Increase Bystander Cardiopulmonary Resuscitation Research Articles

Declining Trend of Sudden Cardiac Death in Younger Individuals: A 20-Year Nationwide Study.

Declining cardiovascular mortality rates have been well-documented, yet temporal trends of sudden cardiac death (SCD) in young individuals remain unclear. We provide contemporary nationwide estimates of the temporal trends of SCD in young individuals (1-35 years of age) from 2000 through 2019 and correlate these trends to changes in out-of-hospital cardiac arrest (OHCA) patterns, rates of inherited cardiac diseases, and implantations of implantable cardioverter defibrillators (ICD). All individuals between 1 and 35 years of age living in Denmark from 2000 through 2019 were included, with annual re-evaluation of the at-risk population in regard to age. Adjudication of SCD cases relied on multiple sources, including death certificates, medical files, and autopsy reports. Information on OHCA, diagnostic rates, and ICD implantations were captured from nationwide administrative registries. Annual incidence rates of SCD were calculated, and temporal trends in SCD incidence were computed as percentage change annualized. Trends in OHCA survival and characteristics, diagnostic rates of inherited cardiac diseases, and ICD implantations were assessed. During the 20-year study period (47.5 million person-years), 1057 SCDs were identified (median age, 29 years; 69% male). The overall incidence of SCD was 2.2 per 100 000 person-years and declined by 3.31% (95% CI, 2.42-4.20) annually, corresponding to a 49% (95% CI, 38.7-57.6) reduction during the study. Rates of witnessed SCD declined markedly (percentage change annualized -7.03% [95% CI, -8.57 to -5.48]), but we observed no changes in the rate of unwitnessed SCD (percentage change annualized -0.09% [95% CI, -1.48 to 1.31]). Therefore, the proportion of unwitnessed SCD increased by 79% (P<0.001). Survival after OHCA in young individuals (1 to 35 years of age) increased from 3.9% to 28%, mainly because of increased bystander cardiopulmonary resuscitation and defibrillation rates. Diagnostic rates of inherited cardiac diseases increased 10-fold (incidence rate ratio, 10.4 [95% CI, 8.46-12.90]) and the ICD implantation rate increased 2-fold (incidence rate ratio, 1.97 [95% CI, 1.51-2.60]). SCD incidence rates in young individuals declined by 49% over the past 2 decades. The decline was paralleled by improved survival of OHCA, higher diagnostic rates of inherited cardiac diseases, and higher ICD implantation rates. However, rates of unwitnessed SCD were unchanged, which calls for new perspectives in preventive strategies.

Abstract 4136267: Racial and ethnic disparities in-hospital outcomes after out-of-hospital cardiac arrest: Insight from the United States national inpatient sample

Background: Out-of-hospital cardiac arrest (OHCA) continues to have a high mortality with an overall survivability to hospital discharge of less than 10%. Increased bystander cardiopulmonary resuscitation has resulted in better survival after OHCA. Some studies have tackled sociodemographic characteristics and rates of survival, but these are mostly localized studies with varied results. We investigated racial disparities in in-hospital mortality and mechanical circulatory support (MCS) use in OHCA. Methods: Retrospective cohort study based on the 2019-2020 National Inpatient Sample database of the Healthcare Utilization Project. Our population included patients 18 years or older with out-of-hospital cardiac arrest (OHCA) identified using ICD-10 codes. The primary risk factors examined were race/ethnicity categorized into White, Black, and Hispanic. The primary outcome was in-hospital mortality among patients with OHCA. The secondary outcome was mechanical circulatory support (MCS) use. Left ventricular assist device (LVAD), extracorporeal membrane oxygenation (ECMO), and intra-aortic balloon pump (IABP) were identified as MCS. Multivariate regression analysis was used to estimate the odds ratio. Results: During the study period, 26,640 hospitalizations with OHCA were identified, of whom 67,4% were White, 22,9% were Black, and 9,7% were Hispanic. The mean (SD) age of patients with OHCA was 65.2 (16) years old, and Black patients well as Hispanic patients had lower mean age compared to White patients (63.1 vs 63 vs 66.3 years old, p&lt;0.001). A total of 19,425 died (72.9%) and 0.9% needed MCS. Notably, more Hispanics needed MCS, compared to White and Black patients (1.7% vs 0.9% vs 0.4%, p=0.049). In the multivariate analysis, we did not find statistical significance among racial/ethnic groups regarding in-hospital mortality. However, Hispanic patients had higher odds of MCS (OR=2.4; CI 95% 1.05-5.55, p=0.039) compared to White patients. No statistical significance was found regarding the use of IABP or LVAD. Conclusion: Overall, in-hospital mortality was elevated. Moreover, our findings highlight significant racial disparities after OHCA regarding MCS use. More research is needed to identify factors of racial disparities to improve outcomes.

