INTRODUCTION:

Sudden cardiac arrest remains a major public health concern worldwide. Early recognition of cardiac arrest and immediate initiation of cardiopulmonary resuscitation (CPR) can double or even triple the chance of survival.

The chain of survival emphasizes six critical components: activation of emergency response, high quality CPR, early defibrillation, advanced resuscitation, post cardiac arrest care and recovery. Among these, early CPR by bystanders is crucial because emergency medical personnel may arrive too late to reverse hypoxic brain injury.

In India, bystander CPR rates are significantly lower compared to many western countries. Lack of awareness, inadequate training opportunities, and fear of legal or physical harm contribute to reluctance in performing CPR. Kerala has a comparatively higher literacy rate and better access to health service, yet CPR knowledge among the general public remains insufficient. Ernakulam district being a major urban center, provides an ideal setting to examine the baseline knowledge level related to CPR among the nonmedical community. Understanding current knowledge gaps can support policymakers and public health authorities in designing targeted educational interventions.

NEED OF THE STUDY:

Sudden cardiac arrest can occur at any time, and immediate CPR is essential to maintain blood flow and increase the person’s chance of survival. Many lives are lost in the community because people nearby do not know how to perform CPR. Although Kerala has high literacy rates, awareness and practical knowledge of CPR among the general population are still low. Ernakulam is a busy district where emergencies can happen at home, workplace and public areas. Therefore, assessing the level of CPR knowledge among non-medical people is important to identify gaps and plan community training programs. Improving CPR awareness can empower ordinary citizens to act confidently during emergencies and help save lives.

OBJECTIVES:

The study was conducted to

1. To assess the level of knowledge regarding cardiopulmonary resuscitation among the non-medical population of Ernakulam district

2. To determine the association between knowledge scores and selected demographic variables such as age, gender, education, occupation and prior CPR training

REVIEW OF LITERATURE:

Global perspective on CPR knowledge:

American heart association emphasized that early bystander CPR can double or triple survival rate in out of hospital cardiac arrest ¹. Despite this, survey in the United States indicate that only 30-40% of adults are trained and confident to perform CPR. Lack of training, fear of causing harm and low confidence are major barrier.

A study in Europe reported wide variation in CPR knowledge and skills. Countries with mandatory CPR training in schools showed significantly higher awareness among the general population compared to those without structured program².

In Japan, it was found that even when CPR training was available, retention of practical skills declined rapidly within a year, highlighting the importance of refresher courses³.

CPR knowledge in India:

A survey among urban adults in Delhi and reported that only 18% of participants were confident to perform CPR. Awareness of chest compression rate and depth was particularly low, with most respondents having heard of CPR through media rather than formal training⁴.

Another study in Karnataka found that prior training significantly improved knowledge scores. However, only 25% of respondents had ever attended any formal CPR sessions⁵.

It was also emphasized that fear of legal consequences, fear of causing harm and lack of access to automated external defibrillator (AEDs) discouraged bystanders from attempting CPR⁶.

Impact of education and Training:

Studies in Kerala demonstrated that adults with higher education level scored significantly better in knowledge assessment compared to those with only secondary education⁷.

Prior exposure to CPR training, even if brief increased the likelihood of performing CPR confidently. The study reported that individuals who had attended workshops with in the past two years were twice as likely to score “good knowledge” on standardized assessments⁸.

MATERIALS AND METHODS:

Study Design:

A descriptive cross-sectional study was conducted in selected urban and rural areas of Ernakulam district

Study Population:

Adult aged >18 years residing in Ernakulam district without medical, Nursing or Paramedical professional background

Sampling method:

Multi stage sampling technique was used. First, areas were selected randomly. Then households were chosen systematically. One eligible adult from each household was selected randomly.

Sample Size:

A total of 200 non-medical adults aged ≥18 Years participated in the study

Data collection Tool:

A structured questionnaire with two parts

· Demographic characteristics

· 20 knowledge-based questions on CPR steps, compression depth, Compression ratio, Compression rate and use of automated external defibrillators (AED) (Scoring 0-20)

Knowledge level were classified as:

· Good Knowledge: ≥15

· Moderate knowledge: 10-14

· Poor Knowledge: < 10

Data Analysis:

Data were analyzed using descriptive statics (Frequency, percentage, mean, SD) and inferential statistics (Ch-square test) to determine association.

Ethical Consideration:

Informed consent was obtained from all participant. Confidentiality was strictly maintained

RESULT:

A total 200 non-medical adults from Ernakulam district participated in the study. The data were analyzed and presented under the following headings:

1. Demographic characteristics of participant:

Table 1: Frequency and percentage distribution of demographic variables (N=200)

Variables	Categories	Frequency (n)	Percentage (%)
Age (Yeas)	18-30	82	41.0
	31-45	66	33.0
	46-60	38	19.0
	>60	14	7.0
Gender	Male	104	52.0
	Female	96	48.0
Education Level	<10^th Standard	36	18.0
	Higher secondary/ Graduate	124	62.0
	Post Graduate	40	20.0
Occupation	Skilled / unskilled worker	58	29.0
	Private / Government job	72	36.0
	Student	46	23.0
	Self employed	24	12.0
Residence	Urban	120	60.0
	Rural	80	40.0
Previous CPR Training	Yes	38	19.0
	No	162	81.0

Table 1 shows that, majority of participant (62%) had higher secondary/ graduate education. Only 19% had undergone any previous CPR training.

