Low Bystander Cardiopulmonary Resuscitation Rates Research Articles

Bystander Response and Out-of-Hospital Cardiac Arrest Outcomes (Bro. Study) in 3 Gulf Countries: Protocol for a Prospective, Observational, International Collaboration Study.

: Globally, there is significant variation in the out-of-hospital cardiac arrest (OHCA) survival rate. Early links in the chain of survival, including bystander cardiopulmonary resuscitation (CPR) and the use of an automated external defibrillator at the scene, are known to be of crucial importance, with strong evidence of increased survival rate with good neurological outcomes. The data from the Middle East are limited and report variable rates of bystander CPR and survival. It is crucial to get prospective, reliable data on bystander response in these regions to help plan interventions to improve bystander response and outcomes. This international collaborative study aims to describe the characteristics, including bystander interventions and outcomes, of OHCAs brought to hospitals enrolled in the study from Abu Dhabi, United Arab Emirates; Doha, Qatar; and Muscat, Oman. It also aims to describe the strength of the association between bystander response and OHCA outcomes, including the return of spontaneous circulation, survival to hospital admission, survival to discharge, and good neurological outcome at discharge in the local context of low bystander CPR rates. This multicenter, prospective, noninterventional observational study (Bro. Study) will be conducted at the emergency departments of 4 participating tertiary care hospitals in 3 countries. The data will be collected prospectively according to the Utstein style (a set of internationally accepted guidelines for uniform reporting of cardiac arrests) on demographic variables (age, sex, nationality, country, participating center, and comorbidities), peri-cardiac arrest variables (location, witnessed or not, bystander CPR, use of automated external defibrillator, time of emergency medical services arrival, initial rhythm, number of shocks, and time of prehospital CPR), and outcome variables (return of spontaneous circulation, survival to discharge, and neurological outcome at discharge and 3 months). Univariate and multivariate analysis with logistic regression models will be used to measure the strength of the association of bystander interventions with outcomes using SPSS (version 22). Data collection began in November 2023 and will continue for 2 years, with publication expected by early 2026. Bystander response to an OHCA is critical to a favorable outcome. The reliable, baseline bystander CPR data will be a cornerstone in the team's next planned projects, which are to qualitatively identify the barriers to bystander CPR, conduct a scoping review of community interventions in the Gulf and other Asian countries, and design and implement strategies to help improve the bystander CPR rate in the community. DERR1-10.2196/58780.

Prospective, multicenter, Turkish out-of-hospital cardiac arrest study: TROHCA.

There is no sufficient data to provide a clear picture of out-of-hospital cardiac arrest (OHCA) across Türkiye. This study is the first to present the prognostic outcomes of OHCA cases and the factors associated with these outcomes. The study was conducted in a prospective, observational, multicenter design under the leadership of the Emergency Medicine Association of Turkey Resuscitation Study Group. OHCA cases aged 18 years and over who were admitted to 28 centers from Türkiye were included in the study. Survived event, return of spontaneous circulation (ROSC), survival to hospital discharge, and neurological outcome at discharge were investigated as primary outcomes. One thousand and three patients were included in the final analysis. 61.1% of the patients were male, and the average age was 67.0 ± 15.2. Cardiopulmonary resuscitation (CPR) was performed on 86.5% of the patients in the prehospital period by emergency medical service, and bystander CPR was performed on only 2.9% by nonhealth-care providers. As a result, the survived event rate was found to be 6.9%. The survival rate upon hospital discharge was 4.4%, with 2.7% of patients achieving a good neurological outcome upon discharge. In addition, the overall ROSC and sustained ROSC rates were 45.2% and 33.4%, respectively. In the multiple logistic regression analysis, male gender, initial shockable rhythm, a shorter prehospital duration of CPR, and the lack of CPR requirement in the emergency department were determined to be independent predictors for the survival to hospital discharge. Compared to global data, survival to hospital discharge and good neurological outcome rates appear to be lower in our study. We conclude that this result is related to low bystander CPR rates. Although not the focus of this study, inadequate postresuscitative care and intensive care support should also be discussed in this regard. It is obvious that this issue should be carefully addressed through political moves in the health and social fields.

Identifying areas of Australia with high out-of-hospital cardiac arrest incidence and low bystander cardiopulmonary resuscitation rates: A retrospective, observational study.

