Bystander-initiated Cardiopulmonary Resuscitation Research Articles

Survival After Out-of-Hospital Cardiac Arrest Before and After Legislation for Bystander CPR

The lack of evidence-based implementation strategies is a major contributor to increasing mortality due to out-of-hospital cardiac arrest (OHCA) in developing countries with limited resources. To evaluate whether the implementation of legislation is associated with increased bystander cardiopulmonary resuscitation (CPR) and automated external defibrillator (AED) use and improved clinical outcomes for patients experiencing OHCA and to provide policy implications for low-income and middle-income settings. This observational cohort study analyzed a prospective city registry of patients with bystander-witnessed OHCA between January 1, 2010, and December 31, 2022. The Emergency Medical Aid Act was implemented in Shenzhen, China, on October 1, 2018. An interrupted time-series analysis was used to assess changes in outcomes before and after the law. Data analysis was performed from May to October 2023. The Emergency Medical Aid Act stipulated the use of AEDs and CPR training for the public and provided clear legal guidance for OHCA rescuing. The primary outcomes were rates of bystander-initiated CPR and use of AEDs. Secondary outcomes were rates of prehospital return of spontaneous circulation (ROSC), survival to arrival at the hospital, and survival at discharge. A total of 13 751 patients with OHCA (median [IQR] age, 59 [43-76] years; 10 011 men [72.83%]) were included, with 7858 OHCAs occurring during the prelegislation period (January 1, 2010, to September 30, 2018) and 5893 OHCAs occurring during the postlegislation period (October 1, 2018, to December 31, 2022). The rates of bystander-initiated CPR (320 patients [4.10%] vs 1103 patients [18.73%]) and AED use (214 patients [4.12%] vs 182 patients [5.29%]) increased significantly after legislation implementation vs rates before the legislation. Rates of prehospital ROSC (72 patients [0.92%] vs 425 patients [7.21%]), survival to arrival at the hospital (68 patients [0.87%] vs 321 patients [5.45%]), and survival at discharge (44 patients [0.56%] vs 165 patients [2.80%]) were significantly increased during the postlegislation period. Interrupted time-series models demonstrated a significant slope change in the rates of all outcomes. These findings suggest that implementation of the Emergency Medical Aid Act in China was associated with increased rates of CPR and public AED use and improved survival of patients with OHCA. The use of a systemwide approach to enact resuscitation initiatives and provide legal support may reduce the burden of OHCA in low-income and middle-income settings.

Time Is Life: Golden Ten Minutes on Scene-EuReCa_Serbia 2014-2023.

Background and Objectives: This study analyzed the frequency of factors influencing the course and outcomes of out-of-hospital cardiac arrest (OHCA) in Serbia and the prediction of pre-hospital outcomes and survival. Materials and Methods: Data were collected during the period from 1 October 2014, to 31 September 2023, according to the protocol of the EuReCa_One study (clinical trial ID number NCT02236819). Results: Overall 9303 OHCA events were registered with a median age of 71 (IQR 61-81) years and 59.7% of them being males. The annual OHCA incidence was 85.60 ± 20.73/100,000. Within all bystander-witnessed cases, bystander-initiated cardiopulmonary resuscitation in 15.3%. Within the resuscitation-initiated group, return-of-spontaneous circulation (ROSC) on scene (any ROSC) was present in 1037/4053 cases (25.6%) and ROSC on admission to the nearest hospital in 792/4053 cases (19.5%), while 201/4053 patients survived to hospital discharge (5.0%). Predictive potential on pre-hospital outcomes was shown by several factors. Also, of all patients having any ROSC, 89.2% were admitted to the hospital alive. The probability of any ROSC dropped below 50% after 17 min passed after the emergency call and 10 min after the EMS scene arrival. These time intervals were significantly associated with survival to hospital discharge (p < 0.001). Five-minute time intervals between both emergency calls and any ROSC and EMS scene arrival and any ROSC also had a significant predictive potential for survival to hospital discharge (p < 0.001, HR 1.573, 95% CI 1.303-1.899 and p = 0.017, HR 1.184, 95% CI 1.030-1.361, respectively). Conclusions: A 10-min time on scene to any ROSC is a crucial time-related factor for achieving any ROSC, and indirectly admission ROSC and survival to hospital discharge, and represents a golden time interval spent on scene in the management of OHCA patients. A similar effect has a time interval of 17 min from an emergency call. Further investigations should be focused on factors influencing these time intervals, especially time spent on scene.

