac arrest survival with a dispatcher-assisted cardio-pulmonary resuscitation package (Pan-Asian resuscitation outcomes study phase 2).
The pooled prevalence was 10.02% (95% CI 6.60 to 14.05, Fig. 5) and when excluding 1 moderate-risk study the prevalence of CPR-V training was 11.14% (95% CI 7.51 to 15.39, Fig. 5). Only one study reported the prevalence of CPR-V training among a total of 1,407 laypersons from a school-going population.
Subgroup analyses by GNI per capita revealed pooled prevalence estimates of 9.54% (95% CI 5.72 to 14.21) and 12.76% (95% CI 9.60 to 16.30) for GNI per capita at high- and upper middle-income levels respectively, with no significant difference between the subgroups (p = 0.54).
Subgroup analyses by continent revealed pooled prevalence estimates of 8.04% (95% CI 5.13 to 11.52), 18.0% (95% CI 17.21 to 18.8), and 10.87% (95% CI 9.08 to 12.81) for the continents of Asia, North America, and Oceania respectively, with significant difference between the subgroups (p < 0.01).
Global prevalence of AED training
Prevalence of AED-E training
Five studies reported the prevalence of only AED-E training among a total of 11,220 laypersons from a national population.
National population based survey on the prevalence of first aid, cardiopulmonary resuscitation and automated external defibrillator skills in Singapore.
The pooled prevalence was 15.70% (95% CI, 10.17 to 22.18) (Table 1). There were no studies which reported the prevalence of only AED-E training among laypersons from a school-going population.
Prevalence of AED-V training
One study from Singapore reported the prevalence of AED-V training among a total of 4,192 laypersons from a national population. The reported prevalence was 3.70% (95% CI, 3.15 to 4.29).
National population based survey on the prevalence of first aid, cardiopulmonary resuscitation and automated external defibrillator skills in Singapore.
There were no studies which reported the prevalence of AED-V training among laypersons from a school-going population.
Meta-regression & comparative Meta-analyses
Meta-regression
On univariate meta-regression of all 28 studies, the higher a country’s GNI group, (β: −0.1810, 95%CI −0.3469 to −0.0151, p = 0.0325) the higher the national prevalence of CPR-E training (Table 2). This bubble plot can be found in Supplementary Material 3: Bubble Plot for CPRE/GNI Group Regression. However, proportion of females and mean age did not significantly influence the national prevalence of CPR-E training. On univariate meta-regression, proportion of females and GNI per capita did not significantly influence the national prevalence of CPR-V training. Meta-regression for other moderators was not attempted due to an insufficient number of studies.
Comparative Meta-analyses
On comparative meta-analysis, education above the primary school level (OR: 4.39, 95%CI 3.45 to 5.57, p < 0.00001) and being employed in an occupation (OR: 2.48, 95%CI 2.17 to 2.83, p < 0.00001) significantly influenced the national prevalence of CPR-E training based on six and four studies respectively. Female gender did not significantly influence the national prevalence of CPR-E training. On comparative meta-analysis, female gender did not significantly influence the national prevalence of CPR-V training. On visual inspection, funnel plot for the comparative meta-analyses for sex (female and male) revealed no publication bias for comparative meta-analysis. This funnel plot can be found in Supplementary Material 2: Funnel Plot for Comparative Meta-analyses (Female).
Discussion
In this study, we found that the prevalence of ever having been trained in CPR in the general population globally ranged from 3% to 65%, with a pooled prevalence of 39.64%. This prevalence was lower, at 10.02%, when using a stricter definition of CPR training (valid training within 2-years). We found evidence of differences in prevalence between continents, a positive correlation with a country’s income, and positive correlations with employment rate and education level. As compared to CPR training, the data surrounding prevalence of AED training is much scarcer. This is, to our knowledge, the most updated systematic review, and the only meta-analysis addressing this research question.
Contemporary guidelines, including the 2020 American Heart Association Guidelines for CPR and Emergency Cardiovascular Care,
advocate for the promotion of CPR mass training and awareness campaigns in the community. Having a sizeable proportion of the general population as layrescuers can increase the chance of an OHCA victim receiving bystander CPR. A Singaporean study has showed that public health interventions such as dispatch-assisted CPR, CPR and AED training, and a first responder mobile application (myResponder) were associated with increased bystander training, increasing CPR frequency and improving survival to hospital discharge after OHCA, compared with the preintervention time period.
However, large-scale programs to train and influence large groups of the population are resource-intensive, and an understanding of the global baseline, regional differences and disparities are essential to guide resource allocation, design and implementation of such programs. Our study found a wide range of prevalence of CPR training across communities, which partially explains the large regional variation in bystander CPR rates observed in previous studies.
These findings suggest inequity in access to life-saving training globally, and by corollary, a gap in governmental and non-governmental funding priority in this area. Our study also provides a possible explanation of reduced bystander CPR rates observed in socioeconomically disadvantaged communities in some regions.
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.
When restricting our analysis to the highest quality studies, our estimate of the global prevalence of CPR-E training was 37.76%, and the estimate of global CPR-V training prevalence was 11.14%. Since several studies reported that a high percentage of bystanders are receptive to CPR training and that CPR training predicts bystander CPR, these low estimates suggest that global efforts to provide CPR training remain inadequate to maximise the performance of bystander CPR. Furthermore, the prevalence of CPR-E training was significantly different between countries of different GNI levels, with CPR prevalence at 43.63%, 40.13%, and 3.00% for high-, upper middle-, and lower middle-income levels respectively, hence suggesting a correlation between higher SES and higher CPR training.