2. Overall knowledge level regarding CPR

Knowledge was scored out of 20 and categorized as

· Poor: <10

· Moderate:10-14

· Good: ≥15

Table 2: Distribution of participants based on level knowledge (N=200)

Knowledge Level	Score Range	Frequency (n)
Poor	<10	36
Moderate	10-14	116
Good	≥15	48

Mean knowledge score: 12.4±3.2

Table 2 Shows that, more than half (58%) had only a moderate level of CPR knowledge, while only 24% demonstrate good knowledge.

3. Item-wise correct response Analysis

Table 3: percentage of correct responses for individual knowledge items (N=200)

Key CPR concepts	% Correct Responses
Checking scene safety before approach the victim	58%
Check the response, recognizing no pulse and breathing as cardiac arrest sign	74%
Calling emergency number (112)	69%
Correct hand placement for chest compression	64%
Compression rate (100-120/min)	68%
Compression depth (At least 5 cm)	41%
Compression ventilation ratio (Sigle rescuer-30:2)	55%
Awareness of AED and its use	32%

Table 3 shows that, the least understood area were AED usage and correct compression depth, which are critical components of effective CPR.

4. Association between knowledge level and selected variables

Chi-square test was used to determine association.

Table4: Association of knowledge level with education and CPR training

Category	Χ² Value	p-Value
≤10^th vs Higher secondary/ Graduate vs Post graduate	18.62	P<0.001
Yes, vs NO	29.14	P<0.001
Male vs Female	2.41	P=0.12
Urban vs Rural	2.89	P=0.09

Table 4 Shows that, participants with higher education and previous CPR training showed significantly higher knowledge. Knowledge was not influenced by gender or place of residence

5. Comparative mean knowledge score based on training

Table 5: Comparison of mean knowledge score (t-test)

Group	Mean ± SD	t-value	p-value	interpretation
Trained participant (n=38)	15.6 ± 2.1	-	-	-
Untrained participant	11.8 ± 3.1	8.20	P<0.001	Significant

Table 5 shows that, participant who had undergone CPR training scored substantially higher than those who had not.

SUMMARY OF RESULTS:

Majority had only moderate understanding of CPR. Knowledge gaps were especially noted in compression depth and AED use. Education level and previous CPR training played a significant role in improving knowledge. This implies that structured community CPR training program can meaningfully improve bystander readiness.

DISCUSSION:

The findings indicate that while a majority of participant had a moderate level of CPR knowledge, only a small portion possessed adequate knowledge that would enable them to perform effective CPR in emergencies. Lack of hands-on training appears to be major barrier. Similar trends have been reported in other regions, where public willingness to help is present but practical skills are limited^4,5.

The strong association between education and CPR knowledge highlights the importance of integrating CPR training into school and colleges curricula. The low percentage of trained individuals indicates the need for accessible community training initiatives^7,8.

CONCLUSION:

The study concludes that the non-medical population in Ernakulam district has moderate yet insufficient knowledge regarding CPR. Increasing access to structured CPR training programs is essential to improve bystander response in cardiac emergencies.

RECOMMENDATIONS:

1. Conduct community-based CPR awareness and hands-on training program

2. Include CPR training modules in school health and college orientation program

3. Promote public access defibrillation and awareness of AED use.

4. Utilize social media and local health campaign to spread emergency response awareness.

LIMITATION:

· The study was limited to selected geographic region; findings may not represent the entire district

· Skills performance was not assessed; only theoretical knowledge was measured.

REFERENCE:

1. American Heart Association. Guidelines for CPR and emergency cardiovascular care. Dallas, TX: AHA; 2020.

2. Böttiger BW, Wnent J, Semeraro F. Public CPR education and its effects on survival: lessons from Europe. Resuscitation. 2019; 139:1–7.

3. Kitamura T, Iwami T, Kawamura T. Retention of CPR skill in the general population: a community-based study. Circulation. 2018; 137(21): 2224–2232.

4. Kumar V, John P. Bystander CPR awareness in urban India. Indian J Emerg Med. 2019; 5(1): 12–18.

5. Rao S, Mehta K, Sharma A. Knowledge of CPR among laypersons in Karnataka. J Family Med Prim Care. 2020; 9(3): 1205–1211.

6. Singh R, Patel M. Factors affecting bystander CPR in India. Indian Heart J. 2021; 73(2): 145–151.

7. Thomas A, Varghese J, Nair R. CPR knowledge among adults in Kerala: an urban–rural comparison. Kerala Med J. 2020; 13(1): 34–41.

8. Desai M, Shah P, Bhatt A. Effect of training on CPR knowledge retention. J Community Health. 2018; 43(6): 1150–1156.

Received on 14.11.2025 Revised on 18.12.2025

Accepted on 10.01.2026 Published on 30.04.2026

Available online from May 02, 2026

Asian J. Nursing Education and Research. 2026;16(2):119-122.

DOI: 10.52711/2349-2996.2026.00024

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