Emergency Medicine International
Volume 2019 (2019), Article ID 3686202, 11 pages
https://doi.org/10.1155/2019/3686202

Research Article

Knowledge of Nonmedical Individuals about Cardiopulmonary Resuscitation in Case of Cardiac Arrest: A Cross-Sectional Study in the Population of Jeddah, Saudi Arabia

Fadi Jandali Qara, Loui K. Alsulimani, Maged M. Fakeeh, and Diyaa H. Bokhary

King Abdulaziz University, Jeddah, Saudi Arabia

Correspondence should be addressed to Fadi Jandali Qara; fadijandali.92@hotmail.com

Received 4 October 2018; Revised 29 December 2018; Accepted 8 January 2019; Published 16 January 2019

Academic Editor: Seiji Morita

Copyright © 2019 Fadi Jandali Qara et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract.

Introduction. In cardiac arrest victims, providing a high-quality cardiopulmonary resuscitation (CPR) is a fundamental component of initial care, especially in the out-of-hospital settings. In this study, we sought to assess the knowledge of nonmedical people regarding cardiopulmonary resuscitation in the case of out-of-hospital cardiac arrest. Methods. A cross-sectional survey containing 22 questions was administered to individuals aged ≥ 18 years, who were not health care providers. Sample included residents of Jeddah, Saudi Arabia. The survey included knowledge about cardiac arrest findings, previous experience with CPR, knowledge of basic life support (BLS), and concerns related to CPR. Results. The fully completed survey forms of 600 respondents were analysed. Out of these, 28.7% stated that they had previously received training in CPR. Regarding manifestations of cardiac arrest, 40.7% suggested loss of consciousness, 36.8% suggested cessation of breathing, and 24.7% suggested cessation of circulation. Only 11.7% among respondents were found to be able to perform chest compressions. Also, only 9.2% could perform mouth-to-mouth ventilation, and 29.5% were able to perform both. While 55.5% knew the location for performing chest compressions, 44.7% knew the correct depth, and only 18.5% knew the correct compression–ventilation rate. Bystander CPR had been performed by only 10.7%. Conclusion. In our sample, we found lack of knowledge regarding CPR. We advise for a coordinated national effort to improve the public awareness about CPR performance. This may include mass education, specialized training, and setting legislations.

1. Introduction

Sudden cardiac arrest is the main cause of death for millions of people worldwide every year [1, 2]. In cardiac arrest victims, cardiopulmonary resuscitation (CPR) is a fundamental component of initial care. The quality of delivered CPR improves the survival rate from cardiac arrest [3], especially when the incident happens out of the hospital.

The incidence of adult out-of-hospital cardiac arrest (OHCA) is estimated to be 95.9 cases per 100,000 persons per year [4, 5]. In a survey performed in a busy street in a city of a western region of Turkey, 40.7% of people living in a highly educated region reported having received CPR training and 3.6% had previously performed bystander CPR [2]. This requires an improvement of community awareness about recognizing the signs of cardiac arrest and determining when to start performing CPR.

There is a significant impact of having good public awareness about how to practice CPR. In the majority of cases, the first person to act in OHCA is a victim's relative, usually a nonmedical person. Approximately 70% to 75% of cases of OHCA are witnessed by nonmedical people [6–8]. The early recognition of OHCA, early activation of emergency medical services (EMS), and early provision of bystander basic life support (BLS) are the most important factors that determine the survival probability in patients with OHCA; these actions depend entirely on the knowledge, attitude, and actions of the bystanders [7, 9]. Survival after OHCA is low (3%–30%) but showed improvement after increased public education and increased use of automatic external defibrillators [7, 10]. Data collected on survival rates showed that OHCA patients who receive bystander CPR have a greater chance of survival versus those who do not [4].

Unfortunately, there are scarce data available about OHCA and CPR performed by individuals who are not health care providers in Saudi Arabia [11]. One study looked at cases of OHCA and identified differences in clinical variables and survival rates in patients arresting out-of-hospital and in the emergency department at a single hospital in Riyadh, Saudi Arabia. The study found that a total of 61 adults arrested out of hospital, and the most prevalent reported presumed cause of arrest was of cardiac origin in 82.3% of patients [11]. Patients arrested at home composed 74% of the study population with an overall mortality rate of 95.8% and a low rate of bystander CPR being performed. A family member most often transported the patient to the hospital [11].

