The authors identify code-status discussions as a recurring example of the problem. Clinical notes may record that a patient wishes to receive cardiopulmonary resuscitation after cardiac arrest, sometimes alongside qualifications about advanced comorbidities, clinical frailty, or the limited likelihood that CPR will benefit the patient. The authors argue that clinicians often respond by presenting available interventions and positioning themselves as neutral parties. They contend that this practice can shift the moral and emotional burden of life-and-death decisions to patients, families, or substitute decision-makers without distinguishing between a patient’s authority to refuse treatment and an unrestricted claim to receive any requested intervention.

The critique is grounded in the principlist framework associated with Beauchamp and Childress, which allows competing moral principles to override respect for autonomy and rejects any fixed hierarchy among principles. Winberg and Slessarev describe how an autonomy-focused approach can become dominant in clinical practice: clinicians offer options, outline risks and benefits, obtain informed consent, and regard their ethical obligations as fulfilled. They call the resulting model consumeristic because patients or substitute decision-makers may bear responsibility for choices made during periods of vulnerability. According to the essay, this shift can weaken shared responsibility and the patient-physician relationship, although the authors do not present measured outcomes from the model.

The authors distinguish the autonomy trap from every decision to provide CPR that clinicians judge unlikely to benefit a patient. CPR may be unable to restore circulation, or it may restore circulation without producing an outcome clinicians consider worthwhile. The latter includes judgments about survival, disability, suffering, and the value of additional time, which are not purely physiological. Patients and families may value brief survival, the assurance that clinicians did not give up, or freedom from feeling responsible for a relative’s death. These considerations may reflect cultural, religious, or social understandings of a good death. The authors state that failure to recognize such meanings can contribute to distrust and inequity, but their essay does not quantify those effects.

They also caution that providing CPR in carefully selected cases after considering broader benefits may itself be an exercise of professional judgment rather than an abdication of responsibility, provided clinicians consider potential suffering. The problematic pattern, in their view, is supplying CPR solely because it was requested without evaluating, communicating about, or accepting responsibility for its medical and ethical appropriateness. This distinction means the essay does not characterize all patient requests for resuscitation as irrational or inappropriate, nor does it support unilateral decisions without contextual evaluation.

The authors propose three origins for the autonomy trap. First, they associate the growth of bioethics with neoliberal economic structures emphasizing market primacy, individualism, and preference maximization, noting that respect for autonomy aligns readily with an understanding of patients as consumers. Second, they identify defensive medicine, defined as practice driven by concern about litigation rather than patient benefit, as a factor that may encourage clinicians to defer to requested interventions to avoid legal, reputational, and institutional pressures. Third, they describe a collapse of administrative and clinical contexts: the former establishes what the biomedical community regards as legitimate medical care, while shared decision-making allows a patient to select among established options that fit their values.

The consequences they anticipate include burdens on patients making decisions during acute stress, pain, and uncertainty; guilt and delayed remorse after informed decisions; and the offer of interventions that cannot achieve their intended goal, which they describe as false choices. Clinicians who provide care they believe is misaligned with a patient’s best interest or approaches harm may experience moral distress and disengagement from outcomes. These are arguments advanced by the viewpoint, not findings from a cohort, simulation, survey, or other outcome study, and the article provides no estimates of their frequency or magnitude.

To avoid the trap while preserving the rejection of paternalism, the authors say physicians should first determine which interventions are medically appropriate through thorough clinical assessment, supplemented where applicable by validated prognostic and risk-stratification tools. Recommendations should integrate prior wishes, baseline functional status, comorbidities, current illness severity and trajectory, treatment risks and benefits, and the patient’s values and acceptable outcomes. Because the efficacy of advance care planning is mixed, they argue that clinicians should help construct values-based care plans in real time amid clinical uncertainty. They frame evidence-informed assessment combined with patient values as shared responsibility rather than a unilateral command.

Trust is central to this model, according to the essay. Clinicians are encouraged to demonstrate competence, communicate clearly and honestly, listen with empathy, explore the patient’s experience, and provide understandable information. The authors also recommend ethics education that deepens understanding of principlism while familiarizing clinicians with care ethics and virtue ethics. They describe microethics as a practical lens for self-reflection, perspective-taking, cultural humility, and attention to how language, framing, and behavior shape trust and redistribute decision-making responsibility. Their final claim is that autonomy remains indispensable to medicine, yet respect for autonomy and informed consent alone cannot carry the full ethical responsibility of care.

Subject of Research: A bioethics viewpoint on balancing patient autonomy with clinical judgment and shared responsibility in care decisions.

Article Title: The Autonomy Trap: When Respect for Choice Becomes Withdrawal of Professional Responsibility

Article References: Winberg, C., & Slessarev, M. (2026). The Autonomy Trap: When Respect for Choice Becomes Withdrawal of Professional Responsibility. Journal of General Internal Medicine. https://doi.org/10.1007/s11606-026-10866-w

Image Credits: AI Generated

DOI: 10.1007/s11606-026-10866-w

Keywords: medical ethics, patient autonomy, shared decision-making, clinical judgment, cardiopulmonary resuscitation, code status, defensive medicine, advance care planning, professional responsibility, Autonomy, Trap, Respect

The research team, led by Rita Opoku-Danso of the Department of Adult Health at the University of Cape Coast’s School of Nursing and Midwifery, set out to measure three distinct dimensions of CPR competence: theoretical knowledge, observed practical skills, and self-reported readiness. Of 331 eligible staff working in critical and emergency care units, 271 participated, an impressive response rate of 81.9 percent. The design was analytical and cross-sectional, meaning the researchers captured a snapshot of competence at a single point in time and then used statistical modeling to identify which factors were associated with readiness.

The measurement strategy is what makes this study technically interesting. Knowledge was assessed with a structured test, the kind of written examination that has long been the default tool for evaluating clinical competence. Skills, by contrast, were observed directly on a manikin using a 12-item checklist, forcing each participant to physically demonstrate the sequence of resuscitation steps rather than merely describe them. Self-reported readiness was captured with an 11-item Likert scale, a psychometric instrument that asks respondents to rate their own confidence and preparedness on a graded continuum. Each instrument therefore probes a different layer of competence, and the study’s central finding emerges from how poorly those layers align.

The headline numbers are sobering. A staggering 94.8 percent of respondents had low CPR knowledge, meaning that nearly every nurse and midwife tested failed to reach an adequate score on the written assessment. Yet when the same professionals were observed performing CPR on a manikin, 65.7 percent demonstrated adequate skills. And when asked how ready they felt to perform resuscitation in a real emergency, 90.0 percent reported moderate readiness. In other words, the workforce that would respond to a cardiac arrest knows the least about the theory, performs the procedure reasonably well in practice, and feels moderately confident about doing it under pressure.

This dissociation between knowledge and performance is not unique to Ghana, but its magnitude here is remarkable. The authors suggest that the pattern likely reflects how nurses and midwives learn and retain resuscitation skills. Practical, repeated exposure to emergency scenarios, even on simulation equipment, appears to build procedural memory that outlasts the theoretical content covered in classroom sessions or occasional refresher courses. Chest compressions, airway management, and the choreography of a resuscitation attempt are motor skills reinforced by doing, while knowledge of compression depths, drug dosages, and algorithm sequences decays rapidly without regular reinforcement.