Characteristics and outcomes of out-of-hospital cardiac arrest in a hilly area: Utstein Registry data from the Nagasaki Medical Region, Japan.

To analyze characteristics and investigate prognostic indicators of out-of-hospital cardiac arrest (OHCA) in a hilly area in Japan. A retrospective population-based study was conducted using the Utstein Registry for 4280 OHCA patients in the Nagasaki Medical Region (NMR) registered over the 10-year period from 2011 to 2020. The main outcome measure was a favorable cerebral performance category (CPC 1-2). Sites at which OHCA occurred were classified into "sloped places (SPs)" (not easily accessible by emergency medical services [EMS] personnel due to slopes) and "accessible places (APs)" (EMS personnel could park an ambulance close to the site). The characteristics and prognosis based on CPC were compared between SPs and APs, and multivariable analysis was performed. No significant improvement in prognosis occurred in the NMR from 2011 to 2020. Prognosis in SPs was significantly worse than that in APs. However, multivariable analysis did not identify SP as a prognostic indicator. The following factors were associated with survival and CPC 1-2: age group, witness status, first documented rhythm, bystander-initiated cardiopulmonary resuscitation (CPR) and automated external defibrillator (AED) use, use of mechanical CPR (m-CPR) device or esophageal obturator airway (EOA), and year. Both m-CPR and EOA use were associated with a poor prognosis. In a hilly area, OHCA patients in SPs had a worse prognosis than those in APs, but SPs was not significantly associated with prognosis by multivariable analysis. Interventions to increase bystander-initiated CPR and AED use could potentially improve outcomes of OHCA in the NMR.

Dispatchers trained in persuasive communication techniques improved the effectiveness of dispatcher-assisted cardiopulmonary resuscitation

BackgroundEarly recognition of cardiac arrest and early initiation of bystander cardiopulmonary resuscitation can increase the survival of patients with out-of-hospital cardiac arrest (OHCA). We compared dispatcher-assisted cardiopulmonary resuscitation (DACPR) effectiveness before and after using different communication models in the dispatching center. MethodWe analyzed dispatch recordings of non-trauma origin OHCA cases received by the Taichung dispatch center between May 1 to September 30, 2021, and November 1, 2021, to March 31, 2022. The dispatchers underwent an 8-hour training intervention consisting of targeted education using a new communication model for DACPR. Several outcome measures were evaluated, including the sustained return of spontaneous circulation and the time to first chest compression. ResultsWe included 640 cases in the preintervention group and 580 cases in the postintervention group. The return of spontaneous circulation (ROSC) rate, the time to first chest compression, and good neurological outcome were significantly improved in the postintervention group (20.9% vs. 31.0%, p < 0.001;168 seconds vs. 151 seconds, p = 0.004; 2.8% vs. 5.3%, p = 0.024, respectively). In subgroup analyses, the intervention was related to a statistical improvement in ROSC rate among patients whose caller was a family member (18.7% vs. 31.4%, p < 0.001). Among patients whose caller was female, both ROSC and good neurological outcome significantly improved after the intervention (19.8% vs. 36.6%, p < 0.001; 2.7% vs. 7.5%, p = 0.006, respectively). There was a statistical difference between the pre-intervention and post-intervention group with respect to ROSC rate among patients whose caller was family (the adjusted odds ratio:1.78, 95% CI: 0.59–1.25], p < 0.001.) or female (the adjusted odds ratio:3.18,95% CI: 1.77–5.70], p = 0.008.) in the multivariable regression model. ConclusionThe new communication model has enhanced the effectiveness of DACPR in terms of the ROSC rate, particularly when the caller was a family member or female, leading to improved rates of ROSC and favorable neurological outcomes.

Enhancing global pediatric cardiac arrest outcomes through bystander cardiopulmonary resuscitation: A comprehensive systematic review

