Barriers to lay rescuer cardiopulmonary resuscitation in Brazil: a nationwide web-based survey

Background Early lay rescuer cardiopulmonary resuscitation (LCPR) is a key determinant of survival and favorable neurological outcomes after out-of-hospital cardiac arrest. Despite strong evidence supporting its effectiveness, LCPR rates remain low, particularly in low- and middle-income countries. This study aimed to identify barriers that prevent Brazilian laypeople from performing CPR and to evaluate factors independently associated with willingness to act. Methods A prospective cross-sectional nationwide web-based survey was conducted in Brazil between January 28 and February 21, 2021. Adults aged ≥18 years who were Portuguese speakers were eligible. Healthcare professionals and prehospital emergency care providers were excluded. The survey assessed sociodemographic characteristics, CPR knowledge and prior exposure, perceived preparedness (0–10 scale), and intended actions in a hypothetical cardiac arrest scenario. Willingness to perform CPR was defined by inclusion of chest compressions in open-ended responses. Associations were analyzed using chi-square or Fisher’s exact tests, Mann–Whitney U test, and multivariable logistic regression. Odds ratios (OR) and adjusted odds ratios (aOR) with 95% confidence intervals (95% CI) were calculated. Results Of 616 completed questionnaires, 512 were included in the analysis. Overall, 180 participants (35.2%) reported willingness to perform CPR. Participants willing to perform CPR reported significantly higher perceived preparedness scores compared with those unwilling to act (median 5.1 vs 2.7; p<0.01). In multivariable logistic regression analysis, previous CPR training (aOR 3.43; 95% CI 2.17–5.42; p<0.001), previous exposure to CPR situations (aOR 1.68; 95% CI 1.12–2.51; p=0.012), and prior knowledge about CPR (aOR 1.97; 95% CI 1.29–3.01; p=0.002) remained independently associated with willingness to perform CPR. The most frequently reported barriers among participants unwilling to act were lack of knowledge (58.1%) and fear (17.1%). Participants unwilling to perform CPR more often reported feelings of guilt and sadness. Conclusion Lack of CPR knowledge and prior training were the main barriers to lay rescuer CPR in Brazil and were independently associated with lower willingness to perform CPR. Expanding population-based CPR education and preparedness strategies may help reduce these barriers and improve lay rescuer response.