The statistical core of the study lies in its binomial logistic regression analysis, which modeled the odds of reporting moderate readiness as a function of knowledge, observed skills, and demographic and training variables. The strongest signal came from observed skills: nurses and midwives who demonstrated adequate CPR skills had dramatically higher odds of reporting moderate readiness, with an adjusted odds ratio of 12.84 and a 95 percent confidence interval spanning 4.09 to 40.36, a result significant at p less than .001. This means that hands-on competence, as measured on the manikin, was the dominant predictor of how ready clinicians felt, dwarfing every other factor the researchers examined.

More puzzling is the finding on knowledge. Compared with staff who had low knowledge, those with moderate knowledge actually showed lower odds of reporting moderate readiness, with an adjusted odds ratio of 0.11 and a confidence interval of 0.03 to 0.46, significant at p equal to .003. The authors themselves urge caution in interpreting this counterintuitive result. One plausible explanation is a version of the Dunning-Kruger dynamic in reverse: clinicians who know more about the complexity of resuscitation may also be more aware of what they do not know, and therefore rate their readiness more conservatively. Those with minimal theoretical grounding may feel unqualified to doubt themselves. Alternatively, the small number of participants in the moderate knowledge category may have made this estimate unstable.

Equally important is what did not predict readiness. Demographic characteristics such as age, professional cadre, and years of experience, along with prior training variables, were not significant predictors in the regression model. This null result carries a practical message: simply having attended a training course at some point in the past, or having accumulated years on the ward, does not guarantee that a nurse or midwife feels, or is, prepared to resuscitate a patient. Readiness appears to track current, demonstrated competence rather than credentials or tenure.

For hospital administrators and nursing educators, the study’s recommendations follow directly from its architecture. The authors call for regular simulation-based training paired with competency assessment that combines knowledge testing with observed practical performance. The logic is precise: because observed skills were so strongly associated with readiness, and because knowledge was so deficient, programs that rely on either written tests or practical demonstrations alone will miss half the picture. Simulation-based approaches, in which teams rehearse resuscitation scenarios on manikins under realistic time pressure, are increasingly recognized as the gold standard for maintaining emergency competence, and this study provides context-specific evidence for that approach in a West African tertiary setting.

The broader significance of the research extends to health systems across low- and middle-income countries, where evidence on CPR competence among nurses and midwives has been limited. Cardiac arrests on hospital wards are common, and the quality of the initial response, delivered overwhelmingly by nursing staff, shapes survival outcomes before physicians and advanced teams arrive. A workforce with strong observed skills but weak theoretical knowledge may perform adequately in routine scenarios yet falter when atypical situations demand algorithmic reasoning, such as recognizing reversible causes of arrest or adjusting to pediatric protocols. Closing that gap requires sustained investment in recurring, assessed training rather than one-off certification. The Ghanaian study, with its unusually high response rate and its triangulation of knowledge, skills, and self-assessment, offers a replicable template for measuring that readiness wherever nurses and midwives stand first in line when a heart stops.

Subject of Research: CPR readiness among nurses and midwives in Ghana

Article Title: Association of knowledge and observed skills with self-reported readiness of nurses and midwives to perform cardiopulmonary resuscitation in a tertiary hospital in Ghana: a cross-sectional study

Article References: Opoku-Danso, R., Bockor, M. A., Quayson, E., Boahemaa, J., Odoom, E., & Owusu, G. (2026). Association of knowledge and observed skills with self-reported readiness of nurses and midwives to perform cardiopulmonary resuscitation in a tertiary hospital in Ghana: a cross-sectional study. BMC Nursing, 25(1), Article 903. https://doi.org/10.1186/s12912-026-05327-y

Image Credits: AI Generated

DOI: 10.1186/s12912-026-05327-y

Keywords: cardiopulmonary resuscitation, nurses, midwives, Ghana, CPR knowledge, observed skills, readiness, simulation-based training, cross-sectional study, tertiary hospital, BMC Nursing, emergency care

The concept is physiologically elegant. In AACD-CPR, a rescuer or device applies compressions to the abdomen and then actively pulls upward to create negative pressure, or decompression, between compressions. The abdominal compression phase raises intra-abdominal pressure and pushes blood forward through the aorta while also squeezing the venous reservoir of the splanchnic circulation. The active decompression phase then expands the abdominal compartment, potentially drawing venous blood back toward the heart and enhancing filling of the right atrium for the next cycle. Proponents have argued that this push-pull action on the abdomen could augment venous return, improve coronary and cerebral perfusion pressures, and even assist ventilation, addressing several of the hemodynamic shortcomings of chest compressions alone. Until now, however, the clinical evidence for the technique has been scattered across small trials of varying quality, making it difficult for guideline committees to draw firm conclusions.

A new systematic review and meta-analysis published in Scientific Reports by Ruifang Cui, Xiaopeng Liu, Xiaoqing Yang, Yifan Huang, Xiaozhan Yang, and Sisen Zhang, researchers affiliated with the Fifth Clinical Medical College of Henan University of Chinese Medicine and collaborating institutions in Zhengzhou, China, set out to settle the question. The team systematically searched eleven electronic databases from their inception through November 2025, identifying eight randomized controlled trials that compared AACD-CPR directly with standard CPR in adults experiencing cardiac arrest. The analysis was conducted in RevMan 5.4.1, and the authors applied the GRADE framework, the grading of recommendations assessment, development, and evaluation system, to rate how much confidence readers should place in each finding. The outcomes they examined spanned the full resuscitation cascade: return of spontaneous circulation, commonly called ROSC, survival at two weeks, neurological outcomes, hemodynamic parameters, arterial blood gas values, oxygen metabolism measures, and adverse events such as injuries caused by the procedure itself.

The headline result is cautiously encouraging. Across the pooled trials, patients receiving AACD-CPR were more likely to achieve return of spontaneous circulation than those receiving standard CPR, and when their hearts did restart, it happened sooner. Time to ROSC matters enormously in resuscitation research, because the duration of no-flow and low-flow states is one of the strongest determinants of whether a survivor walks out of the hospital with an intact brain. A technique that reliably shortens the interval from collapse to a perfusing rhythm would be a meaningful advance even if other endpoints moved more slowly. The finding that AACD-CPR accelerated ROSC therefore stands out as the most clinically significant signal in the analysis, and it aligns with the physiological rationale that abdominal pumping improves circulation during the critical early minutes of an arrest.

But the review is equally notable for what it did not find. Survival at two weeks did not differ significantly between the two techniques. That disconnect, between a physiological endpoint that improves and a survival endpoint that does not, is a familiar pattern in resuscitation science. Achieving ROSC is a necessary step on the path to survival, yet many patients who regain a pulse later die in the intensive care unit from post-arrest organ injury, or survive with devastating neurological damage. A method that helps more hearts restart may still fail to move the needle on two-week survival if the underlying injury burden is too great or if the improved circulation is not sustained long enough to protect the brain. The authors are explicit that the current evidence remains insufficient to support broader clinical implementation of AACD-CPR, and they call for larger multicenter randomized trials powered to detect differences in survival to hospital discharge, long-term survival, and neurologically favorable survival.