We believe that the knowledge of nonmedical people (i.e., individuals who are not health care providers) to recognize and intervene by doing CPR in the kingdom of Saudi Arabia has not previously been evaluated. In the present study, we aimed to assess the knowledge of nonmedical people in Jeddah to recognize and intervene by doing CPR in the case of OHCA.

2. Methods

This cross-sectional survey study was initiated after receiving ethics committee approval from the Unit of Biomedical Ethics at King Abdulaziz University (reference no. 181-18).

Our sample size was 600 persons, which was calculated by the use of OpenEpi (Massachusetts Institute of Technology, Cambridge, MA, USA). All of the selected participants live in Jeddah, the second largest city after Riyadh and the most cosmopolitan city in the kingdom of Saudi Arabia. Prior to filling out the questionnaire, the purpose of the study was explained and verbal consent was obtained from all of the participants in the study. The inclusion criteria were an age of older than or equal to 18 years and not being a health care provider. Those who were younger than 18 years, health care providers, or who refused to participate were excluded.

The questionnaire was distributed to residents of Jeddah, Saudi Arabia, between March 2018 and April 2018. The questionnaire survey used in the present study was taken from an investigation done in Izmir, Turkey [2], and translated into Arabic by an expert in translation and subsequently translated into English by another expert in translation. Both translated versions were reviewed for consistency and clarity. Both the Arabic and the English questionnaires were distributed at separate times to 30 participants who spoke both English and Arabic fluently. The results were the same on both occasions.

The questionnaire included 22 questions in the Arabic language (which were adapted according to our practices and culture) on the demographic features of the participants; their knowledge regarding cardiac arrest manifestations (e.g., cyanosis, difficulty in breathing, nausea, and faintness of the skin); their previous CPR experiences (e.g., witnessing cardiac arrest, conducting CPR, and having a CPR certificate); whether or not they knew the national phone number for emergency situations; their BSL knowledge (e.g., compression location, number, and rate of ventilations/compressions); their concerns regarding CPR (e.g., possibility of making a mistake, contracting a contagious disease from blood and vomitus, and legal concerns); and their attitudes (i.e., who are the people to whom they will give CPR without hesitation) (Supplementary Materials (available here)).

Correct cardiac arrest findings and algorithms of BLS were determined according to the 2015 European Resuscitation Council Resuscitation Guidelines [12], the 2017 American Heart Association Focused Update on Adult BLS and CPR Quality [13], and the 2010 Saudi Heart Association Guidelines on CPR.

The data were analysed using the Statistical Package for the Social Sciences version 15.0 software package program (IBM Corp., Armonk, NY, USA). Categorical data were displayed as numbers (n) and percentages (%), while numerical data were displayed in the form of mean ± standard deviation (after testing for normality of distribution). The chi-squared test was used in the analysis of categorical data. A p value of < 0.05 in the statistical tests was accepted as being significant.

3. Results

3.1. Demographic Data

Out of 600 participants, 360 (60%) were females. The mean age of our population was 37.4 years ± 13.6 years. Two hundred forty-nine (41.8%) people were employees. The number of participants who stated that they had received CPR training was 172 (28.7%). Additional collected demographic data are presented in Table 1.

Table 1: Demographic data.

Variable
Mean ± SD
Range

Age (years)
37.4 ± 13.6
(18–72)

Variable
N

Gender

Male
240
40.0

Female
360
60.0

Education

Elementary
5
0.8

Intermediate
26
4.4

High school
82
13.7

College
59
9.9

University
158
26.4

Postgraduate
268
44.8

Occupation

Unemployed
30
5

Worker
16
2.7

Employee
249
41.8

Housewife
117
19.7

Student
104
17.5

Retired
57
9.6

3.2. Regarding the Prodromal Symptoms and Signs of Sudden Cardiac Arrest

The main reported manifestation was chest pain (68.8%), followed by difficulty in breathing (50.8%), loss of consciousness (40.7%), and discontinuation of breathing (36.8%). The rest of the manifestations suggested by the respondents to indicate sudden cardiac arrest are presented in Table 2.

