Improving bystander CPR and AED training among college students: strategies and barriers.

Out-of-hospital cardiac arrest (OHCA) remains a leading cause of mortality, with survival highly dependent on timely bystander cardiopulmonary resuscitation (CPR) and automated external defibrillator (AED) use. Despite well-established benefits, rates of bystander intervention and training remain suboptimal, particularly within college populations. This review examines current gaps in CPR/AED training, identifies key barriers to implementation, and evaluates emerging strategies to enhance basic life support (BLS) readiness in college settings. Available evidence demonstrates that limited training access, lack of confidence, poor AED awareness, and socioeconomic disparities contribute to low bystander response rates. Although legislative mandates and traditional training programs have improved exposure, variability in training quality and retention persists. Emerging approaches, including hybrid training models, virtual and augmented reality platforms, and mobile technologies such as AED mapping and responder alert systems, offer scalable solutions to improve skill acquisition, retention, and real-time response. Building on these findings, we propose a structured implementation framework for universities centered on policy integration, scalable training delivery, technology-enabled response systems, reinforcement strategies, and outcome-driven evaluation. College campuses represent a uniquely accessible and high-impact environment for large-scale deployment of these interventions. The electrophysiology community is well positioned to lead and support these efforts through collaboration with academic institutions, professional societies, and industry partners. A coordinated, systems-level approach that integrates education, technology, and policy has the potential to significantly improve bystander response and outcomes in OHCA.