Basic Life Support Knowledge Retention Among Instructors and Trained Providers in Three North African Countries

Abstract Background: Basic life support (BLS) training is crucial for improving survival outcomes in out-of-hospital cardiac arrest. However, knowledge retention among providers and instructors remains a concern, especially in low-resource settings. This study examines differences in BLS knowledge retention between trained providers and BLS instructors in three North African countries. Materials and Methods: This multi-center, cross-sectional study included adult BLS instructors and providers who were trained during the last 2 years prior to enrollment in the study. Participants were recruited from Sudan, Egypt, and Tunisia. A structured electronic questionnaire, based on the 2021 European Resuscitation Council BLS guidelines, assessed knowledge retention across the five BLS key components. Statistical analyses included chi-square tests for categorical comparisons and logistic regression to determine factors influencing knowledge retention. Results: The study included 837 participants (171 instructors and 666 trained providers). Instructors demonstrated significantly higher proficiency in airway management ( P = 0.001), correct chest compression depth ( P < 0.001), and overall cardiopulmonary resuscitation (CPR) knowledge ( P < 0.001). However, knowledge gaps existed in CPR termination protocols, with only 19.8% of providers and 11.1% of instructors correctly identifying when to stop resuscitation ( P = 0.008). Logistic regression identified higher education and prior CPR experience as key factors influencing knowledge retention. Conclusion: BLS instructors outperformed providers in key resuscitation skills, highlighting the need for continuous training and refresher courses. Addressing knowledge gaps in CPR termination and expanding BLS training to underrepresented populations could enhance survival outcomes in low-resource settings.