Table 2: Prodromal symptoms and signs of sudden cardiac arrest.

Variable
N

Loss of consciousness
244
40.7

Discontinuation of breathing
221
36.8

Discontinuation of circulation
148
24.7

Cyanosis
185
30.8

Nausea
66
11

Difficulty in breathing
305
50.8

Chest pain
413
68.8

Faintness of the skin
137
22.8

The individual is not moving
142
23.7

3.3. Identification of Cardiac Arrest Findings

With respect to consciousness evaluation, the percentage of those who knew one of the procedures correctly was 44.8%, followed by those knowing two of the procedures correctly being 25.2%, and then those knowing three of the procedures correctly being 12.8%. Regarding respiration evaluation, the percentage of those knowing one of the procedures correctly was 39.2%, followed by those knowing two of the procedures correctly (31.2%), and then those knowing three of the procedures correctly (20.2%). Furthermore, for circulation evaluation, the percentage of those knowing one of the procedures correctly was 51.4%, followed by those knowing both of the procedures correctly (32.2%). More than half of the respondents (57.2%) knew the correct meaning of chest compression, that is, ‘to apply strong compressions to the chest at certain intervals (compression)’. These results are presented in Table 3.

Table 3: Identification of cardiac arrest findings.

Variable
N

Consciousness evaluation

No response when called
373
62.2

No response when touched
221
36.8

Not moving at all
208
34.7

I do not know
114
19

Those knowing three of the procedures correctly
77
12.8

Those knowing two of the procedures correctly
151
25.2

Those knowing one of the procedures correctly
269
44.8

Those who do not know any of the procedures (I do not know)
103
17.2

Respiration evaluation

Not having any respiratory movement
360
60

Not having any respiratory sound
267
44.5

No coming air out of the mouth of an individual
310
51.7

No steaming up of a mirror placed in front of the mouth of an individual
135
22.5

I do not know
42
7

Those knowing three of the procedures correctly
115
20.2

Those knowing two of the procedures correctly
188
31.2

Those knowing one of the procedures correctly
235
39.2

Those who do not know any of the procedures (I do not know)
38
6.3

Circulation Evaluation

Not feeling a pulse in the vessels of the neck
121
20.2

Not feeling a pulse in the vessels of the arm
187
31.2

Both
193
32.2

I do not know
108
18

‘Chest compression’ means

To scrub the chest at certain intervals
67
11.2

To apply strong compression to the chest at certain intervals (compression)
343
57.2

To scrub the heart directly by opening the chest wall
11
1.8

To apply compression directly to the heart by opening the chest wall
24
4.0

I have no idea
155
25.8

3.4. Witnessing a Sudden Death

Only 95 (15.8%) reported witnessing a sudden death before, while only 36 (21.1%) were able to perform CPR. The rest of these results are presented in Table 4.

Table 4: Witnessing a sudden death.

Variable
N

Who was he/she?

Somebody from my family
63
10.5

Somebody from my friends or acquaintances
14
2.3

A stranger
23
3.8

I have not seen a sudden death happen
505
84.2

What did you do in the situation?

I began to give chest compressions
21
15

I conducted mouth-to-mouth ventilation
10
7.1

I both gave chest compressions and conducted mouth-to-mouth ventilation (i.e., I gave CPR)
36
22.1

I called an ambulance
57
40.7

I told somebody to call for help
42
30.7

I called for help by telephone
20
14.3

I just watched and left
25
17.9

3.5. CPR Attitudes

For the respondents who answered the question ‘to whom would you apply CPR without hesitation,’ 465 (94.2%) stated for a family member, followed by 397 who said for a friend (66.2%), and then 313 who said for a neighbour (52.2%). For the question ‘what would you do in the case of a family member,’ ‘call an ambulance’ was selected by 44.4% and ‘begin to give a chest compression’ was selected by 35.8%. For the question ‘what would you do regarding a stranger,’ ‘call an ambulance’ was reported by 54.7% and ‘begin to give a cardiac chest compression’ was stated by 24.5%. The main reason that may prevent someone from giving a chest compression to either a friend/relative or a stranger was reported as ‘making a mistake’ by 71.0% and 62.0%, respectively. The rest of these results are presented in Table 5.

