Cardiopulmonary Resuscitation Performed by Bystanders: A Systematic Review


  • Selamat Yasin Institut Latihan Kementerian Kesihatan Malaysia (ILKKM), Johor, Malaysia
  • Siti Azuna Abu Bakar Department of Critical Care Nursing, Kulliyyah of Nursing, International Islamic University Malaysia, Pahang, Malaysia
  • Mohd Said Nurumal Department of Critical Care Nursing, Kulliyyah of Nursing, International Islamic University Malaysia, Pahang, Malaysia
  • Syamsul Ahmad Arifin Department of Basic Medical Sciences for Nursing, Kulliyyah of Nursing, International Islamic University Malaysia, Pahang, Malaysia



Out-of-hospital cardiac arrest, Cardiopulmonary resuscitation (CPR), Bystander CPR


Cardiopulmonary resuscitation (CPR) is the most popular treatment for unexpected cardiac arrest. In order to enhance the survival and neurological prognosis of out of hospital cardiac arrest patients, both healthcare practitioners and lay rescuers must learn this technique. Millions of people die each year as a result of sudden cardiac arrest across the world due to ineffective CPR performed by bystander. The aim of this review is to identify the existing literature on knowledge, attitude and practice of the community at the out of hospital cardiac arrest level. Guided by the PRISMA Statement review checklist, a systematic review of the Scopus and Web of Science database and Science Direct has identified 332 related studies. The articles were assessed and analysed after evaluation using The Critical Appraisal Skills Programme Qualitative checklist. Total article accepted were n=11. We reviewed 1150 articles and selected 332 for complete evaluation. We included 11 of the 332 papers in this review that was published since 2018. We classified 11 recommendations; those with the highest scores were 1) Knowledge assisted CPR among bystander CPR remain poor, 2) CPR challenge on stranger, 3) CPR challenge on barrier, 4) The impact on quality CPR on survival rate and 5) Conventional CPR with mouth to mouth vs chest-compression only - CPR. CPR at out-of-hospital cardiac arrest, with several factors that influences such as knowledge, attitude, practice of community bystander CPR. While, the willingness (self-efficacy), the barriers and reluctant of bystander CPR still not clear. The targeted group for CPR training and tailored of training CPR for the bystander CPR give the effect and quality of CPR performance. Furthermore, the motivating factors to begin CPR at the out-of-hospital cardiac arrest level that emerged from a study of these publications. Recommendations not supported by evidence include mass training events, pulse taking prior to CPR by community and CPR using chest compressions alone. We evaluated and classified the potential impact of interventions that have been proposed to improve bystander CPR rates. Our results may help communities design interventions to improve their bystander CPR rates.


Kumar, P. & Clark M. Clinical Medicine. 7nd editio. Spain: Elservier; 2009. 1–1360 p.

Virani SS, Alonso A, Benjamin EJ, Bittencourt MS, Callaway CW, Carson AP, et al. Heart disease and stroke statistics—2020 update: A report from the American Heart Association. Circulation. 2020. 139–596 p.

Committee N, Ministry of Health Malaysia RT. Basic Life Support Mannual Training. Vol. 17. 2017.

WHO. WHO Noncommunicable Diseases 2018. Vol. 369, New England Journal of Medicine. 2018. 1336–1343 p.

Qara FJ, Alsulimani LK, Fakeeh MM, Bokhary DH. Knowledge of Nonmedical Individuals about Cardiopulmonary Resuscitation in Case of Cardiac Arrest: A Cross-Sectional Study in the Population of Jeddah, Saudi Arabia. Emerg Med Int. 2019;2019:1–11.

Panchal AR, Bartos JA, Cabañas JG, Donnino MW, Drennan IR, Hirsch KG, et al. Part 3: Adult Basic and Advanced Life Support: 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Vol. 142, Circulation. 2020. 366–468 p.

Shekhar A, Narula J. Globally, GDP Per Capita Correlates Strongly with Rates of Bystander CPR. Ann Glob Heal. 2022;88(1):1–6.

Fariduddin MN, Siau CS. Knowledge, Attitude and Perceptions towards Basic Life Support Training among Student Teachers in a Malaysian University. Eur J Soc Behav Sci. 2021;30(2):132–45.