This study aims to explore regional variation and identify regions within Australia with high incidence of out-of-hospital cardiac arrest (OHCA) and low rates of bystander cardiopulmonary resuscitation (CPR). Adult OHCAs of presumed medical aetiology occurring across Australia between 2017 and 2019 were mapped onto local government areas (LGA) using the location of arrest coordinates. Bayesian spatial models were applied to provide "smoothed" estimates of OHCA incidence and bystander CPR rates (for bystander-witnessed OHCAs) for each LGA. For each state and territory, high-risk LGAs were defined as those with an incidence rate greater than the state or territory's 75th percentile and a bystander CPR rate less than the state or territory's 25th percentile. A total of 62,579 OHCA cases attended by emergency medical services across 543 LGAs nationwide were included in the study. Nationally, the OHCA incidence rate across LGA ranged from 58.5 to 198.3 persons per 100,000, while bystander CPR rates ranged from 45% to 75%. We identified 60 high-risk LGAs, which were predominantly located in the state of New South Wales. Within each region, high-risk LGAs were typically located in regional and remote areas of the country, except for four metropolitan areas-two in Adelaide and two in Perth. We have identified high-risk LGAs, characterised by high incidence and low bystander CPR rates, which are predominantly in regional and remote areas of Australia. Strategies for reducing OHCA and improving bystander response may be best targeted at these regions.

Education of schoolchildren in cardiopulmonary resuscitation - overview of the current literature.

Recognition of cardiac arrest and initiation of cardiopulmonary resuscitation (CPR) can be learned and adequately replicated by schoolchildren. Regular instruction of schoolchildren in CPR is therefore a core element to increase low bystander CPR rates. Thereby, schoolchildren CPR training evolved as own scientific field within the last decade. Aim was to describe current evidence in terms of epidemiology, teaching approaches and political aspects. Schoolchildren demonstrate a high motivation to be trained in CPR. Teaching approaches that combine theoretical and practical learning sessions guarantee a sustainable learning effect. Schoolchildren can adequately perform chest compressions and mouth-to-mouth ventilation from the age of 12 years. Use of digital media is a highly promising teaching approach. CPR training conducted by teachers from the own school is effective and guarantees continuous development of CPR skills. Integration of schoolchildren CPR training into school curricula is the foundation for a sustainable increase of lay resuscitation rates in the population. Scientific and political promotion of schoolchildren CPR training is needed to sensitize the population and move bystander CPR in the social focus. While bystander CPR rates are low in Europe comprehensive establishment of schoolchildren CPR training may sustainably increase survival after cardiac arrest.

Characteristics of out-of-hospital cardiac arrest patients in Riyadh province, Saudi Arabia: a cross-sectional study.

Little work has been done on out-of-hospital cardiac arrest (OHCA) in Saudi Arabia. Our goal is to report the characteristics of OHCA patients and predictors of bystander cardiopulmonary resuscitation (CPR). This cross-sectional study utilized data from the Saudi Red Crescent Authority (SRCA), a governmental emergency medical service (EMS). A standardized data collection form based on the "Utstein-style" guidelines was developed. Data were retrieved from the electronic patient care reports that SRCA providers fill out for every case. OHCA cases that were attended by SRCA in Riyadh province between June 1st, 2020 and May 31st, 2021 were included. Multivariate regression analysis was performed to assess independent predictors of bystander CPR. A total of 1,023 OHCA cases were included. The mean age was 57.2 (±22.6). 95.7% (979/1,023) of cases were adults and 65.2% (667/1,023) were males. Home was the most common location of OHCA [784/1,011 (77.5%)]. The initial recorded rhythm was shockable in 131/742 (17.7%). The EMS mean response time was 15.9 min (±11.1). Bystander CPR was performed in 130/1,023 (12.7%) and was more commonly performed in children as compared to adults [12/44 (27.3%) vs. 118/979 (12.1%), p = 0.003]. Independent predictors of bystander CPR were being a child (OR = 3.26, 95% CI [1.21-8.82], p = 0.02) and having OHCA in a healthcare institution (OR = 6.35, 95% CI [2.15-18.72], p = 0.001). Our study reported the characteristics of OHCA cases in Saudi Arabia using EMS data. We observed young age at presentation, low rates of bystander CPR, and long response time. These characteristics are distinctly different from other countries and call for urgent attention to OHCA care in Saudi Arabia. Lastly, being a child and having OHCA in a healthcare institution were found to be independent predictors of bystander CPR.