The exploratory physiological findings add texture to the picture, though the authors handle them with appropriate caution. Several hemodynamic, arterial blood gas, and oxygen metabolism parameters showed between-group differences favoring the abdominal technique, consistent with the idea that AACD-CPR improves perfusion and oxygen delivery. However, these estimates carried heavy caveats. Substantial statistical heterogeneity was present across studies, meaning the trials disagreed with one another more than would be expected from chance alone, and many of the pooled estimates rested on only two or three small studies. In meta-analysis, heterogeneity of that magnitude can arise from differences in how the intervention was delivered, how arrest rhythms were defined, how quickly treatment began, or how outcomes were measured, and it makes any single pooled number difficult to interpret. The GRADE assessment reflected this fragility: the certainty of evidence across outcomes ranged from very low to moderate, a span that signals how far the field remains from definitive answers.

Safety is the other half of the equation, and here the review offers a genuinely surprising observation. Rib fractures, a well-known and frequent complication of forceful chest compressions, were reported less often in the AACD-CPR groups in two of the included studies. The finding makes mechanical sense, since shifting part of the pumping workload to the abdomen reduces the repetitive, high-force loading of the chest wall. Yet the authors emphasize that evidence for other adverse events was limited, and abdominal compressions carry their own theoretical risks, including injury to abdominal organs. With only two studies informing the fracture comparison and sparse data elsewhere, the safety profile of AACD-CPR cannot yet be considered established in either direction. Any future large trial would need systematic adverse-event ascertainment to determine whether the technique trades chest injuries for abdominal ones, or genuinely reduces procedural harm overall.

The study also illustrates the structural challenges facing resuscitation research. Cardiac arrest trials are notoriously difficult to run: enrollment must happen within minutes, consent is often deferred, and outcomes depend on a chaotic chain of variables stretching from the bystander who calls for help to the post-arrest care team. Small single-center studies with modest sample sizes, like those dominating this evidence base, are vulnerable to bias and to the play of chance, which is precisely why the GRADE ratings are so restrained. The authors’ funding, from the Natural Science Foundation of Henan Province and the Key Science and Technology Project of Henan Province, supported a rigorous synthesis, but no amount of statistical technique can extract certainty from eight small trials. What the review does provide is a clear map of the gaps: diverse populations, multicenter designs, and clinically meaningful endpoints are all missing pieces.

For clinicians and guideline developers, the practical takeaway is patience. Standard CPR remains the default, and nothing in this analysis justifies abandoning chest compressions for an abdominal device in routine practice. But the direction of the physiological signals, faster return of circulation, favorable trends in perfusion and oxygenation, and possibly fewer rib fractures, suggests that AACD-CPR has earned a place on the short list of resuscitation techniques worth testing at scale. The history of emergency medicine is littered with clever mechanical ideas that looked compelling in small studies and collapsed under multicenter scrutiny; it also contains rare exceptions, such as mechanical compression devices and impedance threshold valves, that reshaped practice after definitive trials. Whether abdominal pumping joins that second group will depend on the large, well-designed randomized trials the authors demand, trials that would finally test whether a second pump in the belly can translate faster heart restarts into more survivors leaving the hospital with their minds intact.

Subject of Research: Comparison of active abdominal compression-decompression CPR with standard CPR for adult cardiac arrest

Article Title: Active abdominal compression-decompression cardiopulmonary resuscitation versus standard cardiopulmonary resuscitation for adult cardiac arrest: a systematic review and meta-analysis

Article References: Cui, R., Liu, X., Yang, X., Huang, Y., Yang, X., & Zhang, S. (2026). Active abdominal compression-decompression cardiopulmonary resuscitation versus standard cardiopulmonary resuscitation for adult cardiac arrest: a systematic review and meta-analysis. Scientific Reports. https://doi.org/10.1038/s41598-026-75339-w

Image Credits: AI Generated

DOI: 10.1038/s41598-026-75339-w

Keywords: cardiac arrest, cardiopulmonary resuscitation, AACD-CPR, return of spontaneous circulation, meta-analysis, systematic review, resuscitation, hemodynamics, rib fractures, emergency medicine, GRADE certainty of evidence, randomized controlled trials

The research, published in BMC Medical Education as part of the CORE-LIFE research project, was carried out by a team of clinicians and educators affiliated with the Hospital Universitario Virgen de las Nieves, the Hospital Universitario Clínico San Cecilio, and the University of Granada. Their prospective observational study enrolled 416 primary school students across all six grades of a single school, the Cristo de la Yedra school in Granada, and tested a cardiopulmonary resuscitation curriculum built around two fashionable ideas in modern pedagogy: microlearning and gamification. Microlearning means delivering content in small, focused units that fit a child’s attention span, while gamification wraps the material in game mechanics such as challenges and rewards to sustain motivation.

The intervention itself was deliberately compact. Rather than a full-day workshop, the children received a short, practical, and sequential didactic unit aligned with the European Resuscitation Council’s recommendations for basic life support. The sequence that every resuscitation trainee must master is demanding for a child: check for danger and response, call for help, position the victim, and deliver effective chest compressions. Each of these steps was broken down into digestible segments, and the researchers then waited four months before testing how much the children still remembered and could perform.

That delayed assessment is one of the most interesting technical features of the study. Most educational research measures skill immediately after training, when performance is at its peak and retention has not yet been tested by time. By evaluating the children four months later, the Granada team probed what psychologists call long-term procedural memory, the durable motor and cognitive patterns that would actually matter in a real emergency. The results showed significant differences between school grades in the correct execution of the overall CPR sequence, with a p-value below 0.001, indicating that the probability of observing such differences by chance alone was extremely small. Older children, as one might expect, generally handled the sequence better than their younger schoolmates, but students across the grades demonstrated varying levels of performance on the individual procedural components when retested months after the intervention.

Perhaps the most striking finding came from outside the classroom. The researchers distributed family questionnaires and, of the 259 that were returned, 95.0 percent reported positively on the transmission of CPR-related content into the family environment. In other words, children were apparently going home and talking about chest compressions, emergency calls, and the chain of survival with their parents and siblings. This ripple effect has long been one of the theoretical arguments for teaching resuscitation in schools: each trained child becomes a small vector of knowledge into a household, potentially multiplying the number of prepared bystanders far beyond the classroom roster.

The authors are careful, however, to flag the limits of that family data. The questionnaires were exploratory and self-reported, meaning they capture a perception of dissemination within families but do not provide evidence that parents actually learned CPR or acquired any practical skill. A parent who remembers their child enthusiastically demonstrating compressions on a stuffed animal is not the same as a parent who could perform them. This distinction matters for anyone designing public health policy based on the study, because the true multiplier effect of school-based training remains an open question that would require direct assessment of family members.

On the question of feasibility, the study delivers encouraging but carefully qualified results. The intervention was successfully implemented across all six primary school grades, and a high proportion of non-excluded participants completed the four-month assessment, suggesting that the format was workable within a real school environment and acceptable to children, teachers, and families. Yet the researchers explicitly note that no pre-specified feasibility criteria were established before the study began, so the findings should be read as descriptive indicators of implementation rather than proof that formal feasibility thresholds were met. This is an honest methodological caveat that distinguishes the paper from more promotional accounts of educational innovation.