Sex disparities in bystander defibrillation for out-of-hospital cardiac arrest

Abstract Background Previous studies have suggested that females experiencing out-of-hospital cardiac arrest (OHCA) receive lower rates of both bystander cardiopulmonary resuscitation (CPR) and defibrillation compared to males. Whether this disparity has improved over time is unknown. Purpose To investigate rates of bystander CPR and defibrillation in a sex-disaggregated manner over the last two decades. Methods A state-wide OHCA registry in Victoria, Australia collected data over twenty years (2002-2021) regarding rates of bystander interventions in OHCA. Characteristics and outcomes of each OHCA were compared with logistic regression according to sex and time (defined in two-year periods). Results 32,502 OHCAs were included (69.7% male). Both bystander CPR and defibrillation rates increased for females over time (p&amp;lt;0.0001). There was no sex disparity in receipt of bystander CPR after adjustment for baseline differences. Females were less likely than males to receive bystander defibrillation, with sex disparity increasing from 2010 onwards (adjOR 0.26 (95%CI 0.09-0.80) in 2020-21 for females compared to males). Conclusion Initiatives to increase bystander CPR and defibrillation have resulted in higher overall rates of bystander interventions in the last two decades and no significant sex differences in provision of bystander CPR. However, females receive less bystander defibrillation than males, and sex disparity is increasing. Strategies to promote bystander defibrillation in females experiencing OHCA with a shockable rhythm should be a priority.

Training experience is an important factor affecting willingness for bystander CPR and awareness of AED: a survey of residents from a province in Central China in 2023.

Bystander cardiopulmonary resuscitation (CPR) and the use of automated external defibrillators (AEDs) may improve survival in patients with out-of-hospital cardiac arrest (OHCA). The purpose of this study was to investigate the effect of CPR training experience and sociodemographic characteristics on bystander CPR willingness and AED awareness. In this study, a questionnaire survey was conducted among 3,569 residents in central China. Descriptive statistics, multiple linear regression and multivariate logistic regression modeling were used to investigate the effect of training experience and sociodemographic characteristics on knowledge of cardiac arrest first aid, awareness of AEDs, and willingness for bystander CPR. Of the 3,569 participants, nearly 52% were female, 69.6% were < 23 years old, 23.5% had CPR training and 22.1% had witnessed OHCA. Characteristics of increasing bystander CPR willingness included CPR training experience, male, witnessed OHCA but not acting, knowing whether family members have cardiac disease, older age (>40 years) and lower level of education. Farmers were the subgroup with the least awareness of AED and knowledge of first aid. In China, CPR training experience was an important factor in improving bystanders' CPR willingness, AED awareness and knowledge of cardiac arrest first aid. Additionally, having witnessed OHCA also had a positive effect on bystander CPR willingness.

Wider Dissemination of Simplified Chest Compression-Only Cardiopulmonary Resuscitation Training Combined With Conventional Cardiopulmonary Resuscitation Training and 10-Year Trends in Cardiopulmonary Resuscitation Performed by Bystanders in a City.