Abstract 187: Cardiac Arrest Incidence, Bystander Cardiopulmonary Resuscitation Rates, and Community Characteristics Differ by High and Low Risk Areas

Introduction: Survival from out-of-hospital cardiac arrest (OHCA) has significant variation which may be due to differing rates of bystander cardiopulmonary resuscitation (BCPR). Defining and understanding the community characteristics of high-risk areas (census tracts with low BCPR rates and high OHCA incidence) can help inform novel interventions to improve outcomes. Our objectives were to identify high and low risk census tracts in Franklin County, Ohio and to compare the OHCA incidence, BCPR rates, and community characteristics. Methods: This was a cross-sectional analysis of OHCA events treated by Columbus Division of Fire in Franklin County, Ohio from the Cardiac Arrest Registry to Enhance Survival between 1/1/2010-12/31/2017. Included cases were 18 and older, with a cardiac etiology OHCA in a non-healthcare setting, with EMS resuscitation attempted. After geocoding to census tracts, Local Moran’s I and quartiles were used to determine clustering in high risk areas based on spatial Empirical Bayes smoothed rates. Community characteristics, from the 2014 American Community Survey, were compared between high and low risk areas. Results: From the 3,841 included OHCA cases, the mean adjusted OHCA incidence per census tract was 0.67 per 1,000 with a mean adjusted BCPR rate of 31% and mean adjusted survival to discharge of 9.4%. In the 25 census tracts identified as high-risk areas, there were significant differences in characteristics compared to low-risk areas, including a higher proportion of African Americans (64% vs. 21%, p<0.001), lower median household income ($30,948 vs. $54,388, p<0.001), and a higher proportion living below the poverty level (36% vs. 20%, p<0.001). There was a 3-fold increase in the adjusted OHCA incidence between high and low risk areas (1.68 vs. 0.57 per 1,000, p<0.001) with BCPR rates of 27% and 31% (p=0.31), respectively. Compared to a previous analysis, 9 (36%) census tracts persisted as high-risk but an additional 16 were newly identified. Conclusions: Neighborhood-level variations in OHCA incidence are dramatic with marked disparities in characteristics between high and low risk areas. It is possible that improving OHCA outcomes requires multifaceted interventions to address social determinants of health.

Characteristics of neighbourhoods with high incidence of out-of-hospital cardiac arrest and low bystander cardiopulmonary resuscitation rates in England.

The aim of the project was to identify the neighbourhood characteristics of areas in England where out-of-hospital cardiac arrest (OHCA) incidence was high and bystander cardiopulmonary resuscitation (BCPR) was low using registry data. Analysis was based on 67219 cardiac arrest events between 1 April 2013 and 31 December 2015. Arrest locations were geocoded to give latitude/longitude. Postcode district was chosen as the proxy for neighbourhood. High-risk neighbourhoods, where OHCA incidence based on residential population was >127.6/100000, or based on workday population was >130/100000, and BCPR in bystander witnessed arrest was <60% were observed to have: a greater mean residential population density, a lower workday population density, a lower rural-urban index, a higher proportion of people in routine occupations and lower proportion in managerial occupations, a greater proportion of population from ethnic minorities, a greater proportion of people not born in UK, and greater level of deprivation. High-risk areas were observed in the North-East, Yorkshire, South-East, and Birmingham. The study identified neighbourhood characteristics of high-risk areas that experience a high incidence of OHCA and low bystander resuscitation rate that could be targeted for programmes of training in cardiopulmonary resuscitation and automated external defibrillator use.