Table 5: Taking action.

Variable
N

If sudden death occurs in the following people, for whom would you conduct respiration and give chest compression?

Someone from the family
565
94.2

Friend
397
66.2

Neighbour
313
52.2

A youth in the sports hall
230
38.3

A stranger in the supermarket
220
36.7

A person who has poor personal hygiene at the bus stop
172
28.7

A gamin who is drug-dependent and uses glue, hashish, and/or heroin
154
25.7

If somebody from among your family members or friends felt faint (sudden death), what would you do?

I would begin to give chest compression
215
35.8

I would call an ambulance
264
44.4

I would call somebody or call for help
119
19.8

I would just watch and leave
2
0.3

If you witness a stranger feeling faint, what would you do?

I would begin to give chest compression
147
24.5

I would call an ambulance
328
54.7

I would call somebody or call for help
120
20.0

I would just watch and leave
2
0.5

What concerns may prevent you from giving chest compression to your friends or relatives?

Making a mistake
426
71.0

Causing bone fractures
27
4.5

Causing harm to organs
25
4.2

Stopping a working heart
19
3.2

Punishment due to legal reasons
26
4.3

Contamination by blood or vomiting
5
0.8

Contracting a contagious disease
12
2.0

Other
60
10.0

What concerns may prevent you from giving chest compression to a stranger?

Making a mistake
372
62.0

Causing bone fractures
19
3.2

Causing harm to organs
24
4.0

Stopping a working heart
17
2.8

Punishment due to legal reasons
59
9.8

Contamination by blood or vomiting
12
2.0

Contracting a contagious disease
31
5.2

Other
66
11.0

3.6. CPR Knowledge and Training Status

Only 196 (32.7%) of the participants reported knowing how to give a chest compression and only 172 (28.7%) had received formal training. Regarding where these individuals were trained, 46 (21.3%) reported receiving training ‘at a course given by the trainers of the ministry of health.’ The rest of these results are presented in Table 6.

Table 6: CPR training.

Variable
N

Do you know how to give chest compression in the case of cardiac arrest and respiratory standstill?

No
404
67.3

Yes
196
32.7

Have you received any training?

No
428
71.3

Yes
172
28.7

Where (n = 172)?

At school
23
10.6

At university
32
14.8

During my military service
5
2.3

At a resuscitation society course
13
6.0

At a course given by the trainers of the ministry of health
46
21.3

In a sports club
6
2.8

At a course given in the workplace
37
17.1

Television/Internet/media
53
24.5

3.7. CPR Skills

Less than one-third (177; 29.5%) reported that they could ‘both ventilate and give a chest compression.’ Only 69 (11.5%) knew the proper rate of chest compression to artificial ventilation during CPR (30/2 compression/breath) and only 71 (11.8%) knew the proper rate of chest compressions (i.e., at least 100 times per minute). Of the total participant cohort, 333 (55.5%) knew the applying place of chest compression (middle of the chest) and 267 (44.5%) knew the appropriate force to apply (moderate force, such that the rib cage moves down 5 cm to 6 cm). Additionally, 428 (71.3%) knew about the defibrillator (a device that restarts a heart that has stopped working) and 132 (22.0%) knew where an automated external defibrillator or a pacemaker can be found. The rest of these results are presented in Table 7.

Table 7: Application of CPR.

Variable
N

What BLS applications can you apply?

I can open the airway
58
9.7

I can control respiration
7
1.2

I can ventilate/conduct mouth-to-mouth ventilation
55
9.2

I can give chest compression
70
11.7

I can both ventilate and give chest compression
177
29.5

I do not know
233
38.8

What is the proper rate of chest compression /artificial ventilation during the chest compression (compressions/breaths)?

5/1
173
28.8

15/2
131
21.8

30/2
69
11.5

Other
227
37.8

Which of the following areas must chest compression be applied on?

An upper part of the chest
110
18.3

Middle of the chest
333
55.5

A lower part of the chest
83
13.8

Other
74
12.3

What must be the rate of the chest compression?

At least 150 times per minute
22
3.7

At least 100 times per minute
71
11.8

At least 50 times per minute
162
27.0

I don’t know
345
57.5

How much force must be applied during chest compression?