Karuthan SR, Firdaus PJFB, Angampun ADAG, Chai XJ, Sagan CD, Ramachandran M, et al. Knowledge of and willingness to perform Hands-Only cardiopulmonary resuscitation among college students in Malaysia. Med (United States). 2019;98(51):1–7.

Wan Jusoh AF, Yahaya R, Nik Him NAS, Nik Mohamed NA, Zahary MN, Wan Ibrahim WP. The effectiveness of modified basic life support module on knowledge, attitude, and performance of cardiopulmonary resuscitation among university students. Hong Kong J Emerg Med. 2019;26(3):156–64.

Jiang Y, Wu B, Long L, Li J, Jin X. Attitudes and willingness toward out-of-hospital cardiopulmonary resuscitation: A questionnaire study among the public trained online in China. BMJ Open. 2020;10(10).

Andréll C, Christensson C, Rehn L, Friberg H, Dankiewicz J. Knowledge and attitudes to cardiopulmonary resuscitation (CPR)– a cross-sectional population survey in Sweden. Resusc Plus. 2021;5(December 2020):100071.

Rankin T, Holmes L, Vance L, Crehan T, Mills B. Recent high school graduates support mandatory cardiopulmonary resuscitation education in Australian high schools. Aust N Z J Public Health. 2020;44(3):215–8.

Cartledge S, Saxton D, Finn J, Bray JE. Australia’s awareness of cardiac arrest and rates of CPR training: Results from the Heart Foundation’s HeartWatch survey. BMJ Open. 2020;10(1):1–7.

Blewer AL, Ibrahim SA, Leary M, Dutwin D, McNally B, Anderson ML, et al. Cardiopulmonary resuscitation training disparities in the United States. J Am Heart Assoc. 2017;6(5).

Krammel M, Schnaubelt S, Weidenauer D, Winnisch M, Steininger M, Eichelter J, et al. Gender and age-specific aspects of awareness and knowledge in basic life support. PLoS One. 2018;13(6):1–9.

Riva G, Hollenberg J. Different forms of bystander cardiopulmonary resuscitation in out-of-hospital cardiac arrest. J Intern Med. 2021;290(1):57–72.

Ministry of Health Malaysia. Primary & Secondary Prevention of Cardiovascular Disease. Book. 2017.

Tay PJM, Pek PP, Fan Q, Ng YY, Leong BSH, Gan HN, et al. Effectiveness of a community based out-of-hospital cardiac arrest (OHCA) interventional bundle: Results of a pilot study. Resuscitation. 2020;146(May):220–8.

Fariduddin MN, Jaafar MJ. Retention of cardiopulmonary resuscitation (CPR) knowledge among undergraduate teacher student in Malaysian university. Malaysian J Med Heal Sci. 2021;17(1):3–9.

Ali DM, Hisam B, Shaukat N, Baig N, Ong MEH, Epstein JL, et al. Cardiopulmonary resuscitation (CPR) training strategies in the times of COVID-19: a systematic literature review comparing different training methodologies. Scand J Trauma Resusc Emerg Med. 2021;29(1).

Roy Chowdhury S, Anantharaman V. Public attitudes towards cardiopulmonary resuscitation training and performance in Singapore. Int J Emerg Med. 2021;14(1):1–7.

Kanstad BK, Nilsen SA, Fredriksen K. CPR knowledge and attitude to performing bystander CPR among secondary school students in Norway. Resuscitation. 2011;82(8):1053–9.

Chelladurai G, Azhar AMN, Isa RM, Bustam A, Ahmad R, Munisamy M. Improving cardiopulmonary resuscitation (Cpr) performance using an audio-visual feedback device for healthcare providers in an emergency department setting in malaysia: A quasi-experimental study. Med J Malaysia. 2020;75(5):514–8.

Kiyohara K, Kitamura Y, Ayusawa M, Nitta M, Iwami T, Nakata K, et al. Dissemination of Chest Compression-Only Cardiopulmonary Resuscitation by Bystanders for Out-of-Hospital Cardiac Arrest in Students: A Nationwide Investigation in Japan. J Clin Med. 2022;11(4):1–12.

