Knowledge-based Basic Life Support competency and associated factors among healthcare professionals across different hospital levels: a multicenter cross-sectional study

Abstract

Background Timely and effective Basic Life Support (BLS) is essential for improving survival after cardiac arrest. However, knowledge-based BLS competency among healthcare professionals (HCPs) working at different hospital levels has not been sufficiently characterized. This multicenter cross-sectional study aimed to assess knowledge-based BLS competency among HCPs and identify factors associated with high knowledge-based BLS competency. Methods From March 2025 to March 2026, a cross-sectional survey of 2,017 HCPs (physicians, nurses, technicians, and other clinical staffs) was carried out in tertiary, secondary, and primary hospitals of Chengdu, Sichuan Province in urban areas. Demographic and professional characteristics, CPR training history, and BLS knowledge were assessed using an electronic questionnaire developed by the research team with reference to international BLS guidelines. The internal consistency of the questionnaire in the analytical sample was acceptable, with a Cronbach’s alpha of 0.701. Descriptive statistics, chi-square tests, and multivariable regression analyzes were used to identify factors associated with knowledge-based BLS competency. A total BLS knowledge score of ≥80 points was classified as high knowledge-based BLS competency. Item-level accuracy and domain-specific knowledge scores were also calculated. Results Overall, 40.26% of participants met the criterion for high knowledge-based BLS competency. In the unadjusted analyzes, professional role, hospital level, and educational level were significantly associated with high knowledge-based BLS competency. In the multivariable logistic regression model, physicians (OR = 3.01, 95% CI: 1.58–5.74) and nurses (OR = 2.46, 95% CI: 1.31–4.63) had significantly higher odds of achieving high knowledge-based BLS competency than technicians and other clinical staff. HCPs working in tertiary hospitals also had higher odds of achieving high knowledge-based BLS competency than those working in primary hospitals (OR = 1.48, 95% CI: 1.09–2.00). Core CPR knowledge had the highest domain-specific accuracy (87.43%), whereas defibrillation-related knowledge had the lowest accuracy (59.06%). Conclusion Knowledge-based BLS competency among the surveyed HCPs working in the participating hospitals remained suboptimal, with particularly notable knowledge gaps in defibrillation-related topics. Professional role, hospital level, and educational background were associated with knowledge-based BLS competency. These findings support the development of standardized, regular, and targeted CPR education, particularly for lower-level hospitals and professional groups with relatively lower knowledge-based BLS competency.