Enough that the rib cage moves down 1 cm to 2 cm
203
33.8

Moderate force, such that the rib cage moves down 5 to 6 cm
267
44.5

High force, such that the rib cage moves down 6 cm to 10 cm
42
7.0

As much force as possible
88
14.7

What do you know about the device defined as a defibrillator that is used during the chest compression when necessary?

I have never heard of it
75
12.5

I have heard of it before but not seen it
96
16

It is a device supporting respiration
55
9.2

It is a device used to restart a heart that has stopped working
428
71.3

Do you have any idea about where an ‘automated external defibrillator’ or a ‘pacemaker’ can be found?

I don’t know
468
78.0

Yes
132
22.0

3.8. Association between Identification of Cardiac Arrest Findings and CPR Training

The survey results revealed a significant difference in the identification of cardiac arrest findings between respondents with previous CPR training and those without. Those who had received training showed a higher rate of knowing the correct procedures of evaluation of consciousness, respiration, and circulation (p = 0.151, p = 0.018, and p = 0.026, respectively). For more details, see Table 8.

Table 8: Association between identification of cardiac arrest findings and CPR training.

Variable
Those who have not received CPR training  
N  

Those who have received CPR training  
N  

Total  
N  

p value

Consciousness evaluation

No response when called
126
42
168
0.151

29.4%
24.4%
28.0%

No response when touched
25
13
38

5.8%
7.6%
6.3%

Not moving at all
49
14
63

11.4%
8.1%
10.5%

Those knowing three of the procedures correctly
48
29
77

11.2%
16.9%
12.8%

Those knowing two of the procedures correctly
102
49
151

23.9%
28.5%
41.4%

Those who do not know any of the procedures (I don’t know)
78
25
103

18.2%
14.5%
17.2%

Respiration evaluation

No respiratory movement
90
34
124
0.018

21.0%
19.7%
20.7%

No respiratory sound
35
7
42

8.2%
4.1%
7.0%

No air coming out of the mouth of an individual
55
18
73

12.9%
10.5%
12.2%

No steaming up of a mirror placed in front of the mouth of an individual
17
7
24

4.0%
4.1%
4.0%

Those knowing three of the procedures correctly
66
49
115

15.4%
28.5%
20.2%

Those knowing two of the procedures correctly
133
55
188

31%
32%
31.2%

Those who do not know any of the procedures (I don’t know)
29
9
38

6.8%
5.2%
6.3%

Circulation evaluation

Not feeling a pulse in the vessels of the neck
91
30
121
0.026

21.3%
17.4%
20.2%

Not feeling a pulse in the vessels of the arm
135
52
187

31.5%
30.2%
31.2%

Both
120
73
193

28.0%
42.4%
32.2%

I don’t know
91
17
108

21.3%
9.9%
18%

a: Respondents who chose ‘I do not know’ were excluded from the statistical test of significance

3.9. Association of Response to a Sudden Death with CPR Training

The results revealed no significant difference in the action of the witness of a sudden death between respondents with previous CPR training and those without. For more details, see Table 9.

Table 9: Association between the actions performed to a witnessed cardiac arrest with previous CPR training.

Variable
Those who have not received CPR training  
N  

Those who have received CPR training  
N  

Total  
N  

p value

I both gave chest compressions and conducted mouth-to-mouth ventilation (i.e., I gave CPR)
15
21
36
0.568

16.3%
43.8%
22.1%

I called emergency services
57
22
79

62.0%
45.8%
75.0%

I just watched and left
20
5
25

21.7%
10.4%
17.9%

3.10. Association of CPR Application with CPR Training

The results revealed a significant association between the application of CPR and having CPR training. Those who received training showed a higher rate of knowing the correct answers regarding proper rate of chest compression /artificial ventilation during CPR, where the chest compression must be applied, the rate of chest compressions, and the force that must be applied during chest compression (p < 0.0001, p < 0.0001, p < 0.0001, and p = 0.004, respectively). For more details, see Table 10.

Table 10: Association of CPR application with previous CRP training.

Variable
Those who have not received CPR training  
N  

Those who have received CPR training  
N  

Total  
N  

p value

What BLS applications can you apply?

