• NgTrina PriscillaTPYong Loo Lin School of Medicine, National University of Singapore, Singapore., EngSean Wai-OnnSWYong Loo Lin School of Medicine, National University of Singapore, Singapore., TingJoel Xin RuiJXRYong Loo Lin School of Medicine, National University of Singapore, Singapore., Chermaine Bok, TayGirvan Yang HongGYHLee Kong Chian School of Medicine, Nanyang Technological University, Singapore., KongSo Yeon JoyceSYJStrategic Research, Laerdal Medical, Norway., Willem Stassen, Lin Zhang, de KleijnDominique P VDPVDepartment of Vascular Surgery (G04129), UMC Utrecht, The Netherlands., OngMarcus Eng HockMEHDepartment of Emergency Medicine, Singapore General Hospital, Singapore; Pre-hospital and Emergency Research Center, Duke-NUS Medical School, Singapore., Audrey L Blewer, Jun Wei Yeo, HoAndrew Fu WahAFWDepartment of Emergency Medicine, Singapore General Hospital, Singapore; Pre-hospital and Emergency Research Center, Duke-NUS Medical School, Singapore. Electronic address: andrew.ho@duke-nus.edu.sg., and GOALS Workgroup.
• Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
• Resuscitation. 2023 May 1; 186: 109771109771.

Background And AimsOut-of-hospital cardiac arrest exerts a large disease burden, which may be mitigated by bystander cardiopulmonary resuscitation and automated external defibrillation. We aimed to estimate the global prevalence and distribution of bystander training among laypersons, which are poorly understood, and to identify their determinants.MethodsWe searched electronic databases for cross-sectional studies reporting the prevalence of bystander training from representative population samples. Pooled prevalence was calculated using random-effects models. Key outcome was cardiopulmonary resuscitation training (training within two-years and those who were ever trained). We explored determinants of interest using subgroup analysis and meta-regression.Results29 studies were included, representing 53,397 laypersons. Among national studies, the prevalence of cardiopulmonary resuscitation training within two-years and among those who were ever trained, and automated external defibrillator training was 10.02% (95% CI 6.60 -14.05), 42.04% (95% CI 30.98-53.28) and 21.08% (95% CI 10.16-34.66) respectively. Subgroup analyses by continent revealed pooled prevalence estimates of 31.58% (95%CI 18.70-46.09), 58.78% (95%CI 42.41-74.21), 18.93 (95%CI 0.00-62.94), 64.97% (95%CI 64.00-65.93), and 50.56% (95%CI 47.57-53.54) in Asia, Europe, Middle East, North America, and Oceania respectively, with significant subgroup differences (p < 0.01). A country's income and cardiopulmonary resuscitation training (ever trained) (p = 0.033) were positively correlated. Similarly, this prevalence was higher among the highly educated (p<0.00001).ConclusionsLarge regional variation exists in data availability and bystander training prevalence. Socioeconomic status correlated with prevalence of bystander training, and regional disparities were apparent between continents. Bystander training should be promoted, particularly in Asia, Middle East, and low-income regions. Data availability should be encouraged from under-represented regions.Copyright © 2023 The Authors. Published by Elsevier B.V. All rights reserved.

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