Assessment of knowledge and awareness of cardiopulmonary resuscitation and heart attack symptoms amongst medical students in Syria - a cross-sectional study

BACKGROUND: Cardiovascular diseases, especially acute myocardial infarction (AMI), cause a major global health burden and are also highly prevalent in Syria. Early recognition of myocardial infarction (MI) symptoms and timely delivery of high-quality basic life support are core competencies expected of graduating medical students, yet evidence on these competencies in Syria remains limited. METHODS: We conducted a confidential, online cross-sectional survey of undergraduate medical students from nine Syrian medical schools between 13 and 30 June 2025, using a Google Forms questionnaire that required sign-in to restrict submissions to one response per participant. CPR knowledge was assessed using an 11-item guideline-mapped composite score (range 0–11), and MI symptom knowledge using an 18-item score (range 0–18), awarding 1 point per correct response. RESULTS: Amongst 500 respondents (54.0% female), the mean CPR knowledge score was 5.03 (SD 2.50) out of 11 and the mean MI knowledge score was 11.50 (SD 2.67) out of 18. The largest CPR knowledge gaps involved time-critical defibrillation concepts, including when to use an AED (18.6% correct), the recommended reassessment interval (36.8%), and monophasic defibrillation energy (35.4%). In adjusted analyses, CPR scores were higher amongst clinical-year students (adjusted B 1.66; 95% CI 1.10 to 2.22) and amongst students in public versus private universities (adjusted B 1.07; 95% CI 0.62 to 1.51). CONCLUSIONS: Syrian medical students demonstrated important gaps in guideline-critical CPR knowledge and variable recognition of MI symptoms. Embedding structured BLS/AED training early in the curriculum, reinforced through simulation and competency-based assessment, may address these deficits.