There is a second, equally important limitation: the absence of a comparison group. Because every participating child received the microlearning and gamification programme, and no control group received a different format or no training at all, the study cannot attribute the observed outcomes to either instructional strategy. The children learned, and much of the learning persisted for four months, but whether the game-based microformat outperforms conventional teaching of the same content is unknown. This is a common trade-off in school-based research, where ethical and logistical constraints often make randomized designs difficult, but it means the study establishes feasibility rather than superiority.

The study was approved by the Research Ethics Committee of the University of Granada under registration 1244/CEIH/2020 and conducted according to the principles of the Declaration of Helsinki. Written informed consent was obtained from the parents or legal guardians of all participating children, and the schoolchildren themselves received age-appropriate information about the study before taking part, with their willingness to participate respected throughout. All data were collected and analysed in anonymised form, and the authors declare no competing interests. The research received no dedicated funding, and the team thanked the school’s management for its cooperation.

What the Granada study ultimately contributes is a proof of concept with unusually honest boundaries. It shows that a short, game-infused, microlearning-based CPR curriculum can be delivered across an entire primary school, that children as young as those in the earliest grades can engage with the material, and that measurable procedural knowledge survives a four-month interval, with older grades performing the full sequence more reliably. It also hints at a powerful halo effect into families, even if that effect remains unquantified. For advocates of the Kids Save Lives vision, in which every schoolchild in Europe would graduate with basic life support competence, the study adds a practical data point: the youngest learners are not too young, and the format need not consume whole school days. The next step, which the authors’ own limitations point toward, is a controlled comparison against standard instruction, ideally across multiple schools, to determine whether gamified microlearning is merely a feasible way to teach children to save lives or genuinely a better one.

Subject of Research: School-based CPR education using microlearning and gamification in primary school children

Article Title: Feasibility of a school-based cardiopulmonary resuscitation educational programme incorporating microlearning and gamification in primary school children: a prospective observational study

Article References: Carrasco-Cáliz, A., Parrilla-Ruiz, F. M., Gómez-Moreno, G., Pérez-Villares, J. M., Padilla-Serrano, A., & Cárdenas-Cruz, A. (2026). Feasibility of a school-based cardiopulmonary resuscitation educational programme incorporating microlearning and gamification in primary school children: a prospective observational study. BMC Medical Education. https://doi.org/10.1186/s12909-026-10616-w

Image Credits: AI Generated

DOI: 10.1186/s12909-026-10616-w

Keywords: cardiopulmonary resuscitation, basic life support, microlearning, gamification, primary school children, health education, Kids Save Lives, chain of survival, school-based intervention, skill retention, medical education, public health

The research team set out to answer two questions. First, how much do university students actually know about CPR, and how willing and confident are they to perform it in an emergency? Second, can a brief, peer-delivered workshop measurably shift those variables? The answer to the first question, drawn from a cross-sectional survey of 431 students, was sobering but nuanced. Students generally held positive attitudes toward CPR and expressed willingness to help a stranger in cardiac arrest, but their actual knowledge of how to perform it and their belief in their own ability to do so lagged well behind. In other words, the will was there; the skill and the self-assurance were not.

To measure these dimensions systematically, the researchers used a validated questionnaire covering knowledge, attitudes, behavioral intention, and self-efficacy, a combination abbreviated as KABSE. Self-efficacy, a concept rooted in psychological theory, refers to a person’s belief in their own capacity to execute a specific behavior, and it is widely regarded as a critical predictor of whether training translates into action. Someone can memorize the compression rate of 100 to 120 per minute and the depth of 5 to 6 centimeters, but if they do not believe they can actually push hard enough on a stranger’s chest in a crowded shopping mall, the knowledge may never be used. The survey design allowed the team to examine not just each domain separately but the statistical associations among them.

The demographic patterns that emerged were striking. Female students scored higher on knowledge and attitudes, while male students reported greater self-efficacy, a divergence the authors suggest may reflect gendered differences in confidence rather than competence. Older and married participants showed better attitudes, plausibly reflecting greater life experience and a heightened sense of responsibility for others. Unsurprisingly, students with a healthcare-related background scored higher on knowledge, attitudes, and self-efficacy than their peers from other disciplines, although notably their behavioral intention was not significantly different, suggesting that even clinical training does not automatically convert into a stronger stated resolve to intervene.

Three factors stood out as consistently linked to better scores across the domains: awareness of automated external defibrillators, the ability to use one, and recent CPR training. AEDs are portable devices that analyze the heart’s rhythm and deliver a shock if needed, and they are increasingly installed in public spaces, yet many people walk past them daily without knowing what they are or how to deploy them. The finding that AED awareness and hands-on capability tracked so closely with overall CPR readiness underscores a central theme of resuscitation science: these skills are perishable, and they decay quickly without reinforcement. Students trained within the past two years were meaningfully better prepared than those whose training was older or absent altogether.

The statistical analysis also revealed significant interconnections among the four KABSE domains, reinforcing the idea that knowledge, attitude, intention, and confidence do not operate in isolation. A student who knows what to do is more likely to feel able to do it; a student who feels able is more likely to intend to act. This web of relationships matters for intervention design, because it suggests that a training program targeting only one link, say, knowledge alone, may fail to produce a bystander willing to kneel down and begin compressions. Effective programs must move the whole system at once.

That is precisely what Phase 2 attempted. The researchers recruited 33 students who had received no CPR training in the previous two years and enrolled them in a two-hour workshop delivered by medical students rather than professional resuscitation instructors. The peer-led model has an appealing economics and sociology to it: medical students consolidate their own learning by teaching, the cost is minimal, the instructors are culturally and linguistically closer to their audience, and the informal setting may lower the intimidation barrier that sometimes accompanies formal certification courses. The workshop was explicitly framed as a proof of concept rather than a definitive trial, with a small sample and no control group, but the results were nonetheless compelling.

Comparing pre- and post-workshop questionnaire scores, the team found statistically significant improvements in every domain measured. Knowledge rose sharply, with p-values below 0.001, as did attitude and self-efficacy. Behavioral intention, the domain that had been relatively high to begin with, also improved significantly, at p below 0.01. In the space of a single afternoon, students who had arrived with faded or nonexistent training reported not only knowing more about CPR but believing more strongly that they could and would perform it. The magnitude and consistency of these gains, across all four psychological domains simultaneously, is what distinguishes the finding from studies that improve knowledge alone while leaving confidence untouched.

The caveats are real and the authors are candid about them. Thirty-three participants is a small cohort, the absence of a control group means some of the improvement could reflect test-retest effects or enthusiasm rather than the workshop itself, and the outcomes were self-reported rather than demonstrated on manikins under objective assessment. Self-efficacy measured by questionnaire is not the same as compression quality measured by a feedback device, and the durability of the gains over weeks and months remains unknown. Whether a two-hour session produces bystanders who actually intervene months later is the question that only a larger, controlled, longitudinal study can answer.

Even so, the study lands at a moment when the case for universal bystander CPR training has never been stronger. Out-of-hospital cardiac arrest remains a leading cause of death worldwide, and survival rates in most countries hover in the single digits, largely because help arrives too late. University students, socially active, densely concentrated on campuses, and positioned to carry skills into families and workplaces, are an ideal vector for community-wide preparedness. If a peer-led model can be scaled, validated with objective skill assessments, and refreshed at regular intervals to counteract skill decay, it could offer Malaysian institutions, and institutions elsewhere, a practical template for turning a generation of willing but unprepared students into confident first responders. The heart of the finding is simple: the willingness was already there, waiting for the knowledge and confidence to catch up, and two hours of peer teaching proved enough to start closing that gap.