Identifying barriers to the provision of bystander cardiopulmonary resuscitation (CPR) in high-risk regions: A qualitative review of emergency calls

IntroductionUnderstanding regional variation in bystander cardiopulmonary resuscitation (CPR) is important to improving out-of-hospital cardiac arrest (OHCA) survival. In this study we aimed to identify barriers to providing bystander CPR in regions with low rates of bystander CPR and where OHCA was recognised in the emergency call. MethodsWe retrospectively reviewed emergency calls for adults in regions of low bystander CPR in the Australian state of Victoria. Included calls were those where OHCA was identified during the call but no bystander CPR was given. A thematic content analysis was independently conducted by two investigators. ResultsSaturation of themes was reached after listening to 139 calls. Calls progressed to the point of compression instructions before EMS arrival in only 26 (18.7%) of cases. Three types of barriers were identified: procedural barriers (time lost due to language barriers and communication issues; telephone problems), CPR knowledge (skill deficits; perceived benefit) and personal factors (physical frailty or disability; patient position; emotional factors). ConclusionA range of factors are associated with barriers to delivering bystander CPR even in the presence of dispatcher instructions – some of which are modifiable. To overcome these barriers in high-risk regions, targeted public education needs to provide information about what occurs in an emergency call, how to recognise an OHCA and to improve CPR knowledge and skills.

Does Non-Targeted Community CPR Training Increase Bystander CPR Frequency?

Objective: Only 37% of out-of-hospital cardiac arrests (OHCA) receive bystander Cardiopulmonary resuscitation (CPR) in Kent County, MI. In May 2014, prehospital providers offered one-time, point-of-contact compression-only CPR training to 2,253 passersby at 7 public locations in Grand Rapids, Michigan. To assess the impact of this intervention, we compared bystander CPR frequency and clinical outcomes in regions surrounding training sites before and after the intervention, adjusting for prehospital covariates. We aimed to assess the effect of this broad, non-targeted intervention on bystander CPR frequency, type of CPR utilized, and clinical outcomes. We also tested for differences in geospatial variation of bystander CPR and clinical outcomes clustered around training sites. Methods: Retrospective, observational, before-after study of adult, EMS-treated OHCA in Kent County from January 1, 2010 to December 31, 2015. We generated a 5-kilometer radius surrounding each training site to estimate any geospatial influence that training sites might have on bystander CPR frequency in nearby OHCA cases. Chi-squared, Fisher's exact, and t-tests assessed differences in subject features. Difference-in-differences analysis with generalized estimating equation (GEE) modeling assessed bystander CPR frequency, adjusting for training site, covariates (age, sex, witnessed, shockable rhythm, public location), and clustering around training sites. Similar modeling tested for changes in bystander CPR type, return of spontaneous circulation (ROSC), survival to hospital discharge, and cerebral performance category (CPC) of 1–2 at hospital discharge. Results: We included 899 cases before and 587 cases post-intervention. Overall, we observed no increase in the frequency of bystander CPR or favorable clinical outcomes. We did observe an increase in compression-only CPR, but this was paradoxically restricted to OHCA cases falling outside radii around training sites. In adjusted modeling, the bystander CPR training intervention was not associated with bystander CPR frequency (β −0.002; 95% CI −0.16, 0.15), compression-only CPR (β −0.06; 95% CI −0.15, 0.02), ROSC (β −0.06; 95% CI −0.21, 0.25), survival (β −0.02; 95% CI −0.11, 0.06), or favorable neurologic outcome (β −0.01; 95% CI −0.07, 0.09). Conclusions: We observed no impact in bystander CPR performance or outcomes from a blanket, non-targeted approach to community CPR education. The effect of targeted CPR education in locales with known low bystander CPR rates should be tested in this region.

Identification of characteristics of neighbourhoods with high incidence of out-of-hospital cardiac arrest and low bystander cardiopulmonary resuscitation rates

Purpose of the study: The community in which a person sustains an out-of-hospital cardiac arrest (OHCA) influences the likelihood that they will receive bystander CPR (BCPR) and ultimately survive. The aim of this research was to identify high risk communities in England with a high OHCA/low BCPR incidence to enable targeted strategies to be designed and implemented.

Are sociodemographic characteristics associated with spatial variation in the incidence of OHCA and bystander CPR rates? A population-based observational study in Victoria, Australia

BackgroundRates of out-of-hospital cardiac arrest (OHCA) and bystander cardiopulmonary resuscitation (CPR) have been shown to vary considerably in Victoria. We examined the extent to which this variation could be explained...

