Nationwide trends in residential and non-residential out-of-hospital cardiac arrest and differences in bystander cardiopulmonary resuscitation

The role of bystander CPR in out-of-hospital cardiac arrest: what the evidence tells us

Out-of-hospital cardiac arrest (OHCA) is a global public health problem. Lay bystanders witness almost half of OHCA, so early recognition is critical to allow immediate initiation of cardiopulmonary resuscitation (CPR) by the bystander. The present investigation aims to analyze the most recent scientific evidence of the effect of bystander CPR on survival after an OHCA. A systematic literature review was carried out at the "Web of Science," "Scopus," and "PubMed" databases, including publications from the last 20 years. After inclusion/exclusion criteria, 37 articles were identified. Results indicate that patients who receive CPR are more likely to survive than those who don't, and CPR is associated with a good quality of life post-OHCA. Emphasis should be placed on practicing chest compressions only when the bystander has not mastered the artificial ventilation technique. Finding an AED is the first step to using it in an OHCA situation. Correct use of an AED by laypeople is associated with nearly double the survival rate after an OHCA when compared to standard CPR. It is important to promote CPR and AED training to non-professionals, such as community residents and youth, as training is associated with higher success rates of effective CPR-AED. A mobile phone positioning system to recruit trained laypeople or text message alerts to send citizen volunteers as well as assistance through a mobile app appear to have significant advantages in practicing effective CPR. The benefits of bystander CPR outweigh the risk of injury to victims, highlighting the need to disseminate training to laypeople.

Does witness type affect the chance of receiving bystander CPR in out-of-hospital cardiac arrest?

OBJECTIVES

The relationship between the bystander witness type and receipt of bystander CPR (BCPR) is not well understood. Herein we compared BCPR administration between family and non-family witnessed out-of-hospital cardiac arrest (OHCA).

BACKGROUND

In many communities, interventions in the past decade have contributed to an increased receipt of BCPR, for example in Singapore from 15% to 60%. However, BCPR rates have plateaued despite sustained and ongoing community-based interventions, which may be related to gaps in education or training for various witness types. The purpose of this study was to investigate the association between witness type and BCPR administration.

METHODS

Singapore data from 2010 - 2020 was extracted from the Pan-Asian Resuscitation Outcomes Study (PAROS) network registry (n = 25,024). All adult, layperson witnessed, non-traumatic OHCAs were included in this study.

RESULTS

Of 10,016 eligible OHCA cases, 6,895 were family witnessed and 3,121 were non-family witnessed. After adjustment for potential confounders, BCPR administration was less likely for non-family witnessed OHCA (OR 0.83, 95% CI 0.75, 0.93). After location stratification, non-family witnessed OHCAs were less likely to receive BCPR in residential settings (OR 0.75, 95% CI 0.66, 0.85). In non-residential settings, there was no statistically significant association between witness type and BCPR administration (OR 1.11, 95% CI 0.88, 1.39). Details regarding witness type and bystander CPR were limited.

CONCLUSION

This study found differences in BCPR administration between family and non-family witnessed OHCA cases. Elucidation of witness characteristics may be useful to determine populations that would benefit most from CPR education and training.

Out-of-hospital cardiac arrests and bystander response by socioeconomic disadvantage in communities of New South Wales, Australia

Background & aim

Bystander response to out-of-hospital cardiac arrest (OHCA) may relate to area-level factors, including socioeconomic status (SES). We aimed to examine whether OHCA among individuals in more disadvantaged areas are less likely to receive bystander cardiopulmonary resuscitation (CPR) compared to those in more advantaged areas.

Methods

We analysed data on OHCAs in New South Wales, Australia collected prospectively through a statewide, population-based register. We excluded non-medical arrests; arrests witnessed by a paramedic; occurring in a medical centre, nursing home, police station; or airport, and among individuals with a Do-Not-Resuscitate order. Area-level SES for each arrest was defined using the Australian Bureau of Statistics’ Index of Relative Socioeconomic Disadvantage and its relationship to likelihood of receiving bystander CPR was examined using hierarchical logistic regression models.

Results

Overall, 39% (6622/16,914) of arrests received bystander CPR (71% of bystander-witnessed). The OHCA burden in disadvantaged areas was higher (age-standardised incidence 76–87/100,000/year in more disadvantaged quintiles 1–4 versus 52 per 100,000/year in most advantaged quintile 5). Bystander CPR rates were lower (38%) in the most disadvantaged quintile and highest (42%) in the most advantaged SES quintile. In adjusted models, younger age, being bystander-witnessed, arresting in a public location, and urban location were all associated with greater likelihood of receiving bystander CPR; however, the association between area-level SES and bystander CPR rate was not significant.

Conclusions

There are lower rates of bystander CPR in less advantaged areas, however after accounting for patient and location characteristics, area-level SES was not associated with bystander CPR. Concerted efforts to engage with communities to improve bystander CPR in novel ways could improve OHCA outcomes.