Subject of Research: CPR knowledge, willingness, and self-efficacy among Malaysian university students and the effect of a peer-led CPR workshop

Article Title: Knowledge, willingness, and self-efficacy in CPR: A two-phase study of prevalence and preliminary peer-led workshop in a Malaysian tertiary institution

Article References: Lee, S.-K., Hoo, L. J., Koh Raj, R. Z., Yeo, I. K. L., Beh, Y. W., Ibrahim, R., Liew, K. B., Chew, Y.-L., Tan, E. S. S., & Chua, A.-L. (2026). Knowledge, willingness, and self-efficacy in CPR: A two-phase study of prevalence and preliminary peer-led workshop in a Malaysian tertiary institution. PLOS One, 21(10), e0360510. https://doi.org/10.1371/journal.pone.0360510

Image Credits: AI Generated

DOI: 10.1371/journal.pone.0360510

Keywords: cardiopulmonary resuscitation, CPR training, peer-led workshop, self-efficacy, out-of-hospital cardiac arrest, university students, Malaysia, automated external defibrillator, bystander response, public health, health education, PLOS One

The research team, led by Špela Metličar of the Medical Dispatch Centre Maribor at University Clinical Centre Ljubljana together with collaborators in Denmark, Slovenia, and the United Kingdom, set out to probe a surprisingly basic question. Guidelines from the International Liaison Committee on Resuscitation and the European Resuscitation Council call for compressions 5 to 6 centimeters deep at a rate of 100 to 120 per minute, with full chest recoil and minimal interruptions. The QCPR system condenses these parameters, along with hand position, recoil, and compression fraction, into a single percentage score from 0 to 100. Yet the exact mathematical formula behind that score is proprietary and unpublished, which means educators and researchers cannot independently verify how faithfully the composite number tracks guideline compliance. The team decided to test it directly, using a machine instead of a human rescuer to eliminate the usual noise of human performance.

The experimental setup was elegantly simple. A brand-new Resusci Anne QCPR manikin was placed on the floor and connected to a Corpuls mechanical chest compression device, which holds its piston in a fixed position over the compression point. That standardization matters: by using a machine, the researchers locked in perfect hand position, complete recoil, and an uninterrupted compression fraction, isolating depth and rate as the only variables. They then systematically swept through every combination of compression depth from 2.0 to 6.0 centimeters, in half-centimeter steps, and compression rates from 80 to 120 per minute, in increments of five. Each two-minute compression epoch was repeated with three interchangeable chest springs rated at 30, 50, and 60 kilograms, simulating chests of different stiffness. In total, 243 individual measurements were recorded through the SkillReporter for Tablet application.

The results reveal a scoring system dominated almost entirely by depth. At compressions of just 2.0 to 2.5 centimeters, QCPR scores were a flat zero percent regardless of rate or spring. Scores crept up at 3.0 centimeters, ranging from 10 to 18 percent, and climbed further at 3.5 centimeters, reaching 31 to 51 percent. The most volatile region was 4.0 to 4.5 centimeters, where scores swung dramatically with both rate and spring resistance; at 4.5 centimeters, scores ranged from 49 to 99 percent, with most exceeding 80. From 5.0 centimeters onward, scores were consistently high, between 57 and 100 percent, and became nearly independent of compression rate. In other words, the algorithm rewards pushing deep and largely stops caring about much else once you do.

The spring resistance findings are perhaps the most unsettling. Even with identical preset depth and rate settings, swapping the chest spring changed QCPR scores by up to 18 percent, observed at 4.5 centimeters of depth and rates of 80 and 85 compressions per minute. Differences of 8 to 11 percent appeared at other depths, and even at 5.5 and 6.0 centimeters, where scores approached the maximum, spring-related gaps of up to 4 percent persisted. The mechanism remains uncertain. Because the scoring algorithm is closed, the authors cannot determine whether different spring stiffnesses alter the compression waveform, the recoil dynamics, mechanical oscillation, or the response of the sensors themselves, or whether force-sensitive inputs feed into the score. What is clear is that a difference of this magnitude can flip a learner across a competency threshold, meaning two trainees delivering mechanically identical compressions could receive different verdicts depending on which manikin chest they happened to practice on.

To quantify how well the score maps onto actual guidelines, the team analyzed agreement between the manufacturer’s threshold of 75 percent, the cutoff for an Advanced CPR Performer, and truly guideline-compliant compression epochs, defined as 5 to 6 centimeters deep at 100 to 120 per minute. Of the 243 epochs, only 45, or 18.5 percent, met the guideline definition. The 75 percent QCPR threshold caught every single guideline-compliant epoch, a sensitivity of 100 percent, but its specificity was just 70.2 percent and its positive predictive value a sobering 43.3 percent. Cohen’s kappa, a measure of agreement beyond chance, came in at 0.47, indicating only moderate agreement. Sensitivity analyses at thresholds of 70 and 80 percent told the same story. Put plainly, more than half of the epochs earning a passing grade were delivered at depths or rates outside the recommended ranges.

The implications ripple outward from the simulation lab. In a classroom, a trainee who compresses too shallowly but at a favorable rate might see a respectable score and assume their technique is sound, receiving positive reinforcement precisely when correction is needed. An instructor relying on the composite number might miss the specific parameter that is failing. In certification contexts, a learner could be deemed ready to perform guideline-compliant CPR when their actual compressions would fall short in a real cardiac arrest. The authors are careful to note that manikin findings cannot be extrapolated directly to patient outcomes, but the educational stakes are hard to overstate: feedback systems exist precisely to shape behavior, and a score that diverges from the target behavior risks shaping the wrong one.

There is also a clinical dimension the study could only partially explore. The mechanical device’s operational limits capped testing at 6.0 centimeters, so the researchers could not determine whether the QCPR system penalizes excessively deep compressions at all. This matters because a major registry-based study published in JAMA Cardiology found the highest survival at compression depths of 4.5 to 5.0 centimeters and rates of 100 to 110 per minute, with outcomes declining on both sides of that sweet spot. If the scoring algorithm does not punish depth beyond 6 centimeters, it may overemphasize deep compressions and tolerate broader rate ranges than clinical evidence supports, potentially nudging trainees toward the very compressions associated with injury risk in patients.

The authors’ prescription is refreshingly straightforward. Rather than layering more adjustments onto an opaque composite score, future feedback systems should prioritize transparent, guideline-based reporting: the percentage of compressions with guideline-compliant depth, guideline-compliant rate, complete recoil, and overall compliance. This aligns with the Resuscitation Education Utstein consensus recommendations for uniform reporting in resuscitation research. Some researchers have proposed open-access, AI-driven scoring models trained on large real-world datasets as an alternative to closed proprietary algorithms, and the authors see room for such innovations, but only as complements to, never replacements for, guideline-anchored metrics. Until scoring systems are adjusted for or proven independent of manikin chest stiffness, they argue, spring resistance should always be reported, and QCPR scores should be read alongside absolute depth and rate values.

