The psychological and behavioural factors associated with laypeople initiating CPR for out-of-hospital cardiac arrest: a systematic review

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Chief Scientist Office, Scottish Government

BICeP Study Group

Background

Prompt, effective CPR greatly increases the chances of survival in out-of-hospital cardiac arrest. However, it is often not provided, even by people who have previously undertaken training. Psychological and behavioural factors are likely to be important in relation to CPR initiation by lay-people but have not yet been systematically identified.

Objective

To identify the psychological and behavioural factors associated with CPR initiation amongst lay-people. 

Methods  

Cochrane Library, MEDLINE, EMBASE, CINAHL, PsycInfo and Google Scholar. 

Primary studies reporting psychological or behavioural factors and data on CPR initiation involving lay-people published (inception to 15th January 2020).

Potential studies were screened and quality assessed independently by two reviewers. Study characteristics, psychological and behavioural factors associated with CPR initiation were extracted from included studies, categorised by study type and synthesised narratively. 

Results

Ninety studies (132,429 participants) comprising various designs, populations and of mostly weak quality were identified. The strongest and most ecologically valid studies identified factors associated with CPR initiation: the overwhelming emotion of the situation, perceptions of capability, uncertainty about when CPR is appropriate, feeling unprepared  and fear of doing harm. Current evidence is limited by a preponderance of atheoretical cross-sectional surveys using unvalidated measures with relatively little formal testing of posited ‘predictors’.

Conclusions

We will present the psychological and behavioural factors that are likely useful foci for future interventions aiming to increase CPR initiation. The literature in this area would benefit from more robust study designs which make greater use of theory.