This systematic review investigates the impact of global bystander cardiopulmonary resuscitation (CPR) on outcomes in pediatric cardiac arrest cases. Through a meticulous examination of relevant worldwide studies retrieved from PubMed spanning 2018 to 2022, employing keywords such as “worldwide Bystander CPR (BCPR),” “worldwide out-of-hospital CPR,” and “pediatric CPR” with Boolean operators “OR” and “AND,” the study incorporates 10 selected articles out of the initially identified 13. Findings reveal that bystander-initiated CPR, predominantly chest-only CPR, is administered at rates ranging from 48% to 89% globally, with no significant gender-based disparity, but a lower likelihood observed among worldwide Black children. Return of spontaneous circulation (ROSC) is achieved in 20%–35% of cases and survival to hospital discharge in 5%–10% of instances. Factors associated with worldwide prehospital ROSC include epinephrine administration, bystander intervention before emergency medical services (EMS) arrival, older age, reduced time to EMS response, and worldwide automated external defibrillators. Notably, a shorter time to EMS arrival is the sole significant predictor of worldwide survival to hospital discharge. The study discerns no substantial distinction in achieving prehospital ROSC and favorable outcomes on a global scale. The conclusion underscores the varied worldwide outcomes in out-of-hospital cardiac arrest studies, attributing these variations to multifarious confounding factors. It identifies crucial predictors of prehospital ROSC and recommends targeted CPR training for underserved communities to enhance worldwide BCPR rates and ameliorate pediatric cardiac arrest outcomes.

Basic life support for non-traumatic out-of-hospital cardiac arrests during school-supervised sports activities in children: A nationwide observational study in Japan

ObjectiveTo investigate the prognostic impact of bystander-initiated cardiopulmonary resuscitation (CPR) and public-access automated external defibrillator (AED) use on non-traumatic out-of-hospital cardiac arrest (OHCA) occurring during school-supervised sports activities in children. MethodsFrom a nationwide database of pediatric OHCAs occurring under school supervision in Japan, data between April 2008 and December 2020 were obtained. We analyzed non-traumatic OHCAs that occurred during school-supervised sports activities among schoolchildren from elementary, junior high, high, and technical colleges. A multivariable logistic regression model was used to evaluate the effect of basic life support (BLS) on 1-month survival with favorable neurological outcomes after OHCA. ResultsIn total, 318 OHCA cases were analyzed. The 1-month survival with favorable neurological outcomes was 64.8% (164/253) in cases receiving both bystander-CPR and AED application, 40.7% (11/27) in cases receiving CPR only, 38.5% (5/13) in patients receiving AED application only, and 28.0% (7/25) in cases receiving no bystander intervention. Compared with cases receiving no BLS, cases receiving both CPR and AED had a significantly higher proportion of 1-month survival with favorable neurological outcomes (adjusted odds ratio [AOR]: 3.97, 95% confidence interval [CI]: 1.32–11.90, p = 0.014). However, compared to cases receiving no BLS, there was no significant difference in the outcome in the cases receiving CPR only (AOR: 1.35, 95% CI: 0.34–5.29, p = 0.671) and the cases receiving AED application only (AOR: 1.26, 95% CI: 0.25–6.38, p = 0.778). ConclusionThe combination of CPR and AED as BLS performed by bystanders for non-traumatic OHCA during school-supervised sports activities improved the outcomes.

Effects of the COVID-19 Pandemic on the Frequency of Bystander Intervention in Out-of-Hospital Cardiac Arrests.

Rapid administration of cardiopulmonary resuscitation (CPR) can significantly increase patient survival following an out-of-hospital cardiac arrest (OHCA). Through this study, we aimed to determine if the onset of the coronavirus disease 2019 (COVID-19) pandemic affected the likelihood of OHCAvictims receiving bystander-initiated CPR prior to EMS arrival. We used data collected by the National Emergency Medical Services Information System (NEMSIS) for years 2019 and 2020. Data was filtered to include only cases of OHCA where the status of bystander CPR was listed. We used a chi-squareanalysis to compare frequencies of patients receiving both bystander CPR and standard EMS interventions versus patients receiving only standard EMS interventions for the years before and during the COVID-19 pandemic declaration (2019 and 2020, respectively). Of the 577,011 cases that met our inclusion criteria, 228,259 occurred in 2019 and 348,752 occurred in 2020. The frequency of OHCA cases that reported bystander-initiated CPR prior to EMS arrival significantly decreased from 2019 to 2020 (53.7% vs. 52.5%, P<.001). Bystanders are often the first to administer CPR following a cardiac arrest. It was found that the likelihood of an OHCA victim receiving bystander CPR decreased from 2019 to 2020.

