# Predictors, barriers and facilitators of bystander interventions in out of hospital cardiac arrest: a cross-sectional study from the UAE

## TL;DR

This study explores what influences people in the UAE to help during out-of-hospital cardiac arrests, finding that training and confidence are key factors.

## Contribution

The study identifies demographic and cultural factors affecting bystander CPR and AED use in the UAE, offering insights for targeted public health strategies.

## Key findings

- CPR and AED training significantly increase willingness to intervene during OHCA.
- Women are more likely to perform CPR on young females, while men assist young males.
- Lack of skill, legal concerns, and low confidence are the main barriers to bystander response.

## Abstract

Out-of-Hospital Cardiac Arrest (OHCA) has low survival rates, especially in the Middle East, where bystander response in the UAE remains limited. Early cardiopulmonary resuscitation (CPR) and automated external defibrillator (AED) use improve outcomes. This study assessed public willingness to intervene during OHCA and identified key predictors, barriers, and facilitators.

A cross-sectional survey of 1,020 UAE adults (18+) was conducted using a 35-item, expert-validated questionnaire. Participants were recruited via convenience and snowball sampling, both online and in person. Descriptive statistics and binary logistic regression were conducted to identify factors associated with willingness to intervene.

Responses were predominantly from younger, educated individuals, with South Asians underrepresented relative to the overall UAE population. CPR and AED training were reported by 52 and 34% of participants, respectively. Training was lower among females, South Asians, and those with lower educational attainment. Training correlated with greater confidence and positive attitudes; however, both trained and untrained individuals reported similar cultural and legal barriers to bystander response. Approximately 60.6% of survey responders were willing to perform CPR, while 46.8% were willing to use an AED. Women were more likely to perform CPR on young females, while men were more likely to assist young males. Prior training emerged as the strongest predictor of willingness, with repeated training further increasing willingness alongside being a healthcare provider, confidence in recognizing cardiac arrest, and positive attitudes toward bystander intervention. The main barriers included a lack of skill, legal concerns, and low confidence, while key facilitators were dispatcher guidance and legal protection. Among trained but unwilling participants, more than half cited low confidence as a barrier to performing CPR and using an AED.

Addressing observed demographic, regional, and cultural disparities in training and willingness through targeted public health strategies could support improved bystander response in the UAE.