I can open the airway
39
19
58
0.0001

9.1%
11.0%
9.7%

I can control respiration
6
1
7

1.4%
0.6%
1.2%

I can ventilate/conduct mouth-to-mouth ventilation
32
23
55

7.5%
13.3%
9.2%

I can give chest compression
43
27
70

10.0%
15.7%
11.7%

I can both ventilate and give chest compression
95
82
177

22.2%
47.7%
29.5%

I do not know
215
18
233

50.2%
10.5%
38.8%

What is the proper rate of chest compression /artificial ventilation during the CPR (compressions/breaths)?

5/1
122
51
173
0.0001

28.5%
29.6%
28.8%

15/2
79
50
131

18.4%
29%
21.8%

30/2
23
46
69

5.3%
26.7%
11.5%

Where must chest compression be applied?

An upper part of the chest
82
28
110
0.0001

19.2%
16.3%
18.3%

Middle of the chest
222
111
333

51.9%
64.5%
55.5%

A lower part of the chest
52
31
83

12.1%
18.0%
13.8%

Other
72
2
74

16.8%
1.2%
12.3%

What must be the rate of the chest compression?

At least 150 times per minute
12
10
22
0.0001

2.8%
5.8%
3.7%

At least 100 times per minute
32
39
71

7.5%
22.7%
11.8%

At least 50 times per minute
90
72
162

21.0%
41.9%
27.0%

I do not know
294
51
345

68.7%
29.7%
57.5%

How much force must be applied during chest compression?

Enough that the rib cage moves down 1 cm to 2 cm
133
68
203
0.004

31.0%
39.5%
33.8%

Moderate force, such that the rib cage moves down 5 cm to 6 cm
185
84
267

43.3%
48.8%
44.5%

High force, such that the rib cage moves down 6 cm to 10 cm
35
7
42

8.2%
4.1%
7.0%

As much force as possible
75
13
88

17.5%
7.6%
14.7%

4. Discussion

It is agreed largely that CPR is one of the most essential methods available to save a cardiac patient’s life. As such, we think that it is very important to evaluate the level of knowledge in our society. In the present study, we sought to assess the knowledge of nonmedical people in Jeddah to recognize and intervene by doing CPR in the case of OHCA.

At the beginning of our analysis, we calculated the percentage of nonmedical people who had participated in a CPR course in the past. Unfortunately, we found that only 172 (28.7%) individuals undertook a CPR course, despite the excellent education level that our people generally have. This finding was almost similar to those of two studies conducted in Ireland and New Zealand, respectively, which revealed percentages of 28% and 27%. However, other previous studies showed higher rates of CPR training. Specifically, 79% were reported to have CPR training by a study conducted in Washington [14], 75% in Poland [15], 69.4% in Slovenia [7], 64% in Australia [16], and 40.3% in Turkey [2]. These disparate findings can be explained by the fact that BLS courses are a mandatory requirement before getting a driver’s license or before enrolment in some jobs in certain countries like Turkey and Slovenia [2, 7]. In our country, at this time, it is not a mandatory requirement, except in a very few number of workplaces. One-quarter of trained nonmedical people in the present study got their CPR experience through the Internet, television, or media, which could explain the huge gap between us and the aforementioned countries.

The methods of assessing for cardiac arrest varied between respondents who received BLS course and those who did not in a statistically significant manner. Among those who previously received CPR training, 16.9%, 28.5%, and 17.4% can properly assess consciousness, breathing, and circulation, respectively. Our findings were almost equal to those of the Slovenian study, in which the authors found that 22%, 29.4%, and 9.5% of the trained people could properly assess consciousness, breathing, and circulation, respectively [7]. On the other hand, our results were much better than those reported in a Turkish study in which the investigators found that only 5%, 5.2%, and 7.1% of the trained people could properly assess consciousness, breathing, and circulation, respectively [2]. These findings assert the good quality of the CPR training that nonmedical people in our study received.

