Assessment of Community Interventions for Bystander Cardiopulmonary Resuscitation in Out-of-Hospital Cardiac Arrest

Julie Redfern,Clara K Chow,Tu N Nguyen,Qingtao Meng,Yang Yu,Sonali Munot

doi:10.1001/jamanetworkopen.2020.9256

Abstract

Outcomes from out-of-hospital cardiac arrests (OHCAs) remain poor. Outcomes associated with community interventions that address bystander cardiopulmonary resuscitation (CPR) remain unclear and need further study. To examine community interventions and their association with bystander CPR and survival after OHCA. Literature search of the MEDLINE, Embase, and the Cochrane Library databases from database inception to December 31, 2018, was conducted. Key search terms included cardiopulmonary resuscitation, layperson, basic life support, education, cardiac arrest, and survival. Community intervention studies that reported on comparisons with control and differences in survival following OHCA were included. Studies that focused only on in-hospital interventions, patients with in-hospital cardiac arrest, only dispatcher-assisted CPR, or provision of automated external defibrillators were excluded. Pooled odds ratios (ORs) and 95% CIs were estimated using a random-effects model. This study followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline. Thirty-day survival or survival to hospital discharge and bystander CPR rate. A total of 4480 articles were identified; of these, 15 studies were included for analysis. There were broadly 2 types of interventions: community intervention alone (5 studies) and community intervention combined with changes in health services (10 studies). Four studies involved notification systems that alerted trained lay bystanders to the location of the OHCA in addition to CPR skills training. Meta-analysis of 9 studies including 21 266 patients with OHCA found that community interventions were associated with increased survival to discharge or 30-day survival (OR, 1.34; 95% CI, 1.14-1.57; I2 = 33%) and greater bystander CPR rate (OR, 1.28; 95% CI, 1.06-1.54; I2 = 82%). Compared with community intervention alone, community plus health service intervention was associated with a greater bystander CPR rate compared with community alone (community plus intervention: OR, 1.74; 95% CI, 1.26-2.40 vs community alone: OR, 1.06; 95% CI, 0.85-1.31) (P = .01). Survival rate, however, was not significantly different between intervention types: community plus health service intervention OR, 1.71; 95% CI, 1.09-2.68 vs community only OR, 1.26; 95% CI, 1.05-1.50 (P = .21). In this study, while the evidence base is limited, community-based interventions with a focus on improving bystander CPR appeared to be associated with improved survival following OHCA. Further evaluations in diverse settings are needed to enable widespread implementation of such interventions.

Highlights

Out-of-hospital cardiac arrest (OHCA) is the cessation of cardiac mechanical activity and the absence of signs of circulation that happens outside of the hospital setting
Meta-analysis of 9 studies including 21 266 patients with OHCA found that community interventions were associated with increased survival to discharge or 30-day survival (OR, 1.34; 95% CI, 1.14-1.57; I2 = 33%) and greater bystander cardiopulmonary resuscitation (CPR) rate (OR, 1.28; 95% CI, 1.061.54; I2 = 82%)
Compared with community intervention alone, community plus health service intervention was associated with a greater bystander CPR rate compared with community alone (P = .01)

Summary

Introduction

Out-of-hospital cardiac arrest (OHCA) is the cessation of cardiac mechanical activity and the absence of signs of circulation that happens outside of the hospital setting. Out-of-hospital cardiac arrest is a challenging global public health issue, and the estimated incidence of OHCA treated and recorded after emergency medical service (EMS) intervention ranges from 14.9 to 110.8 per 100 000 persons worldwide.[1,2,3] Despite awareness of this issue, the average survival rate following OHCA remains poor, at approximately 10%, with little improvement in recent decades.[1,2,3,4] The pathway for improving survival includes a set of sequentially resuscitative interventions conceptualized as the chain of survival.[5]. In the past decade, novel approaches and technologies have been introduced to facilitate the learning of CPR skills among laypeople, such as hands-only CPR, brief video kits, mobile applications, or social media broadcasting.[13,14]

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