Little is known about how to effectively increase bystander cardiopulmonary resuscitation (CPR), so we evaluated the 10-year trend of the proportion of bystander CPR in an area with wide dissemination of chest compression-only CPR (CCCPR) training combined with conventional CPR training.Methods and Results: We conducted a descriptive study after a community intervention, using a prospective cohort from September 2010 to December 2019. The intervention consisted of disseminating CCCPR training combined with conventional CPR training in Toyonaka City since 2010. We analyzed all non-traumatic out-of-hospital cardiac arrest (OHCA) patients resuscitated by emergency medical service personnel. The primary outcome was the trend of the proportion of bystander CPR. We conducted multivariate logistic regression models and assessed the adjusted odds ratio (AOR) using a 95% confidence interval (CI) to determine bystander CPR trends. Since 2010, we have trained 168,053 inhabitants (41.9% of the total population of Toyonaka City). A total of 1,508 OHCA patients were included in the analysis. The proportion of bystander CPR did not change from 2010 (43.3%) to 2019 (40.0%; 1-year incremental AOR 1.02 [95% CI: 0.98-1.05]). The proportion of bystander CPR did not increase even after wider dissemination of CPR training. In addition to continuing wider dissemination of CPR training, other strategies such as the use of technology are necessary to increase bystander CPR.

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.

Analysis of factors affecting the return of spontaneous circulation in elderly patients with out-of-hospital cardiac arrest

To investigate the factors that influence the return of spontaneous circulation (ROSC) in elderly patients suffering from out-of-hospital cardiac arrest (OHCA). A retrospective study was used to collect the clinical data of OHCA patients admitted to the emergency center of Zhengzhou People's Hospital from July 2016 to July 2019 based on the pre-hospital emergency database of Utstein model. Patients' gender, age, cardiac arrest (CA) etiology, presence or absence of bystander cardiopulmonary resuscitation (CPR), emergency response time, initial cardiac rhythm, ventilation method, use of epinephrine, defibrillation and ROSC were included. The patients were divided into elderly and young groups according to whether age ≥ 60 years old, and the differences in various indicators between the two groups were compared. Univariate Logistic regression analysis was used to analyze the relationship between emergency response time and ROSC in elderly patients and multivariate Logistic regression analysis was used to identify factors influencing ROSC in elderly patients. A total of 3 429 adult OHCA patients were enrolled in this study, including 2 105 elderly patients (61.39%), and 1 324 young and middle-aged patients (38.61%). Compared to the young group, the proportion of females, non-cardiac causes and asystole as the initial rhythm was higher in the elderly group, the emergency response time was shorter, the rate of defibrillation and tracheal intubation, and the success rate of ROSC were lower (all P < 0.05). Among them, the proportion of cardiac arrest as the initial rhythm in elderly male patients was significantly higher than that of young male patients (P < 0.05); the proportion of non-cardiac causes in elderly female patients was significantly higher than that of young female patients, and the proportion of defibrillation was significantly lower than that of young female patients (all P < 0.05). Multivariate Logistic regression analysis showed that cardiac arrest as the initial rhythm was strongly associated with ROSC in elderly male patients [odds ratio (OR) = 0.126, 95% confidence interval (95%CI) was 0.045-0.352, P < 0.05]. Univariate Logistic regression analysis of the relationship between emergency response time and ROSC in elderly patients showed that although there was no significant difference in the ROSC success rate among elderly patients with various emergency response times, an emergency response time within 10 minutes was beneficial for ROSC in elderly patients. The success rate of ROSC is very low in elderly OHCA patients aged ≥60 years. Although the CPR-related indicators of elderly patients are significantly different from those of young patients, there are gender differences. The association between the elderly male patients and cardiac arrest as the initial rhythm is stronger, while OHCA caused by non-cardiac diseases is more common and defibrillable rhythm is less common in elderly female patients. It may be more beneficial for elderly patients to shorten the emergency response time and increase bystander CPR.

Implementation of basic life support education for the lay public in China: barriers, enablers, and possible solutions.