Regarding BLS application, 29.5% can perform both breathing and cardiac compression, which was similar to the results of the Turkish study (28.7%) but less than the results of the Slovenian study (38%). In comparison, 38.8% reported that they do not know how to do either one of these actions, a finding which was similar to the Turkish study (38.6%) and lower than the Slovenian study (45.4%) [2, 7]. Additionally, when our study population was asked about the details of breathing and cardiac compression (for example, compression place, compression force, compression rate, and compression to breathing ratio), our population showed the same level of knowledge as did those participants in previous studies of other countries, which was very low in general with a clear significant difference between people who received training versus those who did not receive training. This raises the importance of the introduction of an urgent intervention to boost the level of knowledge in order to save as many cardiac arrest patients as possible.

According to our results, 15.8% of our population has witnessed a sudden death, with the majority of those patients being family members (70%). Unfortunately, only 22.1% started CPR in these cases. Similarly, in the Turkish study, 18.6% of the participants reported having witnessed a sudden death and 22% said they started CPR, with the main reason behind not conducting CPR being fear to make a mistake, which could be explained by the low level of knowledge among their population [2]. However, much lower rates of conducting CPR were reported by a study in Japan, in which 19% of participants witnessed a sudden death but only 4% of them started CPR [17]. Thankfully, a good number of people in Saudi Arabia report feeling comfortable regarding giving CPR to a member of their family (94.2%) and to a stranger (36.7%). Similarly, in a study conducted in Arizona, 80% of 750 participants reported feeling fine to perform CPR on a member of their family and 50% reported the same regarding a stranger [18].

When we put our participants in a situation of sudden cardiac arrest of one of their family members or friends, nearly one-third of participants (35.8%) would begin CPR. The most common reason for not conducting CPR was reportedly to be the fear to make a mistake (71.0%). A study conducted in Japan found that the scare of disease transmission was the most common cause (28%) [17].

On the other hand, when we asked our participants about the same situation occurring to strangers, the percentage of those willing to begin CPR decreased to 24.5%, though the most common cause remained a fear of performing it the wrong way (62%). However, the scare of disease transmission and legal issues increased to become 5.2% and 9.85%, respectively. In the study in Arizona, concerns about making a mistake was the most common cause of unwillingness to perform CPR (22.8%), while 17.7% reported hesitation due to potential legal issues [18]. In Japan, the most common cause was scare of transmission of diseases in 63% [17]. Again, these findings raise the value of finding a solution to increase the knowledge about CPR and correct existing mistaken beliefs.

5. Conclusion and Recommendations

The level of knowledge of our community regarding CPR is limited and very shallow compared to the knowledge levels of other neighbouring countries. Furthermore, some mistaken beliefs do exist. For that reason, we have some recommendations that we expect will increase the knowledge regarding CPR in Saudi Arabia. First of all, we highly recommend undertaking huge efforts to increase the awareness and knowledge of CPR. For example, we advise high-grade schools and universities to conduct a BLS course every year and to make it a routine requirement. We additionally advise our government to designate a BLS course as an obligatory requirement before getting a driver’s license or prior to enrolment in some jobs that include contact with other people. Second, we suggest establishing a routine examination of CPR awareness and knowledge, which will assess the benefits of the conduction of BLS courses and attempt to elucidate the weak points so as to further improve the courses in the future. Finally, we believe it is also very important to assess the quality of CPR that has been performed, as this is a very important element in the success of resuscitation [5].

Data Availability

The data used to support the findings of this study are available from the corresponding author upon request.

Additional Points

Limitations. This study has a few limitations that are very important to consider in its interpretation and in the context of further research efforts. One of the major weak points in this research is that, during the filling out of the questionnaire under our supervision, many of the participants asked us what to do in the case of some of the questions that did not have the answer choice of ‘I have not seen this’ or ‘I have no idea.’ Furthermore, a few of the participants asked us for more details about the meaning of some sentences that were not clear enough to them. We tried to explain the meaning of some choices to them, so we expect that some of the responses may be biased as a result of this. Moreover, this study was conducted only in a very limited area (the city of Jeddah), so the results may vary in other Saudi cities or countries.

Conflicts of Interest

The authors declare that they have no conflicts of interest.

Acknowledgments

We would like to express gratitude to Samiha N. Fakih, Amal A. Ismail, Razan M. Almkri, and Majda A. Addas for their important roles in the success of this research.

Supplementary Materials

Supplementary material contains the questionnaire given to the participants. The questionnaire included 22 questions in Arabic and English language. (Supplementary Materials )

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