Members of the public have an essential role to play in the out-of-hospital cardiac arrest (OHCA) chain of survival by acting to call Emergency Medical Services (EMS), start cardiopulmonary resuscitation (CPR) and use a Public Access Defibrillator (PAD) to help save lives. In recent years, there has been a rise in bystander CPR rates across many worldwide EMS systems (Denmark,6.7. United States,8 Japan,9 Canada,10 South Korea.11) In England, the percentage of people sustaining an OHCA that was either unwitnessed or witnessed by a bystander and who received bystander CPR has risen from 55.2% in 2014 to 69.8% in 2019.12.13. In Scotland, this increased from 39.4% in 2011–2012 to 64.0% in 2018–2019.14

In the UK, as in many other countries, there has been a parallel rise in the proportion of people reporting they have trained in resuscitation skills. In 2014, 47% of people reported formal CPR skills training and by 2019 it was 62.2%.15.16. National initiatives are associated with increases in the numbers of people trained, which in turn is associated with increased bystander CPR rates and improved survival outcomes.6.17.

The COVID-19 pandemic appears to have increased the incidence of OHCA cases. In some places bystander CPR rates also appear to be reduced.18.19. National and international organisations have developed revised guidelines for performing CPR as safely as possible on OHCA patients during the pandemic to reduce the risk of the rescuer catching COVID-19 during a resuscitation attempt (such as favouring compression-only CPR with a cloth over the patients mouth rather than CPR with rescue breaths).22.23. However, little is known about the public’s knowledge of this guidance, how their attitudes to performing different resuscitation actions may have changed and reasons for any reluctance to do so during the pandemic. Public health messaging on social distancing may have contributed to increased fear about helping OHCA patients.24

Research to understand whether concerns about the COVID-19 pandemic have adversely affected gains in bystander CPR rates, including any changes in public attitudes to performing CPR is needed. It will inform stakeholders’ strategies to support recovery in the public’s confidence and likelihood of helping people who sustain an OHCA.

We conducted 4 short surveys of adults during the first wave of the pandemic in the UK (April – July 2020) and a longer survey in November 2020 to assess the UK public’s knowledge of revised resuscitation guidance and the impact of the COVID-19 pandemic on their attitudes to CPR and defibrillator use.

University of Lincoln, College of Social Science Research

Claire A. Hawkes, University of Warwick, Warwick Medical School

Inès Kander, University of Warwick, Warwick Medical School

Abraham Contreras, University of Warwick, Warwick Medical School

Chen Ji, University of Warwick, Warwick Medical School

Terry P. Brown, University of Warwick, Warwick Medical School

Scott Booth, University of Warwick, Warwick Medical School

A. Niroshan Siriwardena, University of Lincoln, School of Health and Social Care

Rachael T. Fothergill, London Ambulance Service NHS Trust

Julia Williams, South East Coast Ambulance Service NHS Foundation Trust

Nigel Rees, Swansea University, Institute of Life Science

Estelle Stephenson, British Heart Foundation

Gavin D. Perkins, University of Warwick, Warwick Medical School and University Hospitals Birmingham, Heartlands Hospital