European Journal of Cardiovascular Medicine

Cardiovascular disease remains one of the leading causes of morbidity and healthcare expenditure globally [1–3]. Cardiac arrest, a sudden cessation of cardiac mechanical activity, is a significant contributor to mortality, particularly in developed nations [4]. The American Heart Association (AHA) defines cardiac arrest as “the cessation of cardiac mechanical activity, confirmed by the absence of a detectable pulse, unresponsiveness, and apnea” [5]. Alarmingly, the majority of individuals experiencing cardiac arrest do not survive long enough to reach a healthcare facility [6].

Timely intervention—especially the prompt administration of cardiopulmonary resuscitation (CPR)—is essential in improving the likelihood of survival before the arrival of emergency medical services [6]. Research indicates that patients who receive immediate CPR have significantly higher survival rates compared to those who do not (8.2% vs. 2.5%) [7]. CPR is defined as an emergency procedure intended to restore spontaneous circulation through chest compressions, with or without ventilation.

Basic Life Support (BLS), which includes CPR, plays a crucial role in improving survival following cardiac arrest. The AHA's 2015 guidelines outline the “Chain of Survival,” which includes four critical components: early recognition and activation of emergency response, early CPR, early defibrillation, and effective post-resuscitation care [8]. Scientific literature supports the efficacy of each link in the chain, showing that immediate CPR can double or even triple survival rates [9–13], while the combination of CPR and defibrillation within five minutes can result in survival rates ranging from 50% to 75% [14].

Ultimately, two key factors contribute to successful resuscitation and the reduction of preventable deaths: (1) the availability of individuals trained in CPR, and (2) the prompt and effective execution of CPR at the time of the event. Enhancing community-wide CPR training is therefore vital to ensuring that a capable responder is present during a cardiac emergency.

Objectives of the Study:

1. To assess the baseline knowledge of cardiopulmonary resuscitation (CPR) among degree college students.
2. To implement an educational intervention focused on CPR techniques and procedures.
3. To evaluate the post-intervention knowledge and practical performance of CPR among the students following the educational session.

The study was conducted at Government College for Men, B-Camp, Kurnool, Andhra Pradesh, India, between October 1 and December 31, 2019. Ethical approval was obtained from the Institutional Ethics Committee, and informed consent was secured from all participants prior to enrollment.

Out of 520 male students, a total of 200 degree students aged between 17 and 22 years, representing various academic years and courses, voluntarily participated in the study. Participants first completed a pre-test questionnaire designed to assess their baseline knowledge of cardiovascular emergencies. The questionnaire included items related to symptoms of heart attack, types of chest pain, and key components of Basic Life Support (BLS), including the steps of cardiopulmonary resuscitation (CPR).

Following the pre-test, students received a structured educational intervention on BLS, including detailed instruction and hands-on training in CPR procedures, conducted on November 1. After a 10-day interval, participants were reassessed through observation to evaluate their practical performance. Individualized feedback and additional training were provided based on observed errors.

In total, three training sessions were conducted, incorporating both theoretical education and practical skill development. A post-test questionnaire was administered on December 28 to evaluate knowledge retention, awareness, and skill competency. Additionally, each student’s ability to correctly perform the sequential steps of CPR was assessed, and the data were systematically collected for analysis.

Data Analysis:

Data entry was performed using Microsoft Excel 2007. Descriptive and inferential statistical analyses were carried out using IBM SPSS Statistics version 22.0. To assess the significance of differences in categorical variables before and after the educational intervention, the Chi-square test and Fisher’s Exact Test were employed where appropriate.

The study included 200-degree students aged between 17 and 22 years. Of these, 155 students were in their 1st year and 45 in their 2nd year of study. Participants were enrolled in various academic streams: Bachelor of Arts (B.A.) – 60 students, Bachelor of Commerce (B.Com.) – 60 students, and Bachelor of Science (B.Sc.) – 80 students.

The educational status of participants' fathers was categorized as follows: illiterate (92), primary education (16), secondary education (43), intermediate (26), graduate (21), and postgraduate (22). The occupational classification of participants’ fathers included unskilled (10), semiskilled (20), skilled (30), farmers (60), semi-professionals (60), and professionals (40).

Before intervention Only 21% (42 individuals) of respondents were able to correctly identify chest pain or symptoms related to a heart attack, while a significant majority of 79% (158individuals) could not.About 8% (16 individuals) of the participants could recognize different types of chest pain, whereas 92% (184 individuals) could not(Table1).Poor   awareness of CPR among respondents, with only 12% knowing the full form of CPR. Knowledge of critical steps like checking responsiveness (15%), correct hand placement (22.5%), and chest compressions (14.5%) was also low. Very few participants knew how to open the airway (6%) or the number of breaths per cycle (6%)(Table 2).There is improvement in the knowledge about chest pain/heart attack and CPR after the intervention (Table 3 & 4).This is a statistically significant (p < 0.05)(Table 5 & 6),

Table 1: Pre-Test Knowledge Distribution on Heart attack Among Participants

Table 2: Pre-Test Knowledge Distribution on CPR Among Participants

Table 3: Post-Test Knowledge Distribution on Heart attack Among Participants

Table 4: Post-Test Knowledge Distribution on CPR Among Participants

Table 5: Comparison of Pre-Test and Post-Test Knowledge Scores on Heart attack

Table 6: Comparison of Pre-Test and Post-Test Knowledge Scores on Cardiopulmonary Resuscitation (CPR)

The present study demonstrates that lifesaving maneuvers can be effectively taught to college students. While further research is needed to assess medium- and long-term skill retention, the findings support existing literature suggesting that there is no definitive age at which first aid training is most effective. Research in psychomotor learning indicates that early exposure to such training contributes to the long-term maintenance of skills.