Education for the lay public in basic life support (BLS) is critical for increasing bystander cardiopulmonary resuscitation (CPR) rates and improving survival from out-of-hospital cardiac arrest (OHCA). Despite years of implementation, the BLS training rate in China has remained modest. The aim of this study was to investigate the factors influencing the implementation of BLS training programs in emergency medical service (EMS) centers in China and to identify specific barriers and enablers. Qualitative interviews were conducted with key informants from 40 EMS centers in Chinese cities. The participants included 11 directors/deputy directors, 24 training department leaders, and 5 senior trainers. The interview guide was based on the Exploration, Preparation, Implementation, Sustainment (EPIS) framework. Thematic content analysis was used to identify themes and patterns across the interviews. We identified 16 factors influencing the implementation of BLS training programs encompassing the outer content, inner context, innovation and bridging factors. Some factors acted as either barriers or enablers at different EPIS stages. The main implementation barriers included limited external leadership, insufficient government investment, low public awareness, a shortage of trainers, an absence of incentives, an absence of authoritative courses and guidelines, a lack of qualification to issue certificates, limited academic involvement, and insufficient publicity. The main enablers were found to be supportive government leaders, strong public demand, adequate resources, program champions, available high-quality courses of high fitness within the local context, the involvement of diverse institutions, and effective publicity and promotion. Our findings emphasize the diversity of stakeholders, the complexity of implementation, and the need for localization and co-construction when conducting BLS training for lay public in city EMS centers. Improvements can be made at the national level, city level, and EMS institutional level to boost priority and awareness, promote legislation and policies, raise sustainable resources, and enhance the technology of BLS courses.

Sex disparities in bystander defibrillation for out-of-hospital cardiac arrest

BackgroundPrevious studies have suggested that females experiencing out-of-hospital cardiac arrest (OHCA) receive lower rates of both bystander cardiopulmonary resuscitation (CPR) and defibrillation compared to males. Whether this disparity has improved over time is unknown. MethodsA state-wide OHCA registry in Victoria, Australia collected data over twenty years (2002–2021) regarding rates of bystander interventions in OHCA. Characteristics and outcomes of each OHCA were compared with logistic regression according to sex and time (defined in two-year periods). Results32,502 OHCAs were included (69.7% male). Both bystander CPR and defibrillation rates increased for females over time (p < 0.0001). There was no sex disparity in receipt of bystander CPR after adjustment for baseline differences. Females were less likely than males to receive bystander defibrillation, with sex disparity increasing from 2010 onwards (adjOR 0.26 (95%CI 0.09–0.80) in 2020–21 for females compared to males). ConclusionInitiatives to increase bystander CPR and defibrillation have resulted in higher overall rates of bystander interventions in the last two decades and no significant sex differences in provision of bystander CPR. However, females receive less bystander defibrillation than males, and sex disparity is increasing. Strategies to promote bystander defibrillation in females experiencing OHCA with a shockable rhythm should be a priority.

Geographical Association Between Basic Life Support Courses and Bystander Cardiopulmonary Resuscitation and Survival from OHCA in Denmark.

Annually, approximately 4% of the entire adult population of Denmark participate in certified basic life support (BLS) courses. It is still unknown whether increases in BLS course participation in a geographical area increase bystander cardiopulmonary resuscitation (CPR) or survival from out-of-hospital cardiac arrest (OHCA). The aim of the study was to examine the geographical association between BLS course participation, bystander CPR, and 30-day survival from OHCA. This nationwide register-based cohort study includes all OHCAs from the Danish Cardiac Arrest Register. Data concerning BLS course participation were supplied by the major Danish BLS course providers. A total of 704,234 individuals with BLS course certificates and 15,097 OHCA were included from the period 2016-2019. Associations were examined using logistic regression and Bayesian conditional autoregressive analyses conducted at municipality level. A 5% increase in BLS course certificates at municipality level was significantly associated with an increased likelihood of bystander CPR prior to ambulance arrival with an adjusted odds ratio (OR) of 1.34 (credible intervals: 1.02;1.76). The same trends were observed for OHCAs in out-of-office hours (4pm-08am) with a significant OR of 1.43 (credible intervals: 1.09;1.89). Local clusters with low rate of BLS course participation and bystander CPR were identified. This study found a positive effect of mass education in BLS on bystander CPR rates. Even a 5% increase in BLS course participation at municipal level significantly increased the likelihood of bystander CPR. The effect was even more profound in out-of-office hours with an increase in bystander CPR rate at OHCA.

KIDS SAVE LIVES: Basic Life Support Education for Schoolchildren: A Narrative Review and Scientific Statement From the International Liaison Committee on Resuscitation.