The study has limits worth keeping in view. Each depth, rate, and spring combination was tested only once, though the mechanical compressor minimized variability, and the preset device settings were not independently verified by the scoring system itself. The researchers did not measure compression force or the full waveform, so they cannot say whether score differences arose from compression dynamics, sensor behavior, or the hidden algorithm. Only continuous compressions were tested, a single manikin was used, and unit-specific calibration effects cannot be excluded, although the manikin was new and had received less than 10 percent of the roughly 500,000 compressions that trigger manufacturer-recommended component replacement. The complete dataset and R analysis code are publicly available on Zenodo, an openness that itself models the transparency the authors are calling for. For the millions of trainees who will face a glowing tablet this year, the message is clear: a high CPR score is a signal, not a guarantee, and the numbers beneath the number still matter most.

Subject of Research: Validation of the QCPR chest compression feedback scoring system against guideline-compliant CPR parameters in a manikin model

Article Title: Association of Chest Compression Depth, Rate, and Spring Resistance with “Quality CardioPulmonary Resuscitation” (QCPR) Scores in a Manikin Model

Article References: Metličar, Š., Lauridsen, K. G., Štiglic, G., & Fijačko, N. (2026). Association of Chest Compression Depth, Rate, and Spring Resistance with “Quality CardioPulmonary Resuscitation” (QCPR) Scores in a Manikin Model. Journal of Medical Systems, 50(1), Article 142. https://doi.org/10.1007/s10916-026-02469-z

Image Credits: AI Generated

DOI: 10.1007/s10916-026-02469-z

Keywords: cardiopulmonary resuscitation, chest compressions, QCPR score, feedback system, compression depth, compression rate, chest stiffness, resuscitation training, manikin study, CPR guidelines, Laerdal, simulation

The research, published in BMC Pediatrics by a team at the Postgraduate Institute of Medical Education and Research in Chandigarh, set out to answer a deceptively simple question: does CRM performance in pediatric healthcare providers change depending on how long ago they completed their ALS training? The question matters because certification cycles around the world, governed by bodies such as the American Heart Association and the European Resuscitation Council, typically run on two-year renewals, an interval chosen largely by convention rather than by hard evidence about how skills decay. If performance eroded steadily with time, shorter recertification cycles might be justified. If it did not, the problem would lie deeper than timing, in the very structure of how these courses teach.

To find out, the investigators recruited 99 ALS-certified participants at their quaternary care center, a cohort of 86 pediatric residents and 13 nurses. Participants were stratified into two groups: Group A, comprising 42 providers assessed less than six months after their ALS course, and Group B, comprising 57 providers assessed more than a year out. Each participant took the team leader’s seat in high-fidelity pediatric cardiac arrest scenarios built around three of the most demanding rhythm disturbances in pediatric medicine: ventricular tachycardia, ventricular fibrillation, and supraventricular tachycardia. High-fidelity manikins allowed the scenarios to respond dynamically to interventions, reproducing the cognitive load of a genuine in-hospital cardiac arrest without placing a child at risk.

The methodological rigor of the assessment is what gives the findings their weight. Every scenario was video recorded, and the recordings were scored independently using two validated instruments. Team leader performance was evaluated with the Anaesthetists’ Non-Technical Skills framework, a behavioral marker system originally developed for anesthesia that rates categories such as situation awareness, decision making, task management, and team working. Team member performance was scored with the Mayo High Performance Teamwork Scale, which captures behaviors like role clarity, information sharing, and closed-loop communication. Inter-rater reliability was strong, with intraclass correlation coefficients of 0.83 for the ANTS framework and 0.79 for the teamwork scale, indicating that different assessors watching the same videos reached substantially similar judgments.

The headline result is a null finding with significant implications. Team leader performance, measured by the ANTS framework, showed no statistically significant differences between providers fresh from training and those more than a year out. Team member performance on the Mayo scale was largely comparable as well. The one nuance emerged on univariate analysis, where the recently trained Group A actually performed slightly better on two specific dimensions: role clarity, demonstrated in 74.1 percent of assessments versus 46.1 percent in the later group, and clarity of communication, at 77.7 percent versus 48.7 percent, with p values of 0.04 and 0.02 respectively. Yet these differences were modest, confined to single domains, and the groups were not perfectly matched at baseline, since Group B participants were older and carried greater prior resuscitation experience, factors that could cut in either direction.

More striking than the between-group comparisons is what the study revealed about absolute performance. Across both groups, fundamental CRM behaviors appeared infrequently. Team members introduced themselves in only 35.7 percent of Group A scenarios and 15.7 percent of Group B scenarios, a difference that did not reach statistical significance. Role assignment by the leader occurred in just half of the recent-training group and 36.8 percent of the later group. Closed-loop communication and checklist use, two behaviors repeatedly linked to error reduction in high-stakes medicine, showed no meaningful differences and no encouraging rates in either arm. In other words, the problem was not that skills decayed after training; it was that many of these skills appeared never to have been robustly acquired in the first place.

This interpretation carries the study’s central message. The authors conclude that standard ALS training, whatever its strengths in teaching the technical algorithms of pediatric resuscitation, has inherent limitations in building non-technical competence. That conclusion aligns with a broader body of human-factors research showing that technical knowledge and team performance are separable constructs: a clinician can recite the pulseless ventricular tachycardia algorithm flawlessly and still fail to distribute workload, share situational awareness, or invite input from a nurse who has spotted a dislodged lead. Simulation science has argued for decades that these behaviors must be deliberately practiced, observed, and debriefed, not merely mentioned in a lecture hall between rhythm recognition drills.

The setting of the study adds a crucial dimension. Conducted at a quaternary care pediatric center in India, the work addresses a conspicuous evidence gap, since most CRM research originates in high-income countries with mature simulation infrastructures and different staffing realities. In low- and middle-income settings, where pediatric intensive care units may face higher patient volumes, fewer trained staff per bed, and limited access to recurring simulation programs, the stakes of suboptimal teamwork are correspondingly higher. The authors explicitly frame their findings around this context, suggesting that structured, simulation-based reinforcement strategies may be needed to sustain CRM development where formal recertification alone cannot do the job.

For hospital educators and resuscitation committees, the practical takeaways are concrete. First, the timing of recertification is probably the wrong lever to pull if the goal is better teamwork; a provider at month five and a provider at month eighteen performed similarly. Second, in-situ simulation programs, brief scenario rehearsals conducted in the actual clinical environment, offer a plausible mechanism for embedding role assignment, introductions, and closed-loop communication as habits rather than test-day performances. Third, the validated scoring tools used here, ANTS and the Mayo scale, give institutions a ready-made language for measuring progress, and the high inter-rater reliability reported in this study suggests such measurement can be dependable even outside specialist simulation centers.

The study is not without limits, and the authors are careful about what their data can support. The cross-sectional design captures a snapshot rather than tracking individuals over time, and the baseline differences in age and resuscitation experience between groups complicate any causal reading of the small advantages seen in the recently trained cohort. The sample, drawn from a single quaternary center, may not generalize to smaller hospitals. Yet the consistency of the null result across two validated instruments, and the low absolute rates of critical behaviors, make the core conclusion difficult to dismiss. As pediatric resuscitation science matures, the question is shifting from whether clinicians hold a certificate to whether they can actually lead, communicate, and coordinate when a child’s life hangs in the balance. This study suggests that answering that question will require more than a renewal date on a card; it will require deliberate, repeated, simulation-based practice that treats teamwork as a clinical skill in its own right.