In addition to the acquisition of practical skills—which require continuous retraining for optimal retention—Basic Life Support (BLS) education has the potential to positively shape the attitudes and behaviors of young individuals. This is particularly impactful during formative years, when students are more receptive to adopting new knowledge and behaviors.

Evidence from a study conducted in Norway, which examined children aged 4–5 years, revealed that early training fosters the integration of first aid into daily routines and sustains empathetic behaviors. Similarly, a study in a school setting in Barcelona concluded that schools provide an ideal environment for delivering first aid education. Such programs not only enhance children's self-esteem but may also have life-saving implications.

Incorporating students into first aid education initiatives addresses the broader public health goal of increasing the proportion of the population capable of responding effectively during emergencies. Educational institutions provide access to a wide segment of the community, including family members, thereby maximizing outreach. In the short term, ensuring that students are able to properly alert emergency services is critical, especially considering that a significant number of cardiac arrests occur at home in the presence of relatives and friends.

Moreover, the engagement of teachers plays a pivotal role in promoting a culture of emergency preparedness. Numerous studies have demonstrated that, when adequately trained, both teachers and students are capable of effectively disseminating life-saving techniques within their social circles. This peer-led model reinforces skill acquisition and helps establish a sustainable, community-based approach to emergency response training.

Limitations

This study was conducted within a single college and involved participants aged between 17 and 22 years. As such, the generalizability of the findings to the broader population of the district or state is limited. Additionally, the study did not include a follow-up assessment to evaluate long-term retention of knowledge and skills, such as a reassessment after four months. This limits the ability to determine the durability of the training effects over time.

1. Bonow RO, Smaha LA, Smith SC Jr., Mensah GA, Lenfant C. World heart day 2002: The international burden of cardiovascular disease: Responding to the emerging global epidemic. Circulation 2002;106:1602-5.
2. Murray CJ, Lopez AD. Mortality by cause for eight regions of the world: Global burden of disease study. Lancet 1997;349:1269-76.
3. Michaud CM, Murray CJ, Bloom BR. Burden of diseaseimplications for future research. JAMA 2001;285:535-9.
4. Futterman LG, Lemberg L. Cardiopulmonary resuscitation review: Critical role of chest compressions. Am J Crit Care 2005;14:81-4.
5. Cummins RO, Chamberlain DA, Abramson NS, Allen M, Baskett PJ, Becker L, et al. Recommended guidelines for uniform reporting of data from out-of-hospital cardiac arrest: The utstein style. A statement for health professionals from a task force of the American heart association, the European resuscitation council, the heart and stroke foundation of Canada, and the Australian resuscitation council. Circulation 1991;84:960-75.
6. Kleinman ME, Brennan EE, Goldberger ZD, Swor RA, Terry M, Bobrow BJ, et al. Part 5: Adult basic life support and cardiopulmonary resuscitation quality: 2015 American heart association guidelines update for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation 2015;132:S414-35.
7. Fredriksson M, Herlitz J, Nichol G. Variation in outcome in studies of out-of-hospital cardiac arrest: A review of studies conforming to the utstein guidelines. Am J Emerg Med 2003;21:276-81.
8. Travers AH, Perkins GD, Berg RA, Castren M, Considine J, Escalante R, et al. Part 3: Adult basic life support and automated external defibrillation: 2015 international consensus on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations. Circulation 2015;132:S51-83.
9. Gates S, Quinn T, Deakin CD, Blair L, Couper K, Perkins GD, et al. Mechanical chest compression for out of hospital cardiac arrest: Systematic review and meta-analysis. Resuscitation 2015;94:91-7.
10. Girotra S, Chan PS, Bradley SM. Post-resuscitation care following out-of-hospital and in-hospitalcardiac arrest. Heart 2015;101:1943-9.
11. Hasselqvist-Ax I, Herlitz J, Svensson L. Early CPR in out-ofhospital cardiac arrest. N Engl J Med2015;373:1573-4.
12. McNally B, Robb R, Mehta M, Vellano K, Valderrama AL, Yoon PW, et al. Out-of-hospital cardiac arrest surveillancecardiac arrest registry to enhance survival (CARES), United States, october 1, 2005 december 31, 2010. MMWR Surveill Summ 2011;60:1-9.
13. Al-Turki YA, Al-Fraih YS, Jalaly JB, Al-Maghlouth IA, Al-Rashoudi FH, Al-Otaibi AF, et al. Knowledge and attitudes towards cardiopulmonary resuscitation among university students in Riyadh, Saudi Arabia. Saudi Med J 2008;29:1306-9.
14. Al-Turkistani HK. Awareness and knowledge of pediatric cardio-pulmonary resuscitation in the community of Al-Khobar city. J Family Community Med 2014;21:125-9.