Basic life support education for schoolchildren has become a key initiative to increase bystander cardiopulmonary resuscitation rates. Our objective was to review the existing literature on teaching schoolchildren basic life support to identify the best practices to provide basic life support training in schoolchildren. After topics and subgroups were defined, a comprehensive literature search was conducted. Systematic reviews and controlled and uncontrolled prospective and retrospective studies containing data on students <20 years of age were included. Schoolchildren are highly motivated to learn basic life support. The CHECK-CALL-COMPRESS algorithm is recommended for all schoolchildren. Regular training in basic life support regardless of age consolidates long-term skills. Young children from 4 years of age are able to assess the first links in the chain of survival. By 10 to 12 years of age, effective chest compression depths and ventilation volumes can be achieved on training manikins. A combination of theoretical and practical training is recommended. Schoolteachers serve as effective basic life support instructors. Schoolchildren also serve as multipliers by passing on basic life support skills to others. The use of age-appropriate social media tools for teaching is a promising approach for schoolchildren of all ages. Schoolchildren basic life support training has the potential to educate whole generations to respond to cardiac arrest and to increase survival after out-of-hospital cardiac arrest. Comprehensive legislation, curricula, and scientific assessment are crucial to further develop the education of schoolchildren in basic life support.

KIDS SAVE LIVES: Basic Life Support Education for Schoolchildren: A Narrative Review and Scientific Statement From the International Liaison Committee on Resuscitation

BACKGROUNDBasic life support education for schoolchildren has become a key initiative to increase bystander cardiopulmonary resuscitation rates. Our objective was to review the existing literature on teaching schoolchildren basic life support to identify the best practices to provide basic life support training in schoolchildren. METHODSAfter topics and subgroups were defined, a comprehensive literature search was conducted. Systematic reviews and controlled and uncontrolled prospective and retrospective studies containing data on students <20 years of age were included. RESULTSSchoolchildren are highly motivated to learn basic life support. The CHECK-CALL-COMPRESS algorithm is recommended for all schoolchildren. Regular training in basic life support regardless of age consolidates long-term skills. Young children from 4 years of age are able to assess the first links in the chain of survival. By 10 to 12 years of age, effective chest compression depths and ventilation volumes can be achieved on training manikins. A combination of theoretical and practical training is recommended. Schoolteachers serve as effective basic life support instructors. Schoolchildren also serve as multipliers by passing on basic life support skills to others. The use of age-appropriate social media tools for teaching is a promising approach for schoolchildren of all ages. CONCLUSIONSSchoolchildren basic life support training has the potential to educate whole generations to respond to cardiac arrest and to increase survival after out-of-hospital cardiac arrest. Comprehensive legislation, curricula, and scientific assessment are crucial to further develop the education of schoolchildren in basic life support.

Training in Basic Life Support and Bystander-Performed Cardiopulmonary Resuscitation and Survival in Out-of-Hospital Cardiac Arrests in Denmark, 2005 to 2019

Strategies to improve survival from out-of-hospital cardiac arrest (OHCA) include mass education of laypersons with no official duty to respond to OHCA. In Denmark, basic life support (BLS) course attendance has been mandated by law in October 2006 for obtaining a driver's license for all vehicles and in vocational education programs. To examine the association between yearly BLS course participation rate and bystander cardiopulmonary resuscitation (CPR) and 30-day survival from OHCA and to examine if bystander CPR rate acted as a mediator on the association between mass education of laypersons in BLS and survival from OHCA. This cohort study included outcomes for all OHCA incidents from the Danish Cardiac Arrest Register between 2005 and 2019. Data concerning BLS course participation were supplied by the major Danish BLS course providers. The main outcome was 30-day survival of patients who experienced OHCA. Logistic regression analysis was used to examine the association between BLS training rate, bystander CPR rate, and survival, and a bayesian mediation analysis was conducted to examine mediation. A total of 51 057 OHCA incidents and 2 717 933 course certificates were included. The study showed that the annual 30-day survival from OHCA increased by 14% (odds ratio [OR], 1.14; 95% CI, 1.10-1.18; P < .001) when BLS course participation rate increased by 5% in analysis adjusted for initial rhythm, automatic external defibrillator use, and mean age. An average mediated proportion of 0.39 (95% QBCI, 0.049-0.818; P = .01). In other words, the last result indicated that 39% of the association between mass educating laypersons in BLS and survival was mediated through an increased bystander CPR rate. In this cohort study of Danish BLS course participation and survival, a positive association was found between annual rate of mass education in BLS and 30-day survival from OHCA. The association of BLS course participation rate on 30-day survival was mediated by the bystander CPR rate; approximately 60% of the association of BLS course participation rate on 30-day survival was based on factors other than increased CPR rates.

