A Scoping Review of Barriers and Facilitators to Bystander-Administered Cardiopulmonary Resuscitation

Out-of-hospital cardiac arrest (OHCA) is characterized by its sudden onset and high mortality, posing a major public health challenge worldwide[1]. As the critical first step in the “chain of survival,” bystander cardiopulmonary resuscitation (Bystander CPR) performed within the golden period can significantly improve patient outcomes, with survival rates increasing by 2-3 times[2]. Although the “Healthy China Action (2019-2030)” outlines the widespread promotion of first-aid knowledge, the bystander CPR rate for OHCA patients in China remains below 5%, far below the average levels observed in developed countries such as those in Europe and North America[3]. This situation highlights a significant gap between the widespread dissemination of first-aid knowledge and the actual performance of life-saving interventions, with a common phenomenon of “knowledge-behavior disconnection” among the public[4]. Existing studies have shown that the decision-making process of the first bystander is a complex psychological andbehavioral process influenced by multiple factors. These include the bystander’s personal first-aid skills and self-efficacy, as well as psychological fears of disease transmission, the social “bystander effect,” legal concerns (such as awareness of the liability exemption clause in the Civil Code), and the level of guidance provided by emergency dispatch systems (Dispatcher-assisted CPR)[5-6]. However, the evidence on these barriers and facilitators is scattered across various disciplines such as nursing, medicine, psychology, and law, with research perspectives often being narrow and lacking a systematic interdisciplinary integration. This makes it challenging to form a comprehensive evidence chain that can guide effective intervention strategies[7]. In response, this study aims to employ a scoping review methodology to systematically map and analyze the barriers and facilitators to bystander-administered CPR. The goal of this study is to construct a multidimensional analytical framework to identify research gaps, which will inform the development of targeted public first-aid training strategies, the improvement of legal protection for emergency responders, and the optimization of the social emergency response system. Ultimately, this will contribute to increasing the willingness and capacity of the Chinese public to perform life-saving interventions in emergency situations.