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Clin Exp Emerg Med > Volume 10(3); 2023 > Article
Birkun: Global prevalence of resuscitation training among the general public: current evidence and future directions
Dear Editor,
Investigation of international practices in community cardiopulmonary resuscitation (CPR) training constitutes an important area of research, as it may uncover disparities in resuscitation education and inform public health initiatives to improve bystander CPR rates and outcomes after out-of-hospital cardiac arrest. Along with individual population-based surveys carried out around the globe to investigate the prevalence of CPR training among the general public, some systematic research has been undertaken to map and analyze evidence from these observational studies.
A scoping review conducted by our research group [1] was the first study that investigated international evidence from population-based surveys reporting the prevalence of community resuscitation training. Based on 61 published studies conducted in 29 countries, the review showed the following: (1) a lack of data on community CPR training for most countries of the world, (2) a predominance of studies conducted in high-income countries compared to countries with low-income economies, and (3) considerable variation in reported CPR training rates (3%–79%) with a median global prevalence of CPR training amounting to 40% [1]. Alongside this, the scoping review demonstrated significantly higher rates of resuscitation training in countries with higher income economies (50%, 23%, and 17% for high-, upper middle-, and lower middle-income countries, respectively), indicating international disparities in existing practices of community CPR training and suggesting the need to further improve public awareness of cardiac arrest and education on resuscitation worldwide [1].
A recently published systematic review and meta-analysis by Ng et al. [2] corroborated the findings of the aforementioned scoping review [1]. In particular, based on the results of 17 studies, the pooled prevalence of ever been trained in CPR in the general global population was 39.6% (ranging from 3% to 65%), and significant variation was demonstrated for CPR training rates among continents and countries with different gross national income levels (43.6%, 40.1%, and 3.0% for high-, upper middle-, and lower middle-income levels, respectively) [2]. The authors confirmed a positive correlation between national income and the prevalence of community CPR training and concluded that CPR training needed to be promoted among laypersons, particularly in Asia, the Middle East, and low-income regions [2].
While not denying the importance of the research by Ng et al. [2], it is worth noting that the authors neglected to discuss the preceding scoping review [1], while including it in the reference list. The omission of the scoping review results [1] led the authors to overlook some relevant publications, which fit the aim of their systematic review [2], including but not limited to the articles reporting the prevalence of CPR training based on national population-based surveys conducted in China [3], Poland [4], Korea [5], and Taiwan [6]. This emphasizes the value of a scoping review as a precursor tool that is intended to determine coverage of a body of literature and to provide an overview of studies available on a given topic in order to inform future systematic reviews [7]. The highlighted issue should be regarded as a limitation of the systematic review [2] and remembered to support the scientific rigor and transparency of future studies.
Regarding further research, the results of both reviews suggest that further efforts are needed to develop international best practices for measurement, monitoring, and analysis of community resuscitation training. Besides the general paucity of studies in this area, population-based surveys investigating the prevalence of CPR training among the general public are highly heterogeneous in survey design, methodology, and reporting patterns, which complicates interpretation and comparison of the findings [1]. Hence, development of international Utstein-like consensus guidelines on a standardized survey methodology and reporting of data on CPR training practices seems to be a reasonable way to improve consistency and comparability of future surveys. The availability of such uniform guidance could also encourage resuscitation research in regions of the world where CPR training prevalence is currently unknown, particularly in lower middle- and low-income countries. Reliable research data on CPR education in turn could contribute to the development of interventions seeking to improve public access to resuscitation training, which could contribute to better survival after out-of-hospital cardiac arrest.


Not applicable.
No potential conflict of interest relevant to this article was reported.


1. Birkun A, Gautam A, Trunkwala F. Global prevalence of cardiopulmonary resuscitation training among the general public: a scoping review. Clin Exp Emerg Med 2021; 8:255-67.
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2. Ng TP, Eng SW, Ting JX, et al. Global prevalence of basic life support training: a systematic review and meta-analysis. Resuscitation 2023; 186:109771.
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3. Yan S, Gan Y, Wang R, Song X, Zhou N, Lv C. Willingness to attend cardiopulmonary resuscitation training and the associated factors among adults in China. Crit Care 2020; 24:457.
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4. Rasmus A, Czekajlo MS. A national survey of the Polish population’s cardiopulmonary resuscitation knowledge. Eur J Emerg Med 2000; 7:39-43.
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5. Ro YS, Shin SD, Song KJ, Hong SO, Kim YT, Cho SI. Bystander cardiopulmonary resuscitation training experience and self-efficacy of age and gender group: a nationwide community survey. Am J Emerg Med 2016; 34:1331-7.
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6. Pei-Chuan Huang E, Chiang WC, Hsieh MJ, et al. Public knowledge, attitudes and willingness regarding bystander cardiopulmonary resuscitation: a nationwide survey in Taiwan. J Formos Med Assoc 2019; 118:572-81.
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7. Munn Z, Peters MD, Stern C, Tufanaru C, McArthur A, Aromataris E. Systematic review or scoping review? Guidance for authors when choosing between a systematic or scoping review approach. BMC Med Res Methodol 2018; 18:143.
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