Association Between Number of Volunteer Responders and Interventions Before Ambulance Arrival for Cardiac Arrest

BackgroundVolunteer responder (VR) programs for activation of laypersons in out-of-hospital cardiac arrest (OHCA) have been deployed worldwide, but the optimal number of VRs to dispatch is unknown. ObjectivesThe purpose of this study was to investigate the association between the number of VRs arriving before Emergency Medical Services (EMS) and the proportion of bystander cardiopulmonary resuscitation (CPR) and defibrillation. MethodsWe included OHCAs not witnessed by EMS with VR activation from the Capital Region (September 2, 2017, to May 14, 2019) and the Central Region of Denmark (November 5, 2018, to December 31, 2019). We created 4 groups according to the number of VRs arriving before EMS: 0, 1, 2, and 3 or more. Using a logistic regression model adjusted for EMS response time, we examined associations between the number of VRs arriving before EMS and bystander CPR and defibrillation. ResultsWe included 906 OHCAs. The adjusted ORs for bystander CPR were 2.40 (95% CI: 1.42-4.05), 3.18 (95% CI: 1.39-7.26), and 2.70 (95% CI: 1.32-5.52) when 1, 2, or 3 or more VRs arrived before EMS (reference), respectively. The adjusted OR for bystander defibrillation increased when 1 (1.97 [95% CI: 1.12-3.52]), 2 (2.88 [95% CI: 1.48-5.58]), or 3 or more (3.85 [95% CI: 2.11-7.01]) VRs arrived before EMS (reference). The adjusted OR of bystander defibrillation increased to 1.95 (95% CI: 1.18-3.22) when ≥3 VRs arrived first compared with 1 VR arriving first (reference). ConclusionsWe found an association of increased bystander CPR and defibrillation when 1 or more VRs arrived before the EMS with a trend toward increased bystander defibrillation with increasing number of VRs arriving first.

The dramatic increase in sudden cardiac deaths and the alarming low survival: A global call to action to improve outcome with the engagement of tertiary education system.

The number of out-of-hospital cardiac arrests, cause of disability and death, has dramatically increased worldwide, but despite the progress, the incidence of survival does not appear to have increased significantly. Bystander cardiopulmonary resuscitation (CPR) remains the principal factor in saving out-of-hospital cardiac arrest victims. Analyzing the immense efforts produced by states and professional organizations to train people in CPR skills for immediate intervention in the occurrence of a cardiac arrest, the primary global strategy is centered on CPR education and training for schoolchildren. But the rate of CPR training remains low, with wide differences among communities. The concept of CPR training for schoolchildren to increase bystander CPR rates needs to be implemented. We suggest a global call to action for the tertiary education system for CPR learning and training, including all undergraduate students regardless of the degree course, as a possible method to improve the traditional CPR training today centered on the secondary education system. Extending CPR training courses to the university educational system could significantly increase the number of people educated in life-saving maneuvers. The final objective is to improve the survival rate of patients with out-of-hospital primary cardiac arrest, which has dramatically increased worldwide.

The “ABC SAVES LIVES”: A Schoolteacher-Led Basic Life Support Program in Navarra, Spain

To implement a teacher-led basic life education program in schools. Design thinking methodology was used to develop a comprehensive program to make teachers competent and confident in the delivery of Basic Life Support (BLS), and then to independently implement teaching programs in their school’s community. Specific teaching material and training manikins were provided by the “ABC Save Lives association.” Training was open to all but focused on physical education teachers at all schools in the region. Between 2011 and 2019, 1,726 teachers from 208 schools [35% preschool-primary, 28% secondary, 28% private schools partly funded by public funds; 9% vocational] participated in the program. Sixty percent (619) were physical education teachers, who trained 59465 students. All schools have progressively been supplied with at least five BLS manikins each. In 2014, the regional government of Navarra approved mandatory BLS education in physical education in primary and secondary schools. With adequate education and proper support, physical education teachers can independently implement a Basic Life Support program in their schools aiming to increase bystander cardio-pulmonary resuscitation competencies. Furthermore, the Basic Life Support education increases students’ confidence of social responsibilities and awareness of cardiac arrest as a public health problem.

