Abstract 12908: Impact of Bystander Cardiopulmonary Resuscitation by Family Members on Return of Spontaneous Circulation and Neurological Prognosis in Patients With Out-of-Hospital Cardiac Arrests: A Nationwide, Population-Based Cohort Study

Abstract

Introduction: Out-of-hospital cardiac arrests (OHCAs) are critical events and bystander cardiopulmonary resuscitation (byCPR) affects the survival and prognosis of OHCAs. Most byCPR occur in a family setting in Japan. Although there are many reports on the effect of byCPR, there are few considerations about the person who operated byCPR in Japan. Hypothesis: We hypothesized that byCPR by a family member is more effective for return of spontaneous circulation (ROSC) and neurological prognosis against OHCAs of cardiac origin compared to non-family operators without emergency medical services (EMS ). Methods: In All-Japan Utstein Registry of the Fire and Disaster Management Agency, 1,176,363 patients who suffered from OHCAs were enrolled between 2005 and 2014. We selected 162,390 patients who were witnessed, those aged > 18 years and had OHCAs of cardiac origin. We classified the patients by age, gender, initial rhythm, verbal instruction, witness-to-CPR time by EMS, airway management, drug administration in ambulance, and secondary lifesaving treatment by doctor in ambulance. Results: In this study cohort, the byCPR by citizen were included family members (n=137,147), friends (n=9,132), colleagues (n=7,956), and passersby (n=8,155). The incidence of ROSC was 11.6%, 18.8%, 24.7%, and 22.2% among family members, friends, colleagues, and passersby, respectively and was significantly higher in friends (OR: 1.25, 95%CI: 1.18-1.33, p<0.000), colleagues (OR: 1.35, 95%CI: 1.28-1.44, p<0.000), or passersby (OR: 1.46, 95%CI: 1.38-1.55, p<0.000) than family members. In family members, the rates of defibrillation, first aid and chest compression were significantly lower than those in others. The time from witness to byCPR was significantly later in family members than in others. The incidence of ROSC after adjusting above-mentioned factors and the rates of defibrillation was also significantly lower in family members than in others. We also performed same investigation for neurological prognosis, and the results were similar. Conclusions: The incidence of ROSC and neurologically intact survival in byCPR by family members were lower than in others, regardless of the presence of defibrillation. Family members need to have education as bystanders.