Hubail D, Mondal A, Al Jabir A, Patel B. Comparison of a virtual reality compression-only Cardiopulmonary Resuscitation (CPR) course to the traditional course with content validation of the VR course – A randomized control pilot study. Ann Med Surg. 2022;73(December 2021):103241.

Scapigliati A, Zace D, Matsuyama T, Pisapia L, Saviani M, Semeraro F, et al. Community initiatives to promote basic life support implementation—a scoping review. J Clin Med. 2021;10(24).

Kiguchi T, Okubo M, Nishiyama C, Maconochie I, Ong MEH, Kern KB, et al. Out-of-hospital cardiac arrest across the World: First report from the International Liaison Committee on Resuscitation (ILCOR). Resuscitation [Internet]. 2020;152(February):39–49.

Ojifinni K, Motara F, Laher AE. Knowledge, Attitudes and Perceptions Regarding Basic Life Support Among Teachers in Training. Open Access Orig Artic. 2019;11(12):4–13.

Hung MSY, Chow MCM, Chu TTW, Wong PP, Nam WY, Chan VLK, et al. College students’ knowledge and attitudes toward bystander cardiopulmonary resuscitation: A cross-sectional survey. Cogent Med [Internet]. 2017;4(1):1334408.

Dobbie F, Uny I, Eadie D, Duncan E, Stead M, Bauld L, et al. Barriers to bystander CPR in deprived communities: Findings from a qualitative study. PLoS One. 2020;15(6):1–11.

Böttiger BW, Lockey A, Aickin R, Carmona M, Cassan P, Castrén M, et al. Up to 206 million people reached and over 5.4 million trained in cardiopulmonary resuscitation worldwide: The 2019 international liaison committee on resuscitation world restart a heart initiative. J Am Heart Assoc. 2020;9(15):10–3.

Nishiyama C, Sato R, Baba M, Kuroki H, Kawamura T, Kiguchi T, et al. Actual resuscitation actions after the training of chest compression-only CPR and AED use among new university students. Resuscitation. 2019;141(May 2019):63–8.

Lockey AS, Brown TP, Carlyon JD, Hawkes CA. Impact of community initiatives on non-EMS bystander CPR rates in West Yorkshire between 2014 and 2018. Resusc Plus. 2021;6(March):100115.

Lee SY, Ro YS, Shin S Do, Song KJ, Hong KJ, Park JH, et al. Recognition of out-of-hospital cardiac arrest during emergency calls and public awareness of cardiopulmonary resuscitation in communities: A multilevel analysis. Resuscitation. 2018;128(May):106–11.

Shimamoto T, Kiyohara K, Matsuyama T, Kitamura T, Kiguchi T, Nishiyama C, et al. Impact of bystander cardiopulmonary resuscitation and dispatcher assistance on survival after out-of-hospital cardiac arrest among adult patients by location of arrest. Int Heart J. 2020;61(1):46–53.

Nishiyama C, Kitamura T, Sakai T, Murakami Y, Shimamoto T, Kawamura T, et al. Community-wide dissemination of bystander cardiopulmonary resuscitation and automated external defibrillator use using a 45-minute chest compression–only cardiopulmonary resuscitation training. J Am Heart Assoc. 2019;8(1):1–10.

Takahashi H, Sagisaka R, Natsume Y, Tanaka S, Takyu H, Tanaka H. Does dispatcher-assisted CPR generate the same outcomes as spontaneously delivered bystander CPR in Japan? Am J Emerg Med. 2018;36(3):384–91.

Lee MJ, Shin TY, Lee CH, Moon JD, Roh SG, Kim CW, et al. 2020 korean guidelines for cardiopulmonary resuscitation. Part 9. education and system implementation for enhanced chain of survival. Clin Exp Emerg Med. 2021;8(S):S116–24.

Brown TP, Booth S, Hawkes CA, Soar J, Mark J, Mapstone J, et al. Characteristics of neighbourhoods with high incidence of out-of-hospital cardiac arrest and low bystander cardiopulmonary resuscitation rates in England. Eur Hear J - Qual Care Clin Outcomes. 2019;5(1):51–62.

Woollard M, Whitfield R, Newcombe RG, Colquhoun M, Vetter N, Chamberlain D. Optimal refresher training intervals for AED and CPR skills: A randomised controlled trial. Resuscitation. 2006;71(2):237–47.