Long-term Effect of Face-to-Face vs Virtual Reality Cardiopulmonary Resuscitation (CPR) Training on Willingness to Perform CPR, Retention of Knowledge, and Dissemination of CPR Awareness

Increased bystander cardiopulmonary resuscitation (CPR) is essential to improve survival after cardiac arrest. Although most studies focus on technical CPR skills, the randomized Lowlands Saves Lives trial prespecified a follow-up survey on other important aspects that affect the widespread performance of CPR. To investigate bystander willingness to perform CPR on a stranger, theoretical knowledge retention, and dissemination of CPR awareness 6 months after undergoing short face-to-face and virtual reality (VR) CPR trainings. A prespecified 6-month posttraining survey was conducted among 320 participants in the Lowlands Saves Lives trial, a randomized comparison between 20-minute face-to-face, instructor-led CPR training and VR training. Participants were recruited at the Lowlands music festival, with a designated area to conduct scientific projects (August 16-18, 2019; the Netherlands). Statistical analysis was performed from March 1, 2020, to July 31, 2021. Two standardized 20-minute protocols on CPR and automated external defibrillator use: instructor-led face-to-face training using CPR manikins or VR training using the Resuscitation Council (UK)-endorsed Lifesaver VR smartphone application and a pillow to practice compressions. Primary outcomes were willingness to perform CPR on a stranger, theoretical knowledge retention, and dissemination of CPR awareness as reported by the entire cohort. As secondary analyses, the results of the 2 training modalities were compared. Of 381 participants, 320 consented to this follow-up survey; 188 participants (115 women [61%]; median age, 26 years [IQR, 22-32 years]) completed the entire survey and were accordingly included in the secondary analysis. The overall proportion of participants willing to perform CPR on a stranger was 77% (144 of 188): 81% (79 of 97) among face-to-face participants and 71% (65 of 91) among VR participants (P = .02); 103 participants (55%) reported feeling scared to perform CPR (P = .91). Regarding theoretical knowledge retention, a median of 7 (IQR, 6-8) of 9 questions were answered correctly in both groups (P = .81). Regarding dissemination of CPR awareness, 65% of participants (123 of 188) told at least 1 to 10 family members or friends about the importance of CPR, and 15% (29 of 188) had participated in certified, instructor-led training at the time of the survey, without differences between groups. In this 6-month posttraining survey, young adult participants of short CPR training modules reported high willingness (77%) to perform CPR on a stranger, with slightly higher rates for face-to-face than for VR participants. Theoretical knowledge retention was good, and the high dissemination of awareness suggests that these novel CPR training modules staged at a public event are promising sensitizers for involvement in CPR, although further challenges include mitigating the fear of performing CPR. ClinicalTrials.gov Identifier: NCT04013633.

The Effect of Building-Level Socioeconomic Status on Bystander Cardiopulmonary Resuscitation: A Retrospective Cohort Study

