Heart disease is a leading cause of death worldwide, and sudden cardiac arrest is a critical emergency affecting individuals across all age groups (1). Timely, life-saving interventions are essential for preventing deaths related to sudden cardiac arrest. Globally, approximately 92% of individuals experiencing out-of-hospital cardiac arrest do not survive, often due to limited access to cardiopulmonary resuscitation (CPR) (2). Out-of-hospital cardiac arrest significantly contributes to both mortality and disability, accounting for up to 10% of total mortality in developing countries (3, 4). Temporal trends in recent years have shown that more and more bystanders are practicing CPR, however this trend has not necessarily been reflected in the survival outcomes of those affected, highlighting the importance of optimal preparation and correct practice of CPR in these scenarios (5).

Basic Life Support (BLS) entails recognizing various conditions such as myocardial infarction, sudden cardiac arrest, foreign-body airway obstruction, and administering CPR and defibrillation using an automated external defibrillator (4). The American Heart Association (AHA) emphasizes that prompt CPR and defibrillation within the first 3–5 min of collapse can substantially increase survival rates, ranging from 49% to 75% of cases (6, 7). Successful BLS implementation can double or even triple survival rates for witnessed sudden cardiac arrest (8). Therefore, healthcare workers’ knowledge and awareness of BLS are of utmost importance (9–11).

On the other hand, Advanced Life Support (ALS) involves not only high-quality CPR but also a series of actions aimed at restoring spontaneous circulation as quickly as possible. These actions include invasive interventions, such as endotracheal intubation and the use of intravenous catheters for fluid and drug administration (12). ALS focuses on treating underlying causes and providing support during post-cardiac arrest recovery. Optimizing the chain of events that must occur in rapid succession to maximize the chances of survival from sudden cardiac arrest (chain of survival) is crucial for ensuring functional survival for adults experiencing cardiac arrest (10).

Nursing professionals regularly encounter emergency cases, including sudden cardiac arrest, in both hospital and non-hospital settings (10, 13). In these scenarios, among healthcare personnel, nurses have been identified as key first responders capable of performing BLS. Studies have shown that nurses effectively applying first aid and BLS techniques in acute conditions positively impact morbidity and mortality rates related to cardiac arrest (13). However, it has been observed that both knowledge and skills tend to fade over time, with ALS skills deteriorating more rapidly than BLS skills. This underscores the ongoing need for regular training and resource utilization to reinforce these skills (14, 15).

In this context, various studies have highlighted deficiencies in life support skills among nursing professionals. For example, a study in India assessed skills and knowledge in BLS and ALS among nursing staff, revealing an average score of 9 out of 20 points (16). Additionally, De Lima et al. found that only 65% of nursing professionals possess knowledge of the sequential actions required in BLS and ALS, and their understanding of medication preparation and administration was particularly low (17).

In Ecuador, nurses and doctors are expected to manage cardiac arrest according to standards accepted by providers, despite the limited availability of cardiac arrest equipment in most public hospitals (18). However, to date, the knowledge of nursing professionals regarding life support in Ecuador has not been explored. Thus, the objective of this study is to evaluate the level of knowledge about both basic and advanced life support resuscitation guidelines among nurses in Ecuador.

Given the significant impact that cardiopulmonary arrest and sudden death have on global healthcare systems, healthcare professionals—particularly physicians and nurses—play a pivotal role in mitigating the effects of these emergencies on affected individuals (23, 24). Therefore, medical and nursing professionals need a comprehensive understanding of cardiopulmonary resuscitation to execute timely and effective interventions (25, 26). To the best of our knowledge, this is the first study evaluating the theoretical understanding of life support among Ecuadorian nurses. Our findings indicate that most participants are young, have limited work experience, and have not pursued further academic specialization beyond obtaining a bachelor’s degree in nursing. Additionally, the predominant gender among participants was female (77.4%), aligning with trends observed worldwide among nursing professionals (27–31).

Despite the clear importance of life support training, as of 2023, Basic Life Support (BLS) and Advanced Life Support (ALS) training are not mandatory components of nursing curricula in Ecuadorian universities (32). This absence is evident, with 17.5% of participants reporting not having received any life support training during their university studies. Furthermore, less than half of the participants reported holding official certifications in BLS (44.7%) and ALS (19.4%). Paradoxically, 53.3% and 42.9% of participants self-perceived having sufficient levels of knowledge in BLS and ALS, respectively. This demonstrates a higher level of confidence in their knowledge despite lacking official certifications, which may underscore an underestimation of the importance of formal life support training for nursing professionals in Ecuador. This underestimation could originate from the beginning of their university training since life support is not part of their academic curricula, as mentioned.

In terms of actual knowledge levels, Ecuadorian nurses scored suboptimally on both BLS and ALS tests, averaging 4.8/10 ± 1.8 and 4.3/10 ± 1.8 points, respectively. These scores align with similarly low BLS, and both BLS and ALS knowledge levels reported in studies involving nurses from South Africa, Yemen, and Uganda, who scored 46/100, 53.65/100, and 53.8/100, respectively (31, 33, 34).

