Abstract 16890: Improved Rates of Bystander Cardiopulmonary Resuscitation, First Responder Defibrillation and Outcome in Black and White Patients but More Improvement for White Patients: Results From the North Carolina Heartrescue Project

Abstract

Introduction: Known differences in bystander cardiopulmonary resuscitation (CPR) and survival for out of hospital cardiac arrest (OHCA) exist for blacks compared with whites. Following the HeartRescue project, bystander and first responder interventions and survival increased in North Carolina (NC). Our objective was to study how these improvements were distributed by racial groups. Methods: Using the CARES registry, we identified OHCA cases of cardiac etiology from counties in NC (population 3 million) with 100% case capture from 2010-14. Unadjusted incidence rates per 100,000 were calculated based on US Census data (2010-13). Temporal changes in rates of bystander CPR, first responder defibrillation, and outcomes were assessed according to black or white race. Results: Of 7,558 OHCA patients, 36.3% were black (incidence: 94.7/100,000) and 63.7% were white (64.8/100,000). From 2010-14, bystander CPR increased by 34%, irrespective of race (Figure). No improvement in first responder defibrillation was seen for black patients (2010 to 2014: 40.3% to 44.4%, p=0.38), but was demonstrated for white patients (38.3% to 47.2%, p<0.01). Return of spontaneous circulation improved significantly for black patients (23.0% to 27.6%, p<0.01) and more significantly for white patients (19.2% to 34.0%, p< 0.01). No significant increase in survival over time was seen for black patients (8.6% to 9.2%, p=0.32), but was demonstrated for white patients (5.6% to 11.7%, p< 0.01). Among patients receiving bystander CPR, favorable neurologic outcome increased significantly regardless of race (relative increase 59% for blacks and 81% for whites). Conclusion: After the HeartRescue quality improvement program, bystander CPR increased by 34% in black and white patients. There were substantial improvements in survival with favorable neurologic outcome in both black and white patients receiving bystander CPR, however gains in interventions and outcomes were greater for whites.