Objective Understanding the social determinants of bystander cardiopulmonary resuscitation (CPR) receipt can inform the design of public health interventions to increase bystander CPR. The association of socioeconomic status with bystander CPR is generally poorly understood. We evaluated the relationship between socioeconomic status and bystander CPR in cases of out-of-hospital cardiac arrest (OHCA). Methods This was a retrospective cohort study based on the Singapore cohort of the Pan-Asian Resuscitation Outcomes Study registry between 2010 and 2018. We categorized patients into low, medium, and high Singapore Housing Index (SHI) levels—a building-level index of socioeconomic status. The primary outcome was receipt of bystander CPR. The secondary outcomes were prehospital return of spontaneous circulation and survival to discharge. Results A total of 12,730 OHCA cases were included, the median age was 71 years, and 58.9% were male. The bystander CPR rate was 56.7%. Compared to patients in the low SHI category, those in the medium and high SHI categories were more likely to receive bystander CPR (medium SHI: adjusted odds ratio [aOR] 1.48, 95% CI 1.30–1.69; high SHI: aOR 1.93, 95% CI 1.67–2.24). High SHI patients had higher survival compared to low SHI patients on unadjusted analysis (OR 1.79, 95% CI 1.08–2.96), but not adjusted analysis (adjusted for age, sex, race, witness status, arrest time, past medical history of cancer, and first arrest rhythm). When comparing high with low SHI, females had larger increases in bystander CPR rates than males. Conclusions Lower building-level socioeconomic status was independently associated with lower rate of bystander CPR, and females were more susceptible to the effect of low socioeconomic status on lower rate of bystander CPR.

Teaching Hands-Only CPR (HOCPR) skills to 8th-grade students in urban Bengaluru: Development of a comprehensive Hands-Only CPR programme for high school students.

Background and Aims:Out-of-hospital cardiac arrest is one of the leading causes of death in India. Only 1.3% of these arrests receive bystander cardiopulmonary resuscitation (CPR). Bystander CPR increases a victim's chances of survival; training school children in Hands-Only CPR (HOCPR) is a proven method of increasing bystander CPR rates. Heart Rescue India is an international project working to improve care for cardiovascular diseases, and as a part of it, a ten module Cardiovascular disease (CVD) educational programme, including HOCPR training, was conducted in ten schools in 2017–18. The objective of our study was to assess the effectiveness of HOCPR training for 8th-grade high school students.Methods:Four hundred fourteen of the 530 enroled students from ten schools of Bengaluru participated in the study. The participants attended a one-hour didactic session about the recognition of cardiac arrest and HOCPR in three simple steps. Subsequently, students received hands-on training for HOCPR. The sessions included pre- and post-assessment of knowledge and skills. The results were statistically analysed using paired t-test and the McNemar test.Results:The mean overall pre-assessment score for knowledge was 62.07 ± 28.38%, and the post-assessment score was 72.42 ± 26.58% (P < 0.001). In addition, there was a statistically significant improvement in the post-training scores for HOCPR in all three parameters, namely compressions per minute, depth and chest recoil.Conclusion:The study demonstrated a simple yet effective HOCPR programme for high school children.

Alert system-supported lay defibrillation and basic life-support for cardiac arrest at home.

AimsAutomated external defibrillators (AEDs) are placed in public, but the majority of out-of-hospital cardiac arrests (OHCA) occur at home.Methods and resultsIn residential areas, 785 AEDs were placed and 5735 volunteer responders were recruited. For suspected OHCA, dispatchers activated nearby volunteer responders with text messages, directing two-thirds to an AED first and one-third directly to the patient. We analysed survival (primary outcome) and neurologically favourable survival to discharge, time to first defibrillation shock, and cardiopulmonary resuscitation (CPR) before Emergency Medical Service (EMS) arrival of patients in residences found with ventricular fibrillation (VF), before and after introduction of this text-message alert system. Survival from OHCAs in residences increased from 26% to 39% {adjusted relative risk (RR) 1.5 [95% confidence interval (CI): 1.03–2.0]}. RR for neurologically favourable survival was 1.4 (95% CI: 0.99–2.0). No CPR before ambulance arrival decreased from 22% to 9% (RR: 0.5, 95% CI: 0.3–0.7). Text-message-responders with AED administered shocks to 16% of all patients in VF in residences, while defibrillation by EMS decreased from 73% to 39% in residences (P < 0.001). Defibrillation by first responders in residences increased from 22 to 40% (P < 0.001). Use of public AEDs in residences remained unchanged (6% and 5%) (P = 0.81). Time from emergency call to defibrillation decreased from median 11.7 to 9.3 min; mean difference –2.6 (95% CI: –3.5 to –1.6).ConclusionIntroducing volunteer responders directed to AEDs, dispatched by text-message was associated with significantly reduced time to first defibrillation, increased bystander CPR and increased overall survival for OHCA patients in residences found with VF.