Demographic factors like age and gender, as well as job characteristics such as work area and experience, did not significantly influence BLS knowledge scores. This finding is congruent with studies conducted on South African and Egyptian nurses (30, 31). However, participants who had undergone various forms of BLS training, including undergraduate education and certification, exhibited improved knowledge levels in BLS (p < 0.05).

Concerning ALS knowledge, although the mean score was still lower than that for BLS, older participants (aged 41 to 50) exhibited a higher level of knowledge in ALS. A similar positive effect was observed among nurses with over 6 years of work experience. Certification in both BLS (p = 0.003) and ALS (p = 0.100) also corresponded with higher scores. We believe that the discrepancy found regarding the significance of these differences in knowledge in BLS and ALS certification contexts could be due to the lack of consideration for the time that has elapsed from certification to the time of examination. In several cases, participants with ALS certification may have obtained it either a considerable time ago or more recently. In this context, the high level of knowledge observed in those who have been certified can be attributed to various intervening variables, including the experience gained through daily professional practice, often referred to as the ‘hidden curriculum,’ since the time of certification.

An intriguing aspect of this research is the high level of self-perceived sufficiency in knowledge of BLS and ALS among the participants, even though the average knowledge scores in both areas were deficient. Specifically, BLS scores averaged 5.0/10 ± 1.7 points, and ALS scores averaged 4.4/10 ± 1.8 points. This discrepancy may suggest a level of overconfidence in the participants’ abilities, a phenomenon also noted in another study involving healthcare professionals, including nurses (35). Further analysis is required to substantiate this observation.

It has been established that the level of knowledge concerning CPR guidelines among nursing professionals is influenced by motivation, attitude, and willingness to learn (31). This is corroborated by our study, which revealed that nurses using evidence-based summaries for extracurricular training achieved significantly higher scores in both BLS (p = 0.001) and ALS (p < 0.001).

Despite the global emphasis on the critical role that nurses play in life support settings, our study indicates deficiencies and inadequacies in training initiatives in Ecuador, both during undergraduate education and through official programs. It is evident that these shortcomings result in deficient levels of knowledge, a concern heightened by the fact that competency in basic and advanced life support generally declines 6 months after completing training (36). Previous research underscores the importance of continuing training and education in BLS and ALS to enhance the effectiveness of CPR (17, 37).

In Ecuador, knowledge deficiencies in life support have been observed in other groups of health workers, such as doctors (38), highlighting a structural problem where key stakeholders, including universities, health institutions, and ultimately the health system, do not assign the necessary importance to life support preparation. We believe that addressing the deficiency of knowledge in life support among nursing personnel in Ecuador can be initiated by making life support a mandatory requirement in all higher education institutions. This should follow a gradual approach, beginning in the first year of the university degree and continuing throughout subsequent years of training based on international guidelines. Additionally, practical courses should be included annually to maintain optimal competence over the four and a half years of training (11). Furthermore, health institutions and health authorities must concentrate efforts and allocate resources to ensure the periodic training of nursing professionals. This will enable them to update their knowledge and achieve optimal results.

Ecuadorian nursing professionals demonstrate alarmingly insufficient general levels of theoretical knowledge in both basic and advanced life support. Although knowledge of BLS was marginally better than that of advanced life support, participants did not achieve an acceptable average score in either case.

This research reinforces previous postulates regarding the positive impact and importance of continuous training and education in life support contexts, as evidenced by higher scores among these groups.

In the Latin American context, the development and inclusion of nursing professionals in basic and advanced life support training programs are of paramount importance.

The datasets presented in this study can be found in online repositories. The names of the repository/repositories and accession number(s) can be found at DOI: 10.6084/m9.figshare.23506539.

All collected information was anonymized, and participation was voluntary. Ethical approval was obtained from the Ethics Committee of the Hospital San Francisco de Quito, under the code CEISH151 HGSF-2023-011, ensuring compliance with ethical guidelines and standards.

JI-C: Conceptualization, Data curation, Formal analysis, Funding acquisition, Investigation, Methodology, Project administration, Resources, Software, Supervision, Visualization, Writing – original draft, Writing – review & editing. FA: Conceptualization, Investigation, Resources, Validation, Writing – original draft. ED-S: Writing – original draft. NA: Investigation, Resources, Validation, Writing – original draft. MR: Investigation, Resources, Validation, Writing – original draft. PN-L: Data curation, Investigation, Resources, Validation, Visualization, Writing – original draft. AM: Data curation, Investigation, Methodology, Resources, Validation, Writing – original draft. JJ-S: Data curation, Investigation, Methodology, Resources, Validation, Writing – original draft. DC: Investigation, Resources, Validation, Visualization, Writing – original draft. BG: Investigation, Resources, Validation, Visualization, Writing – original draft. NG: Data curation, Investigation, Resources, Validation, Writing – original draft.