Subject of Research: Crisis resource management performance and time since Advanced Life Support training in pediatric healthcare providers

Article Title: Association between time since advanced life support training and crisis resource management performance in pediatric healthcare providers: a simulation-based study

Article References: Awasthi, P., Takia, L., Aramanadka, R., Bhalala, U., & Bansal, A. (2026). Association between time since advanced life support training and crisis resource management performance in pediatric healthcare providers: a simulation-based study. BMC Pediatrics. https://doi.org/10.1186/s12887-026-07758-7

Image Credits: AI Generated

DOI: 10.1186/s12887-026-07758-7

Keywords: pediatrics, cardiopulmonary resuscitation, crisis resource management, advanced life support, simulation training, teamwork, clinical competence, non-technical skills, medical education, cardiac arrest, LMIC healthcare, BMC Pediatrics

The choice of population was deliberate. Students training to become teachers occupy a unique position in the public health landscape: they are future educators who can disseminate life-saving knowledge through schools and communities, multiplying the impact of any single training program. By assessing their preparedness, the researchers hoped to gauge the potential for a self-renewing generation of first responders in a country where sudden cardiac arrest remains one of the most urgent and under-recognized public health crises. The study, published in the Journal of Emergency and Disaster Medicine, was conducted between April and May 2024 using a convenience sample with a calculated minimum requirement of 128 participants, ultimately enrolling 134 students with no missing data.

Demographically, the cohort was dominated by 23-year-olds, who made up 41 percent of respondents, followed by 22-, 24-, and 25-year-olds. Slightly more than half of the participants, 56.7 percent, were male, and nearly two-thirds were postgraduate students. Data were collected through a structured, self-administered questionnaire covering demographic variables, CPR awareness, self-rated ability, prior training, and barriers to intervention. Researchers scored five domains: confidence in performing specific skills such as checking responsiveness, assessing breathing, delivering chest compressions, using an automated external defibrillator, and providing wound care; recognition of situations indicating CPR, including unconsciousness, drowning, burns, and choking; correct response actions; symptom recognition during resuscitation; and overall perceptions of CPR’s importance.

The psychometric properties of the instrument were examined in detail. The confidence domain showed strong internal consistency, with a Cronbach’s alpha of 0.808 across its five items, while the indication, support, and symptom recognition domains demonstrated moderate reliability suitable for exploratory research, with alphas of 0.640, 0.649, and 0.630 respectively. The perception domain, by contrast, showed low internal consistency at 0.201, prompting the authors to analyze those items individually and interpret them cautiously. The overall instrument achieved an acceptable alpha of 0.645. Descriptive statistics revealed that confidence was the most variable measure, ranging from 0 to 17 with a mean of 9.22 and a standard deviation of 3.70, while perception scores were the most tightly clustered.

Attitudes toward CPR were overwhelmingly positive. A striking 70.1 percent of participants considered first aid and CPR more important in light of recent health emergencies, and 71.6 percent strongly agreed with the importance of these skills overall. Yet actual exposure was limited: 20.1 percent had never witnessed a first aid or CPR event, only 9 percent had ever provided CPR, 40.3 percent reported lacking training, and 23.9 percent cited fear of infection as a deterrent. When asked why they might hesitate, 44 percent pointed to safety protocols, 25.4 percent to needed training modifications, and only 17.9 percent reported no hesitation at all. Confidence itself was uneven, with 29.1 percent very confident in performing CPR but 11.9 percent reporting no confidence at all in basic first aid.

The statistical core of the study produced its most important insight. One-way analysis of variance showed a significant relationship between exposure to real first aid or CPR events and total preparedness scores, with F equal to 3.466 and a p-value of 0.010. Students who had actually provided CPR scored dramatically higher, averaging 27.4 points against 20.4 for those with no prior exposure, a gap that dwarfed differences attributable to perception or self-reported barriers. Neither perceived impact of CPR on health emergencies nor reasons for hesitation showed significant score differences, suggesting that nothing substitutes for hands-on experience when it comes to building genuine readiness to act.

Gender emerged as a persistent fault line. Male students scored significantly higher than female students on overall CPR preparedness, with means of 23.8 versus 20.5 and a t-statistic of 3.319 with p equal to 0.002. Chi-square analysis reinforced the pattern, showing that 56.6 percent of males fell into the high-preparedness category compared with 36.2 percent of females, a difference that was statistically significant. In univariate logistic regression, sex was a significant predictor, with female students showing odds of high preparedness less than half those of their male counterparts. However, the association lost significance in the multivariable model, hinting that the disparity may stem from differences in training exposure and experience rather than inherent capability, echoing prior research showing that women often underestimate their skills despite performing comparably.

Age and training status also mattered. Participants aged 22 showed a disproportionate concentration in the low-preparedness group, and trained students were significantly more likely to demonstrate high preparedness, at 59.4 percent versus 35.4 percent for the untrained. Formal training showed a marginal positive association with high preparedness in the multivariable logistic regression, with an odds ratio of 2.21 and p equal to 0.051, while the overall model was statistically significant and passed the Hosmer–Lemeshow goodness-of-fit test. Notably, undergraduate students scored slightly higher than postgraduates, a marginally non-significant difference suggesting that academic progression alone does not translate into emergency readiness, and that practical skill-based education must be embedded deliberately within university life.

The barriers identified by the study extend beyond knowledge. Fear of causing harm, anxiety, and uncertainty have long been documented as psychological obstacles to bystander CPR, and the COVID-19 pandemic added infection risk to the calculus, particularly around mouth-to-mouth ventilation. International resuscitation bodies responded by promoting compression-only CPR and protective equipment, and evidence has since shown that trained laypersons can use automated external defibrillators safely and effectively within structured response systems. In India, cultural discomfort with physical contact with strangers and limited public awareness of the Good Samaritan law, which legally protects emergency helpers, compound the hesitation. The authors argue that training programs must therefore address emotional preparedness and confidence-building alongside technical instruction, using simulation-based learning and periodic refresher sessions to sustain competence over time.

The study’s authors conclude that universities should implement regular, hands-on CPR and first aid programs paired with targeted interventions to dismantle psychological barriers, with particular attention to groups reporting lower confidence. They envision Varanasi, with its massive student population, becoming a model city for bystander CPR readiness, generating scalable lessons for cardiac arrest response across urban and semi-urban India. The findings come with caveats: the cross-sectional design precludes causal claims, the convenience sample of education students from a single faculty limits generalizability, and self-reported questionnaires may not reflect actual CPR competency. Still, the central message is clear and actionable, aligning with expert calls to embed CPR and defibrillator training in schools and colleges nationwide. Communities with high bystander CPR rates see substantially better survival after out-of-hospital cardiac arrest, and young people, armed with practical experience rather than theory alone, are best positioned to become the life-saving bridge between collapse and definitive care.