Association of prehospital tracheal intubation with outcomes comparing to supraglottic airway device during out-of-hospital cardiac arrest by drowning: nationwide cohort study in Japan

Abstract Background/Introduction Drowning is the third leading cause of unintentional injury death, which causes more than 500,000 deaths annually worldwide. Several studies have examined the impact of tracheal intubation for outcomes in out-of-hospital cardiac arrest (OHCA) patients, however few studies examined it in OHCA patients by drowning. Purpose To compare survival outcomes among adults OHCA patients by drowning between tracheal intubation and supraglottic airway device. Methods This study compared the outcome of OHCA patients by drowning according to the airway management using Japanese nationwide, population-based registry (All-Japan Utstein Registry). From 2014 to 2020, consecutive adult OHCA patients were included. Patients who received tracheal intubation during cardiopulmonary resuscitation (CPR) were matched with patients treated with supraglottic airway device on the basis propensity scores in a 1:1 ratio, with a 0.2 caliper width. Propensity score was calculated by logistic regression model using following variables; year, prefectural preference of ETI use, age, sex, witnessed status, those who witnessed (By family, citizen, EMS, others), AED use, bystander-initiated CPR, prehospital involvement of physician, defibrillation by EMS, administration of adrenaline, time from call to CPR, first rhythm documented by EMS. The outcome measures were return of spontaneous circulation, survival at one month, and favorable neurological outcome defined as cerebral performance status 1 or 2. Results Of the 11, 703 eligible patients, 4467 (38.2%) and 7236 (61.8%) received tracheal intubation and supraglottic airway device during CPR, respectively. After propensity score matching, 3566 patients in each cohort were matched. The return of spontaneous circulation was higher in those with tracheal intubation compared with those with supraglottic airway device: 207/3566 (5.8%) versus 167/3566 (4.7%) (odds ratio 1.25, 95% confidence interval[CI] 1.02 to 1.55). There was no difference between the groups in one-month survival and favorable neurological outcome: 32/3566 (0.90%) versus 34/3566 (0.95%) (odds ratio 0.94, 95% CI 0.58 to 1.53), and 9/3566 (0.25%) versus 8/3566 (0.22%) (odds ratio 1.13, 95% CI 0.43 to 2.92), respectively. Conclusions In the propensity score matched study for adult OHCA by drowning, tracheal intubation was associated with the return of spontaneous circulation, whereas it was not associated with survival and favorable neurological outcome at one month compared to those with supraglottic airway device. Further studies such as to investigate the heterogeneity of the effect of intubation during the resuscitation might be mandated for the improvement of the outcome among the OHCA patients by drowning.Out-of-hospital cardiac arrest outcomes

Abstract 391: Association Between Defibrillation to Epinephrine Interval and Short-Term Outcomes in Out-of-Hospital Cardiac Arrest Patients With Shockable Rhythm

Background: The optimal timing of epinephrine administration after defibrillation in out-of-hospital cardiac arrest (OHCA) patients with shockable rhythm is unknown. Aim: We evaluated the association between defibrillation to epinephrine interval and short-term outcomes. Methods: Between 2011 and 2020, we enrolled 1,259,960 OHCA patients from a nationwide prospective population-based registry in Japan. After applying exclusion criteria, 20,905 patients with shockable rhythm as the first documented rhythm at emergency medical services (EMS) arrival who received epinephrine after defibrillation were eligible for the study. Clinical outcomes included prehospital return of spontaneous circulation (ROSC), survival, and favorable neurological outcome at 30 days. To examine whether each variable predicted a good short-term outcome, multivariable logistic regression models were constructed using age, gender, year, district, origin of cardiac arrest, witnessed arrest, bystander-initiated cardiopulmonary resuscitation, call to EMS arrival interval, EMS arrival to defibrillation interval, and defibrillation to epinephrine interval. Results: At 30 days, 1,618 patients (8%) had a favorable neurological outcome. The defibrillation to epinephrine interval in these patients was significantly shorter than the interval in patients with an unfavorable neurological outcome [8 (5-12) vs 11 (7-16) min; P&lt;0.001]. The proportion of patients who achieved prehospital ROSC, survived, or had a favorable neurological outcome at 30 days decreased as time to epinephrine after defibrillation increased (P&lt;0.001 for trend). Multivariable analysis showed that shorter defibrillation to epinephrine interval independently predicted good outcomes ( Table ). Conclusion: A shorter defibrillation to epinephrine interval is significantly associated with good short-term outcomes in OHCA patients with shockable rhythm.