Sand K, Guldal AU, Myklebust TÅ, Hoff DAL, Juvkam PC, Hole T. Cardiopulmonary resuscitation retention training for hospital nurses by a self-learner skill station or the traditional instructor led course: A randomised controlled trial. Resusc Plus. 2021;7(May):100157.

OSHA. Training Requirements in OSHA Standards. Saf Heal. 2015;257.

Ministry of Human Resources Malaysia. Department of Occupational Safety (DOSH) and Health. Guidelines on first-aid in the workplace. 2004;(I):17.

Mekonnen CK, Muhye AB. Basic life support knowledge and its associated factors among a non-medical population in Gondar town, Ethiopia. Open Access Emerg Med. 2020;12:323–31.

Yoon W, Ro YS, Cho S il. A mediation analysis of the effect of practical training on the relationship between demographic factors, and bystanders’ self-efficacy in CPR performance. PLoS One. 2019;14(4):1–14.

Bobrow BJ, Spaite DW, Berg RA, Stolz U, Sanders AB, Kern KB, et al. Chest compression-only CPR by lay rescuers and survival from out-of-hospital cardiac arrest. JAMA - J Am Med Assoc. 2010;304(13):1447–54.

Uny I, Angus K, Duncan E, Dobbie F. Barriers and facilitators to delivering bystander cardiopulmonary resuscitation in deprived communities: a systematic review. Perspect Public Health. 2022;XX(X).

Hsu SC, Kuo CW, Weng YM, Lin CC, Chen JC. The effectiveness of teaching chest compression first in a standardized public cardiopulmonary resuscitation training program. Med (United States). 2019;98(13):1–5.

Brooks SC, Clegg GR, Bray J, Deakin CD, Perkins GD, Ringh M, et al. Optimizing Outcomes After Out-of-Hospital Cardiac Arrest With Innovative Approaches to Public-Access Defibrillation: A Scientific Statement From the International Liaison Committee on Resuscitation. Circulation. 2022;145(13).

Liou FY, Lin KC, Chien CS, Hung WT, Lin YY, Yang YP, et al. The impact of bystander cardiopulmonary resuscitation on patients with out-of-hospital cardiac arrests. J Chin Med Assoc. 2021;84(12):1078–83.

Obermaier M, Zimmermann JB, Popp E, Weigand MA, Weiterer S, Dinse-Lambracht A, et al. Automated mechanical cardiopulmonary resuscitation devices versus manual chest compressions in the treatment of cardiac arrest: Protocol of a systematic review and meta-analysis comparing machine to human. BMJ Open. 2021;11(2):1–13.

Arturo Abraldes J, Fernandes RJ, Rodríguez N, Sousa A. Is rescuer cardiopulmonary resuscitation jeopardised by previous fatiguing exercise? Int J Environ Res Public Health. 2020;17(18):1–11.

Salhi RA, Fouche S, Mendel P, Nelson C, Fetters MD, Guetterman T, et al. Enhancing Prehospital Outcomes for Cardiac Arrest (EPOC) study: Sequential mixed-methods study protocol in Michigan, USA. BMJ Open. 2020;10(11).

Yu Y, Meng Q, Munot S, Nguyen TN, Redfern J, Chow CK. Assessment of Community Interventions for Bystander Cardiopulmonary Resuscitation in Out-of-Hospital Cardiac Arrest: A Systematic Review and Meta-analysis. JAMA Netw Open. 2020;3(7):1–13.

Yasin S, Said Nurumal M, Lokman Md Isa M, Arifin Arif K, Arif Mohd Omar A, Seng Kiat T, et al. The Prevalence of Cardiopulmonary Resuscitation for Out-of-Hospital Cardiac Arrest in Melaka State, Malaysia. Adv Heal Sci Res. 2021;39(SeSICNiMPH):34–43.




How to Cite

Yasin, S., Abu Bakar, S. A., Nurumal , M. S., & Ahmad Arifin, S. (2023). Cardiopulmonary Resuscitation Performed by Bystanders: A Systematic Review. INTERNATIONAL JOURNAL OF CARE SCHOLARS, 6(1), 71–91.

Most read articles by the same author(s)

1 2 > >>