title: Public awareness and self-efficacy of cardiopulmonary resuscitation in communities and outcomes of out-of-hospital cardiac arrest: A multi-level analysis.
abstract: BACKGROUND
  This study aims to test the association between capacity of cardiopulmonary resuscitation (CPR) at community level and survival after out-of-hospital cardiac arrest (OHCA).
  
  
  METHODS
  Emergency medical service (EMS)-treated OHCAs with cardiac etiology in Korea between 2012 and 2013 were analyzed, excluding cases witnessed by EMS providers. Exposure variables were five indexes of community CPR capacity: awareness of CPR (CPR-Awareness), any training experience of CPR (CPR-Any-Training), recent CPR training within the last 2 years (CPR-Recent-Training), CPR training with a manikin (CPR-Manikin-Training), and CPR self-efficacy (CPR-Self-Efficacy). All measures of capacity were calculated as aggregated values for each county level using the national Korean Community Health Survey database of 228,921 responders sampled representatively from 253 counties in 2012. Endpoints were bystander CPR (BCPR) and survival to discharge. We calculated adjusted odds ratios (AORs) per 10% increment in community CPR capacity using multi-level logistic regression models, adjusting for potential confounders at individual levels.
  
  
  RESULTS
  Of 29,052 eligible OHCAs, 11,079 (38.1%) received BCPR. Patients were more likely to receive BCPR in communities with higher proportions of residents with CPR-Awareness, CPR-Any-Training, CPR-Recent-Training, CPR-Manikin-Training, and CPR-Self-Efficacy (all p<0.01). AORs for BCPR were 1.06 (1.03-1.10) per 10% increment in CPR-Awareness, 1.10 (1.04-1.15) for CPR-Any-Training, and 1.08 (1.03-1.13) for CPR-Self-Efficacy. For survival to discharge, AORs (95% CIs) were 1.34 (1.23-1.47) per 10% increment in CPR-Awareness, 1.36 (1.20-1.54) for CPR-Any-Training, and 1.29 (1.15-1.45) for CPR-Self-Efficacy.
  
  
  CONCLUSIONS
  Higher CPR capacity at community level was associated with higher bystander CPR and survival to discharge rates after OHCA.
authors.affiliation: Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Republic of Korea. Electronic address: Ro.youngsun@gmail.com.
authors.forename: Young Sun
authors.initials: YS
authors.lastname: Ro
authors.affiliation: Department of Emergency Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea. Electronic address: shinsangdo@medimail.co.kr.
authors.forename: Sang Do
authors.initials: SD
authors.lastname: Shin
authors.affiliation: Department of Emergency Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea. Electronic address: skciva@gmail.com.
authors.forename: Kyoung Jun
authors.initials: KJ
authors.lastname: Song
authors.affiliation: Korea Centers for Disease Control and Prevention, Chungbuk, Republic of Korea. Electronic address: soh822@hanmail.net.
authors.forename: Sung Ok
authors.initials: SO
authors.lastname: Hong
authors.affiliation: Korea Centers for Disease Control and Prevention, Chungbuk, Republic of Korea. Electronic address: ruyoung@cdc.go.kr.
authors.forename: Young Taek
authors.initials: YT
authors.lastname: Kim
authors.affiliation: Ministry of Health and Welfare, Sejong, Republic of Korea. Electronic address: dr.academicus@gmail.com.
authors.forename: Dong-Woo
authors.initials: DW
authors.lastname: Lee
authors.affiliation: Department of Epidemiology, Graduate School of Public Health, Seoul National University, Seoul, Republic of Korea. Electronic address: scho@snu.ac.kr.
authors.forename: Sung-Il
authors.initials: SI
authors.lastname: Cho
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001364:Awareness; D016887:Cardiopulmonary Resuscitation / Q000379:methods*; D003430:Cross-Sectional Studies; D004632:Emergency Medical Services / Q000592:standards*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D058687:Out-of-Hospital Cardiac Arrest / Q000401:mortality / Q000628:therapy*; D011159:Population Surveillance; D056910:Republic of Korea / Q000453:epidemiology; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D013997:Time Factors
keywords: Bystander cardiopulmonary resuscitation; Cardiac arrest; Community