Annual patterns in the outcomes and post-arrest care for pediatric out-of-hospital cardiac arrest: A nationwide multicenter prospective registry in Japan

AimOut-of-hospital cardiac arrest (OHCA) has a poor prognosis in children; however, the annual patterns of prognosis and treatment have not been fully investigated. MethodsFrom the Japanese Association for Acute Medicine OHCA registry, a multicenter prospective observational registry in Japan, we identified pediatric patients (zero to 17 years old) between June 2014 and December 2019. The primary outcome was one-month survival. We investigated the annual patterns in patient characteristics, treatment, and one-month prognosis. ResultsDuring the study period, 1188 patients were eligible for analysis. For all years, the zero-year-old group accounted for a large percentage of the total population (between 30% and 40%). There were significant increases in the rates of bystander-initiated cardiopulmonary resuscitation (CPR; from 50.6% to 62.3%, p = 0.003), dispatcher instructions (from 44.7% to 65.7%, p = 0.001), and adrenaline administration (from 2.4% to 6.9%, p = 0.014) over time, whereas the rate of advanced airway management decreased significantly (from 17.7% to 8.8%, p = 0.003). The odds ratios for one-month survival adjusted for potential resuscitation factors also did not change significantly (from 7.1% to 10.3%, adjusted odds ratio for one-year increment = 0.98, confidence interval: 0.86–1.11). ConclusionDespite an increase in the rate of bystander-initiated CPR and pre-hospital adrenaline administration, there was no significant change in one-month survival.

Effect of location on out-of-hospital cardiac arrests involving older adults in Hong Kong: secondary analysis of a territory-wide cohort.

Most out-of-hospital cardiac arrests in Hong Kong involve older adults. The likelihood of survival varies among locations. This study investigated patient and bystander characteristics, as well as the timing of interventions, that affect the prevalences of shockable rhythm and survival outcomes among cardiac arrests involving older adults in homes, on streets, and in other public places. This secondary analysis of a territory-wide historical cohort used data collected by the Fire Services Department of Hong Kong from 1 August 2012 to 31 July 2013. Bystander cardiopulmonary resuscitation was primarily performed by relatives in homes but not in non-residential locations. The intervals in terms of receipt of emergency medical services (EMS) call, initiation of bystander cardiopulmonary resuscitation, and receipt of defibrillation were longer for cardiac arrests that occurred in homes. The median interval for EMS to reach patients was 3 minutes longer in homes than on streets (P<0.001). Forty-seven percent of patients who developed cardiac arrest on streets had a shockable rhythm within the first 5 minutes after receipt of EMS call. Defibrillation within 15 minutes after receipt of EMS call was an independent predictor of 30-day survival (odds ratio=4.07; P=0.02). Fifty percent of patients who received defibrillation within 5 minutes in non-residential locations survived. There were significant location-related differences in patient and bystander characteristics, interventions, and outcomes among cardiac arrests involving older adults. A large proportion of patients had a shockable rhythm in the early period after cardiac arrest. Good survival outcomes in out-of-hospital cardiac arrests involving older adults can be achieved through early bystander defibrillation and intervention.

Abstract 266: Impact Of Bystander-patient Relationship On Neurological Outcome In Witnessed Elderly Patients With Out-of-hospital Cardiac Arrest According To Age: A Nationwide Population-based Observational Study

Introduction: Elderly patients with out-of-hospital cardiac arrest (OHCA) witnessed by a family member were associated with worse neurological outcome than those witnessed by a non-family bystander. Hypothesis: Impact of bystander-patient relationship (family member or non-family bystander) on neurological outcome in witnessed elderly OHCA patients could differ based on age. Methods: We evaluated 13,773 bystander-witnessed elderly OHCA patients (age ≥ 65 years) of cardiac origin who achieved prehospital return of spontaneous circulation (ROSC). Data were obtained from the prospectively recorded All-Japan Utstein-style Registry between 2011 and 2016. The primary outcome was 1-month neurologically intact survival, defined as a cerebral performance category (CPC) score of 1 or 2. Patients were divided into three groups by age (65-74, 75-89, and ≥ 90 years). Results: The rates of 1-month CPC 1-2 and the frequencies of bystander-initiated cardiopulmonary resuscitation (BCPR) were significantly higher in patients witnessed by a non-family bystander [27.4% (1,360/4,971) and 68.5% (3,407/4,971)] than in those witnessed by a family member [19.7% (1,736/8,802) and 44.8% (3,942/8,802)] (p &lt; 0.001, respectively). The rates of 1-month CPC 1-2 in patients aged 65-74, 75-89, and ≥ 90 years decreased with advancing age, 36.2% (1,733/4,788), 16.9% (1,264/7,469), and 6.5% (99/1,516), respectively (p for trend &lt; 0.001). The rates of 1-month CPC 1-2 were significantly higher in patients witnessed by a non-family bystander than in those witnessed by a family member in those aged 65-74 years (45.0% and 30.9%) and 75-89 years (20.2% and 15.3%) (p &lt; 0.001, respectively), but not in those aged ≥ 90 years (6.4% and 6.7%, p = 0.83). In multivariate logistic regression analysis adjusted for sex, initial rhythm, and time from call receipt to ROSC, witness by a non-family bystander and BCPR were significantly associated with 1-month CPC 1-2 for patients aged 65-74 years (adjusted odds ratio: 1.37 and 1.44, respectively; 95% confidence interval: 1.19-1.58 and 1.26-1.66, respectively), but not in those aged 75-89 and ≥ 90 years. Conclusions: Impact of bystander-patient relationship on neurological outcome in witnessed elderly OHCA patients varied with age.

