Theory–practice discrepancy in cardiopulmonary resuscitation performance: a multi-centre evaluation of emergency healthcare providers in China

Despite the widespread implementation of standardised cardiopulmonary resuscitation (CPR) training programmes, the actual competency of emergency healthcare providers in China has not been established. This study evaluated the alignment between theoretical knowledge and practical CPR skills among frontline clinicians. In total, 586 physicians and nurses of a hospital emergency department were evaluated. Theoretical knowledge was assessed via questionnaire, while practical skills were evaluated by two certified basic life support (BLS) instructors using standardised checklists and manikin-based simulation with audiovisual feedback. Key outcomes included adherence to guidelines and quantitative CPR quality metrics. Participants were predominantly bachelor’s degree holders (480/586; 81.91%), nurses (379/586; 64.68%) and working in tertiary hospitals (436/586; 74.40%). Furthermore, 507 (86.52%) underwent CPR training within 6 months. In the theoretical assessments, over 88% correctly identified key steps, such as the compression landmark, compression rate and compression depth. However, practical evaluation by BLS instructors revealed lower proficiency in correct pulse location (383/586; 65.36%), use of a firm surface (240/586; 40.96%), recommended compression depth (250/586; 42.66%) and compression rate (350/586; 57.17%). The mean operation score awarded by BLS instructors was 24.89 ± 2.71. Audiovisual feedback revealed a mean compression accuracy of 17%, compression depth compliance of 34%, rate compliance of 55% and complete recoil of 77%. Additionally, subgroup analysis showed that physicians with a body weight of 50–60 kg had superior performance compared to other weight in compression depth, compression rate, and chest recoil. Although theoretical knowledge of CPR among Chinese emergency healthcare professionals is generally strong, practical execution, especially in compression, remains insufficient, highlighting the need to improve simulation-based training.