Hospital nurses’ knowledge of adult cardiopulmonary resuscitation: a systematic review

Background Hospital nurses are often among the first healthcare professionals to recognize in-hospital cardiac arrest, activate the emergency response system, and initiate cardiopulmonary resuscitation. Adequate and current knowledge is therefore essential for timely, guideline-based care. However, studies assessing nurses’ knowledge of adult cardiopulmonary resuscitation vary widely in populations, settings, assessment instruments, and criteria used to define adequate knowledge. This systematic review aimed to synthesize international evidence on hospital nurses’ objectively assessed knowledge of adult cardiopulmonary resuscitation in the context of in-hospital cardiac arrest. Methods A systematic review of observational studies was conducted and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 statement. PubMed, Embase, Scopus, Web of Science, CINAHL, LILACS Plus, PsycINFO and the Cochrane Central Register of Controlled Trials (CENTRAL) were searched on March 15, 2026, for studies published from January 1, 2010 onward, with no language restrictions. Eligible studies quantitatively assessed adult cardiopulmonary resuscitation knowledge among hospital nurses. Two reviewers independently performed study selection, data extraction, and methodological quality assessment. Methodological quality was assessed using the Joanna Briggs Institute Critical Appraisal Checklist for studies reporting prevalence data. Because of substantial variability in instruments, scoring systems, and competency thresholds, findings were synthesized narratively. Results Twenty-five studies involving 4,653 nurses from 17 countries were included. All included studies used cross-sectional designs. Knowledge assessment methods varied considerably, with instruments ranging from 7 to 32 items and covering general cardiopulmonary resuscitation, basic life support, advanced life support, or combined domains. Reporting of instrument validity and reliability was inconsistent. Competency thresholds ranged from approximately 50% to more than 85% of correct responses, while several studies used relative or study-specific classifications. Overall, hospital nurses’ knowledge was frequently reported as poor, insufficient, moderate, or average. This methodological variability precluded quantitative pooling and limited direct comparison across studies. Conclusions Hospital nurses’ knowledge of adult cardiopulmonary resuscitation was frequently incomplete or intermediate. Interpretation was limited by variability in assessment instruments, knowledge domains, and competency thresholds. These findings support regular training, periodic assessment, and standardized, validated, role-sensitive instruments to identify knowledge gaps and guide targeted education. Systematic review registration PROSPERO CRD420261351580. Clinical trial number Not applicable.