Abstract 150: Left-digit Bias In Out-hospital Cardiac Arrest - JCS ReSS

Introduction: Left-digit bias, a cognitive bias, has been linked to medical errors in clinical decision-making. Although the impact of left-digit bias on outcome and behavior has previously been examined in the setting of in-hospital cardiac arrest, that in the setting of our-of-hospital cardiac arrest has not been fully evaluated. In the current study, we investigated the impact of left-digit bias on resuscitators’ behavior during out-of-hospital cardiac arrest (OHCA). Methods: The All-Japan Utstein Registry of the Fire and Disaster Management Agency is a nationwide, prospective, population-based OHCA registration system in the Utstein format. We retrospectively included all consecutive OHCA patients within three years below and above the age of 80 witnessed by family members from January 1, 2005, to December 31, 2020. The primary endpoints were the percentage of bystander-initiated cardiopulmonary resuscitation (BCPR) performed by family members or EMS and the percentage of prehospital physician-staffed advanced cardiac life support (ACLS). We compared the percentages of resuscitation performed by family members, emergency medical services (EMS), and physicians, by using a regression discontinuity methodology to evaluate if there was a dramatic change in the percentage of BCPR and ACLS performed rate at the age threshold of 80 years, which would imply left-digit bias. Results: Of total 1,930,273 cases of OHCA in the All-Japan Utstein registry, we enrolled total of 92,674 (4.8%) patients. The mean age of the population was 80.1 years; 61284 (66.1%) patients were men. There were 37,903 (40.9%) patients between the ages of 77 and 80, and 54,771 (59.1%) patients between the ages of 80 and 83. In this model, we identified no discontinuities in the level (risk difference, -0.50%; 95%CI -1.35% to 0.36%, 0.27%; 95%CI -0.29% to 0.84%, 0.68%; 95%CI -0.29% to 1.66%) for the percentage of BCPR by family members and EMS, and physicians’ ACLS, respectively. Conclusions: In conclusion, our findings did not imply that age-related cognitive bias affected the resuscitators’ behavior during out-of-hospital cardiac arrest.

Awareness of CPR among the family members of the patients visiting the hospital. A cross-sectional survey study

Background: Cardiac arrest is a common cause of morbidity and mortality. In out-of-hospital setting, early recognition of cardiac arrest and bystander-initiated cardiopulmonary resuscitation (CPR) improves both the chance of survival and quality of life. Objectives: The study aimed to explore awareness regarding cardiac arrest and knowledge of CPR among visitors of patients at a tertiary level hospital. Design: Cross sectional study. Method: The validated and tested self-administered questionnaire were distributed among 394 visitors of the patients admitted at Alka Hospital Pvt. Ltd, Lalitpur, Nepal. Results: Our study demonstrated that 221 (56.1%) of the respondents have knowledge regarding CPR and 201 (51.0%) of respondents have awareness about cardiac arrest through medias (37.8%) like movies and television. We found a significant difference among age group, occupation and geographical location regarding awareness of cardiac arrest. People with greater age and education knew better about cardiac arrest. There was, however, no significant difference amongst groups regarding knowledge of CPR. Very little respondents have heard about automated external defibrillators (AED). Conclusions: There is paucity in knowledge of cardiac arrest and CPR among respondents. Similarly, there is a general lack of knowledge regarding AED. Effective programs to raise the awareness of cardiac arrest and knowledge of CPR needs to be undertaken at the community level to reinforce bystander-initiated CPR and potentially save lives in the scenario of out-of-hospital cardiac arrest. Bangladesh Crit Care J September 2022; 10(2): 82-87

Efficacy of Basic Life Support and Automatic External Defibrillator Educational Program for High School

