Qualitative Study Maps Multilevel Barriers to CPR Effectiveness

Cardiopulmonary resuscitation is a life-saving intervention, yet its effectiveness is frequently compromised by challenges that extend beyond standard clinical guidelines. In Iran, survival rates following cardiac arrest remain low, highlighting the urgent need to identify specific barriers to effective resuscitation. A new qualitative study published in BMC Emergency Medicine explores the contextual and perceptual challenges affecting CPR effectiveness as perceived by resuscitation team members in emergency departments.

The study was conducted in selected educational-therapeutic centers in Kermanshah, Iran. It utilized conventional content analysis to gather insights from early February to early June 2026. The researchers selected twenty-one resuscitation team members through purposive sampling. These participants included supervisors responsible for team coordination, anesthesiologist nurses who managed airways, and clinical nurses who performed chest compressions, administered medication, monitored patients, and operated defibrillators. To ensure relevant experience, participants were required to have at least two years of experience, active team membership, and participation in five or more CPR operations in the prior three months.

Data collection involved semi-structured interviews with these team members. The research team analyzed the data using the approach developed by Graneheim and Lundman, utilizing MAXQDA software to manage the qualitative coding process. The findings were reported in accordance with the Consolidated Criteria for Reporting Qualitative Research, or COREQ, guidelines.

The primary result of the study is the development of a conceptual model titled ‘Multilevel Contextual–Perceptual Factors in CPR Compromise.’ This model comprises four interrelated categories that describe the complex environment in which resuscitation teams operate. The outermost layer consists of Physical and Environmental Threats. These external factors trigger Cognitive and Motivational Barriers within the team members. These barriers then interact with Psychological and Ethical Stressors at the team level. Finally, Socio-Cognitive Challenges extend these barriers beyond the immediate hospital setting, indicating that factors outside the clinical room also play a role in compromising performance.

This nested structure illustrates how environmental, cognitive, psychological, and sociocultural factors interact across multiple levels to collectively compromise CPR performance. The study emphasizes that these factors do not operate in isolation.

The specific contribution of this study lies in revealing the interaction of these multilevel factors rather than merely cataloging individual barriers. The findings suggest that targeted interventions in scene safety, psychological support, legal clarity, and public education may help improve resuscitation outcomes.

The study is limited by its qualitative nature and its focus on a specific geographic region in Iran.

Subject of Research: Qualitative analysis of contextual and perceptual barriers to cardiopulmonary resuscitation effectiveness

Article Title: Contextual and perceptual challenges in cardiopulmonary resuscitation: a qualitative study

Article References: Babaei, K., Naderipour, A., Elyasi, M., Koulani, A., & Goodarzi, A. (2026). Contextual and perceptual challenges in cardiopulmonary resuscitation: a qualitative study. BMC Emergency Medicine. https://doi.org/10.1186/s12873-026-01806-2

Image Credits: AI Generated

DOI: 10.1186/s12873-026-01806-2

Keywords: cardiopulmonary resuscitation, qualitative study, emergency medicine, clinical barriers, team dynamics, Iran, healthcare systems, patient safety, Contextual, perceptual, challenges, cardiopulmonary