On the national level, high GNI countries may have the financial capability to place a larger emphasis on CPR training, resulting in better national measures and resource allocation regarding CPR training applied across all states, regardless of individual state income. On the individual level, lower SES may create barriers such as financial barriers, information barriers, and barriers which lower personal motivation which discourage individuals from seeking CPR education.
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.
As a result, the lower middle-income countries should be prioritised when it comes to BLS training.
In schools, the prevalence of CPR-E training was 12.60%, and the prevalence of CPR-V training was 5.76%. The “Kids Save Lives” Statement 2015, which highlights the importance of teaching CPR to school children worldwide, recommends two hours of CPR training annually from the age of twelve in schools worldwide, especially since children are responsive to instructions and learn easily.
However, our study revealed a gap in knowledge on CPR and AED training in schools despite the potential benefit of such training among younger age groups, which should be explored in future research.
Overall, the paucity of studies investigating the prevalence of only AED training although bystander AED intervention improves survival and functionally-favourable outcomes.
suggests that more research is needed in this area. Internationally, resources should be channeled towards establishing CPR training guidelines, which may eventually involve training locals to become CPR trainers themselves, working with local policymakers, healthcare professionals and experts to come up with CPR guidelines specific to their countries’ needs and culture, and the provision of training resources tailored to the country’s local languages. At a national level, governmental policies aiming to increase the reach of CPR training could be instituted. These measures could include the creation of a combined self-instruction and instructor-led courses with hands-on training, alternatives for self-directed training,
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.
Finally, individuals may be motivated at a personal level to pick up CPR as a life skill if there is greater education about the value of CPR in improving survival in cardiac arrest,
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.
so greater public education is required especially among countries with a low prevalence of CPR training. This is particularly relevant among geographic regions which have a lower prevalence of CPR training, such as the Middle East and Asia.
Strengths and Limitations
This study is the first study to date which investigates the prevalence of CPR and AED training in populations worldwide. The limitation of this study is the high heterogeneity observed in the statistical analysis. This may be attributed to many factors, such as the lack of South American and African papers, the different methods in which data was analysed, and the different ways CPR or AED training was defined. Finally, there is a risk of misclassifying individual persons’ socioeconomic statuses using GNI, which is a regional-level indicator of socioeconomic status.
However, we note that the finding of a significant, positive correlation was invariant even in our comparative meta-analysis of individual-level socioeconomic indicators (education level, employment status).
Conclusions
This systematic review and meta-analysis found that large regional variation exists in the data availability, and prevalence of CPR and AED training amongst laypersons. Socioeconomic status correlated with prevalence of CPR training and regional disparities were apparent between continents. As such, community bystander training should be promoted, particularly in Asia, Middle East and low-income regions, while data availability should be encouraged from under-represented regions.
Funding
AFWH was supported by the Estate of Tan Sri Khoo Teck Puat (Khoo Clinical Scholars Programme), Khoo Pilot Award (KP/2019/0034), Duke-NUS Medical School and National Medical Research Council (NMRC/CS_Seedfd/012/2018).
Author Information
The Global Access to Lifesaving Skills Training (GOALS) workgroup currently consists of: Joyce Kong, Willem Stassen, Sang Do Shin, Bryan McNally, Helge Myklebust, Freddy Lippert, Marcus Ong, Audrey Blewer, Andrew Ho, Lin Zhang, Zhi-Jie Zheng, Kyoung Jun Song, B. Hollong, Ramana Rao, Junaid Razzak, Sattha Riyapan, and Thanh Nguyen.
CRediT authorship contribution statement
Trina Priscilla Ng: Writing – original draft. Sean Wai-Onn Eng: Writing – original draft. Joel Xin Rui Ting: Writing – original draft. Chermaine Bok: . Girvan Yang Hong Tay: . So Yeon Joyce Kong: Supervision. Willem Stassen: Supervision. Lin Zhang: Supervision. Marcus Eng Hock Ong: Supervision. Audrey L Blewer: Supervision. Jun Wei Yeo: Supervision. Andrew Fu Wah Ho: Supervision.
Conflicts of Interest
So Yeon Joyce Kong is an employee of Laerdal Medical, but has no conflict of interest.
Dr. Audrey L. Blewer declares research funding through grants from the National Institutes of Health and the Laerdal Medical Foundation.
Lin Zhang declares research project support through the Laerdal Medical Foundation.
Acknowledgements
The authors thank Ms. Wong Suei Nee (Senior Librarian, National University of Singapore Libraries) for her invaluable input in the design and implementation of the search strategy.
Appendix A. Supplementary data
The following are the Supplementary data to this article:
Supplementary figure 1Funnel Plot for Comparative Meta-analyses (Female).
The global survival rate among adult out-of-hospital cardiac arrest patients who received cardiopulmonary resuscitation: a systematic review and meta-analysis.
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.
Association of national initiatives to improve cardiac arrest management with rates of bystander intervention and patient survival after out-of-hospital cardiac arrest.
Bank TW. Health nutrition and population statistics [Available from: https://databank.worldbank.org/metadataglossary/health-nutrition-and-population-statistics/series/NY.GNP.PCAP.CD.
National population based survey on the prevalence of first aid, cardiopulmonary resuscitation and automated external defibrillator skills in Singapore.
Knowledge of the national emergency telephone number and prevalence and characteristics of those trained in CPR in Queensland: baseline information for targeted training interventions.
Association AH. Guidelines for Cardiopulmonary Resuscitation (CPR) and Emergency Cardiovascular Care (ECC). 2020 [Available from: https://cpr.heart.org/en/resuscitation-science/cpr-and-ecc-guidelines.
International multi-center real world implementation trial to increase out-of-hospital cardiac arrest survival with a dispatcher-assisted cardio-pulmonary resuscitation package (Pan-Asian resuscitation outcomes study phase 2).
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.
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