Background: Bystander-initiated cardiopulmonary resuscitation (CPR), the automatic external defibrillator (AED), and rapid activation of emergency medical service have major roles in the chain of survival of out-of-hospital cardiac arrest patients. To integrate the basic life support (BLS) knowledge into the high school curriculum, teachers are the key person. Objective: To examine the effectiveness of the BLS training program for high school teachers. Methods: In this prospective study of 146 participants, before and immediately after 2 hours lecture and 3 hours hands-on activity of BLS training program consisting of instruction on CPR, AED, and first aid for foreign body aspiration, written tests were done to assess knowledge while participants’ attitudes were evaluated by a questionnaire survey. Results: A total of 146 participants, BLS knowledge increased in all parts (early activation, chest compression, and defibrillation increased by 27.3%, 51.3%, and 82.1% with adjusted OR 13.81, 19.08, and 849.47, respectively; P &lt; .001), as well as participant’s confidence increased from 47.6% to 95.8% (adjusted OR, 31.69; P &lt; .001). Conclusions: BLS training in high school teachers increased both knowledge of chains of survival and confidence.

Bystander-initiated cardiopulmonary resuscitation and automated external defibrillator use after out-of-hospital cardiac arrest: Uncovering disparities in care and survival across the urban–rural spectrum

AimTo evaluate the association between bystander cardiopulmonary resuscitation (CPR), automated external defibrillator (AED) use, and survival after out-of-hospital cardiac arrest (OHCA) across the urban–rural spectrum. MethodsThis was a retrospective cohort study of 325,477 adult OHCAs within the Cardiac Arrest Registry to Enhance Survival from 2013 to 2019. Bystander interventions were categorized into no bystander intervention, bystander CPR alone, and bystander AED use (with or without CPR). The primary outcome was survival to hospital discharge with good neurological outcome. Multivariable logistic regression was used to evaluate the association between bystander interventions and survival by geographical status (urban, suburban, large rural, small town, or rural). ResultsBystander CPR alone occurred most often in rural areas (50.8%), and least often in urban areas (35.4%). Bystander AED use in public settings was similar across the urban–rural spectrum (10.5–13.1%). Survival with good neurological outcome varied for urban (8.1%), suburban (7.7%), large rural (9.1%), small town (7.1%), and rural areas (6.1%). In comparison to no bystander intervention, the adjusted odds ratios (95% confidence intervals) for bystander AED use and survival were 2.57 (2.37–2.79) in urban areas, 2.58 (1.81–3.67) in suburban areas, 1.99 (1.44–2.76) in large rural areas, 1.90 (1.27–2.86) in small towns, and 3.05 (1.99–4.68) in rural areas. Bystander CPR alone was also associated with survival in all areas (adjusted odds ratio range: 1.29–1.45). There was no strong evidence of interaction between bystander interventions and geographical status on the primary outcome (p = 0.63). ConclusionBystander CPR and AED use are associated with positive clinical outcomes after OHCA in all areas along the urban–rural spectrum.

Dispatching citizens as first responders to out-of-hospital cardiac arrests: a systematic review and meta-analysis.

Mobile phone technologies to alert citizen first responders to out-of-hospital cardiac arrests (OHCAs) were implemented in numerous countries. This systematic review and meta-analysis aim to investigate whether activating citizen first responders increases bystanders' interventions and improves outcomes. We searched PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials from inception to 24 November 2021, for studies comparing citizen first responders' activation versus standard emergency response in the case of OHCA. The primary outcome was survival at hospital discharge or 30 days. Secondary outcomes were discharge with favourable neurological outcome, bystander-initiated cardiopulmonary resuscitation (CPR), and the use of automated external defibrillators (AEDs) before ambulance arrival. Evidence certainty was evaluated with GRADE. Our search strategy yielded 1215 articles. After screening, we included 10 studies for a total of 23 351 patients. OHCAs for which citizen first responders were activated had higher rates of survival at hospital discharge or 30 days compared with standard emergency response [nine studies; 903/9978 (9.1%) vs. 1104/13 247 (8.3%); odds ratio (OR), 1.45; 95% confidence interval (CI), 1.21-1.74; P < 0.001], return of spontaneous circulation [nine studies; 2575/9169 (28%) vs. 3445/12 607 (27%); OR, 1.40; 95% CI, 1.07-1.81; P = 0.01], bystander-initiated CPR [eight studies; 5876/9074 (65%) vs. 6384/11 970 (53%); OR, 1.75; 95% CI, 1.43-2.15; P < 0.001], and AED use [eight studies; 654/9132 (7.2%) vs. 624/14 848 (4.2%); OR, 1.82; 95% CI, 1.31-2.53; P < 0.001], but similar rates of neurological intact discharge [three studies; 316/2685 (12%) vs. 276/2972 (9.3%); OR, 1.37; 95% CI, 0.81-2.33; P = 0.24]. Alerting citizen first responders to OHCA patients is associated with higher rates of bystander-initiated CPR, use of AED before ambulance arrival, and survival at hospital discharge or 30 days.

