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 [1]. 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 [2-9]. Yet the rate at which bystander initiated CPR is administered varies considerably and is dependent on the location of the arrest [6,10-14]. 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 [5,15,16]. 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 [17,18]. 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 [2,19,20]. The purpose of this study is to identify how social and educational factors impact reported barriers to bystander CPR.