Subject of Research: First aid and CPR confidence, training gaps, and preparedness among university students in Varanasi, India

Article Title: The state of first aid & cardio-pulmonary resuscitation: assessment of confidence, support, and perceptions in the wake of a health emergency among students of Banaras Hindu University, Varanasi

Article References: Verma, A., Raj, D., Kumar, S., & Yadav, A. S. (2026). The state of first aid & cardio-pulmonary resuscitation: assessment of confidence, support, and perceptions in the wake of a health emergency among students of Banaras Hindu University, Varanasi. Journal of Emergency and Disaster Medicine, 2(1), Article 13. https://doi.org/10.1007/s44467-026-00016-x

Image Credits: AI Generated

DOI: 10.1007/s44467-026-00016-x

Keywords: cardiopulmonary resuscitation, first aid, bystander CPR, cardiac arrest, health emergency preparedness, CPR training, university students, gender disparity, basic life support, COVID-19, India, Banaras Hindu University

The rationale for studying resuscitation readiness in dental settings is more compelling than it might first appear. Cardiovascular disease remains the leading cause of death in Iran, accounting for nearly half of all fatalities, with ischemic heart disease alone responsible for roughly a quarter of deaths. Although medical emergencies in dental clinics are uncommon, they do occur, sometimes among patients, sometimes among dentists and staff, and sometimes among accompanying companions. Previous research has quantified the risk: in the United States, the annual incidence of cardiac arrest in medical and dental practices has been estimated to range between 0.008 and 1 per 133 practitioners, while the United Kingdom reports an incidence of 0.002 per dentist per year. In Germany, 57 percent of dentists report encountering at least three medical emergencies annually. These figures, while modest, underscore a simple truth: dental offices are healthcare environments, and emergencies can and do happen there.

What distinguishes the new study from earlier surveys is its scope. Most prior investigations focused exclusively on dentists, overlooking the assistants and office secretaries who might be the first to recognize a collapse, call for help, or begin chest compressions. Because all members of a dental team are healthcare providers who should be capable of performing basic life support, the researchers designed a cross-sectional survey covering the entire team. Between October 2021 and April 2022, they sampled clinics and offices across Isfahan, the largest city in central Iran, using stratified simple random sampling that divided practices by type, public versus private, and by geographic district, then selected clinics at random within each stratum to minimize selection bias.

The instrument itself was built for rigor. A 27-item structured questionnaire was developed by emergency medicine faculty, each with more than a decade of experience running CPR workshops, and aligned with the American Heart Association’s 2020 guidelines. It covered three domains: demographic information, nine items of theoretical and practical CPR knowledge, and fourteen items on attitude and experience, including prior exposure to cardiac arrest, workshop participation, and willingness to pursue future training. A pilot study of 20 dentists, excluded from the main analysis, confirmed clarity and reliability, with Cronbach’s alpha values of 0.82 for the knowledge domain and 0.79 for the attitude domain, both within the accepted range for psychometric consistency. Ethical approval came from Isfahan University of Medical Sciences, and written informed consent was obtained from every participant.

The findings were stark. Of 201 valid responses, including 101 dentists representing an 81 percent response rate among those approached, the median CPR knowledge score was just 3 out of a possible 9, with a mean of 2.61 and a standard deviation of 1.75, and the distribution of scores was positively skewed, clustering heavily at the low end. Participants had a mean age of 31.75 years, and 62.2 percent were female. Only five participants, 2.5 percent of the entire sample, had ever encountered a cardiac arrest in dental practice, and just eleven individuals, 5.5 percent, reported having personally performed CPR. Perhaps most striking, only 12.9 percent had attended a CPR workshop in the previous two years, and a mere 13.4 percent considered themselves competent to perform resuscitation at all.

Buried within the data was a counterintuitive and potentially important pattern: knowledge declined with age and experience. The analysis revealed a significant negative correlation between dentists’ age and CPR knowledge scores (r = −0.184, P = 0.009) and between years of professional experience and knowledge (r = −0.231, P = 0.020). This mirrors a finding from Kuwait, where younger dentists and those with fewer than ten years of experience outperformed their senior colleagues, but it contradicts studies from India and among oral and maxillofacial surgeons in which experienced practitioners knew more. The authors propose a plausible explanation: most participants in the current study had not received recent refresher training, so whatever knowledge older dentists once acquired has simply eroded. They also caution that recency of formal education may confound the relationship, since younger graduates may have been trained under more current guidelines, and they recommend that future studies control for graduation year and timing of the last CPR course.

The strongest positive signal in the data came from training itself. Dentists who had participated in CPR workshops within the past two years scored significantly higher on the knowledge assessment than those who had not (P = 0.007), a result consistent with findings from Iran and Kuwait, and one that aligns with the well-documented kinetics of skill decay: theoretical knowledge declines markedly within about 12 months, and practical competence deteriorates substantially after 18 months without reinforcement. Encouragingly, the appetite for remediation is already there. A striking 84.1 percent of respondents said they wanted to attend future CPR workshops, and among dentists specifically the figure exceeded 88 percent. Gender, meanwhile, made no measurable difference in knowledge scores (P = 0.124).

The study’s limitations are acknowledged candidly by its authors. Competence was measured only through a self-administered questionnaire, capturing theoretical knowledge rather than hands-on skill, and no simulation-based practical testing was performed. The cross-sectional design, the single-city setting, and the sample of 201 participants restrict causal inference and generalizability, and self-reported data are always vulnerable to recall and social desirability bias. Non-response was analyzed as a potential source of bias and appeared minimal, with no significant differences between respondents and the 19 percent who declined, most commonly citing lack of time or lack of interest. Still, the convergence of these findings with an international literature spanning Brazil, India, Turkey, Kuwait, and earlier Iranian surveys, which found, for example, that only 37 percent of Iranian dentists in a 2007 study possessed adequate CPR knowledge, strengthens the conclusion that preparedness deficits in dentistry are systemic rather than local.

The implications reach beyond clinical performance into patient safety and law. Previous reports have documented deaths from cardiopulmonary arrest occurring in dental settings, and inadequate resuscitation capability carries potential legal consequences for practitioners, alongside the more intangible costs of insecurity among dental teams and eroded patient trust. The authors argue that a single CPR course, however well taught, is not enough, and they call for mandatory, periodic CPR training woven into both undergraduate dental curricula and continuing professional education, explicitly extending the requirement beyond dentists to assistants and office staff. Given the strong expressed willingness of the workforce to train, they note, structured recurrent programs are not only medically necessary but entirely feasible. In a field where minutes decide survival, the study’s central message is hard to ignore: readiness must be renewed, not assumed, and the whole dental team, not just the person holding the drill, must be ready to act.

Subject of Research: Knowledge and attitudes toward cardiopulmonary resuscitation among dental teams in Isfahan, Iran

Article Title: Life-saving skills in dentistry: knowledge and attitude toward cardiopulmonary resuscitation among dental teams

Article References: Heydari, F., Nasr Isfahani, M., Masoumi, B., Esmailian, M., Khosravi, H., & Nasr-Esfahani, M. (2026). Life-saving skills in dentistry: knowledge and attitude toward cardiopulmonary resuscitation among dental teams. Journal of Emergency and Disaster Medicine, 2(1), Article 15. https://doi.org/10.1007/s44467-026-00018-9

Image Credits: AI Generated

DOI: 10.1007/s44467-026-00018-9

Keywords: cardiopulmonary resuscitation, CPR, basic life support, dentistry, dental teams, cardiac arrest, emergency preparedness, medical emergencies, dental education, Iran, American Heart Association guidelines, continuing professional development