Feasibility of public CPR training kiosks to increase bystander resuscitation: a Monte Carlo simulation study

Survival after out-of-hospital cardiac arrest (OHCA) depends on immediate bystander cardiopulmonary resuscitation (CPR), yet rates range from 42 % to 70 % in Canada. Traditional CPR education faces barriers of access, retention, and scalability. Public CPR kiosks are a novel alternative, but their potential population-level impact is uncertain.

We developed a Monte Carlo and queueing-based simulation model to estimate the effect of CPR kiosks on bystander CPR in Toronto, Canada. The model incorporated venue-specific passer volumes, funnel attrition (approach, engagement, practice, competence), demographic witness likelihood, post-training willingness to act, and skill retention. Outcomes included competent trainees, witness-weighted trainees, additional CPR attempts, change in citywide bystander CPR, lives saved, and cost-effectiveness. We modeled deployment of 30 kiosks across four venue types-mega-volume public spaces (n = 6), hospitals (n = 8), large commercial venues (n = 8), and community sites (n = 8)-each with empirically informed passer volumes and engagement probabilities.

Median annual throughput per kiosk ranged from 488 competent trainees (95 % credible interval [CrI], 94-1550) at small sites (0.5 million passers) to 19,618 (95 % CrI, 3706-50,000) at mega-sites (40 million passers). Witness-weighted trainees were highest in hospitals and pharmacies, reflecting more caregivers and seniors. Training increased willingness to act from 40 % to 60-80 %; this action uplift strongly influenced outcomes. In Toronto, a blended network of 30 kiosks (6 mega, 8 hospital, 8 community, 8 large) increased bystander CPR by 7.5-8.0 percentage points, with a 90-95 % probability of meeting or exceeding a 5-point target within one year. This translated to ∼150 additional CPR attempts and 15 lives saved annually. Costs were ∼$10,000 per life saved and ∼$1250 per quality-adjusted life year (QALY).

Simulation modeling suggests CPR kiosks can feasibly and cost-effectively increase bystander CPR, with impact shaped by visibility, action willingness, and targeting individuals most likely to witness arrest.