Dissemination of Chest Compression-Only Cardiopulmonary Resuscitation by Bystanders for Out-of-Hospital Cardiac Arrest in Students: A Nationwide Investigation in Japan.

We aimed to investigate how the types of bystander-initiated cardiopulmonary resuscitation (CPR) for out-of-hospital cardiac arrest (OHCA) among students have changed recently. We also determined the association between two types of bystander-CPRs (i.e., chest compression-only CPR [CCCPR] and conventional CPR with rescue breathing [CCRB]) and survival after OHCA. From a nationwide registry of pediatric OHCAs occurring in school settings in Japan, the data of 253 non-traumatic OHCA patients (elementary, junior high, and high school/technical college students) receiving bystander-CPR between April 2008 and December 2017 were analyzed. Multivariable logistic regression analysis was conducted to assess the impact of different types of bystander-CPR on 30-day survival with favorable neurological outcomes. The proportion of patients receiving CCCPR increased from 25.0% during 2008–2009 to 55.3% during 2016–2017 (p for trend < 0.001). Overall, 53.2% (50/94) of patients receiving CCCPR and 46.5% (74/159) of those receiving CCRB survived for 30 days with favorable neurological outcomes. Multivariable analysis showed no significant difference in outcomes between the two groups (adjusted odds ratio: 1.23, 95% confidence interval: 0.67–2.28). In this setting, CCCPR is a common type of bystander-CPR for OHCA in students, and the effectiveness of CCCPR and CCRB on survival outcomes seems comparable.

Effect of large-scale disasters on bystander-initiated cardiopulmonary resuscitation in family-witnessed, friend-witnessed and colleague-witnessed out-of-hospital cardiac arrest: a retrospective analysis of prospectively collected, nationwide, population-based data

ImportanceThe effect of large-scale disasters on bystander cardiopulmonary resuscitation (BCPR) performance is unknown.ObjectiveTo investigate whether and how large-scale earthquake and tsunami as well as subsequent nuclear pollution influenced BCPR performance...

A national population-based study of patients, bystanders and contextual factors associated with resuscitation in witnessed cardiac arrest: insight from the french R\xe9AC registry

BackgroundIn out-of-hospital cardiac arrest (OHCA), bystander initiated cardiopulmonary resuscitation (CPR) increases the chance of return of spontaneous circulation and survival with a favourable neurological status. Socioeconomic disparities have been highlighted in OHCA field. In areas with the lowest average socioeconomic status, OHCA incidence increased, and bystander CPR decreased. Evaluations were performed on restricted geographical area, and European evaluation is lacking. We aimed to analyse, at a national level, the impact of area-level social deprivation on the initiation of CPR in case of a witnessed OHCA.Methods We included all witnessed OHCA cases with age over 18 years from July 2011 to July 2018 form the OHCA French national registry. We excluded OHCA occurred in front of rescue teams or in nursing home, and patients with incomplete address or partial geocoding. We collected data from context, bystander and patient. The area-level social deprivation was estimated by the French version of the European Deprivation Index (in quintile) associated with the place where OHCA occurred. We assessed the associations between Utstein variables and social deprivation level using a mixed-effect logit model with bystander-initiated CPR.ResultsWe included 23,979 witnessed OHCA of which 12,299 (51%) had a bystander-initiated CPR. More than one third of the OHCA (8,326 (35%)) occurred in an area from the highest quintile of social deprivation. The higher the area-level deprivation, the less the proportion of bystander-initiated CPR (56% in Quintile 1 versus 48% in Quintile 5). The In the multivariable analysis, bystander less often began CPR in areas with the highest deprivation level, compared to those with the lowest deprivation level (OR=0.69, IC95%: 0.63-0.75).ConclusionsThe level of social deprivation of the area where OHCA occurred was associated with bystander-initiated CPR. It decreased in the more deprived areas although these areas also concentrate more younger patients.