TAKE10: A community approach to teaching compression-only CPR to high-risk zip codes

ObjectiveBystander cardiopulmonary resuscitation (CPR) for out-of-hospital cardiac arrest (OHCA) has the ability to improve patient survival. However, the rates at which CPR occurs are suboptimal. We hypothesized that targeted CPR training in neighborhoods with low bystander CPR and high incidence of cardiac arrests would increase the incidence of bystander CPR for adult OHCA. MethodsThis study is a descriptive observation and analysis of the TAKE 10 program, which recruited City of Austin and Travis County residents to teach fellow community members compression-only CPR. Twelve zip codes in Austin and Travis County were identified as “high-risk,” based on low bystander CPR rates and high incidences of cardiac arrest. Data was collected on bystander CPR for OHCA over the study period of July 2008 to September 2013. Incidence of cardiac arrest and bystander CPR were calculated yearly and overall. ResultsOver the study period, a total of 11,242 community members completed compression-only CPR training. While there was no significant difference in the number of individuals trained in high-risk zip codes compared to the other zip codes (High-Risk [n±sd] 263±235; General 212±193; p-value 0.46), the amount of people trained in the high-risk zip codes did trend upwards over the study period. Additionally, there was an increase in percent of bystander CPR per eligible cardiac arrest in the high-risk zip codes (2009: [n±sd] 0.28±0.34 to 2013: 0.39±0.28). ConclusionsTargeted compression-only CPR training in high-risk neighborhoods may be associated with increased bystander CPR rates over time.

Resuscitation training for lay persons in first aid courses: Transfer of knowledge, skills and attitude

Bystander cardiopulmonary resuscitation (CPR) is the most effective intervention for out of hospital sudden cardiac arrest; therefore, basic life support (BLS) courses for lay persons have become well established in industrialized countries, often since decades. Despite this favorable situation bystander CPR rates still remain low in some countries (e.g. in Germany), indicating serious implementation problems. The quality of instruction in these courses could be one reason for low bystander CPR rates. We therefore analyzed official lay BLS courses in terms of the teaching quality in the domains of knowledge, skills and attitudes (according to Bloom's taxonomy). A total of 20 officially accredited lay BLS courses in Berlin, Germany, were analyzed by a participating observer, who remained blinded to the instructor and course participants until the end of the course. Courses were offered by German rescue organizations and private providers according to European Resuscitation Council (ERC) guidelines. Teaching quality was rated by a standardized checklist including 21 observable criteria of teaching quality for transfer of knowledge (n = 10), skills (n = 8) and attitudes (n = 3). In order to achieve comparability between items the results of each criterion were quantified by Likert scales ranging from +2 (very good) to -2 (very poor). The average score of all courses was +0.47 (SD ±0.46) for transfer of knowledge, +0.03 (SD ±0.61) for skills and -1.08 (SD ±0.73) for attitudes. In the domain of knowledge transfer, learning atmosphere and course structure were rated to be generally good, whilst marked deficits were found with respect to correctness of content. In the domain of skills the more positive ratings were given for teaching of single BLS elements (e.g. compressions and ventilation), in contrast to the training of BLS context, where e.g. realistic scenarios were only used by 3 out of 20 instructors. The domain of attitude transfer had the worst rating. Detailed ratings were -0.90 for "reducing fear of doing harm to the victim", -1.25 for "positive attribution of practical training" and -1.10 for "explaining course relevance from the learners' perspective". Within the observed BLS courses the teaching quality revealed significant deficits, especially for the transfer of positive attitudes to learners. Also, the use of meaningful realistic scenario teaching was very scarce. These findings can significantly contribute to low bystander CPR rates because transfer of learned content into practice may be hampered.

Association of neighborhood characteristics with incidence of out-of-hospital cardiac arrest and rates of bystander-initiated CPR: Implications for community-based education intervention

ObjectiveA 10-fold regional variation in survival after out-of-hospital cardiac arrest (OHCA) has been reported in the United States, which partly relates to variability in bystander cardiopulmonary resuscitation (CPR) rates. In order for resources to be focused on areas of greatest need, we conducted a geospatial analysis of variation of CPR rates. MethodsUsing 2010–2011 data from Durham, Mecklenburg, and Wake counties in North Carolina participating in the Cardiac Arrest Registry to Enhance Survival (CARES) program, we included all patients with OHCA for whom resuscitation was attempted. Geocoded data and logistic regression modeling were used to assess incidence of OHCA and patterns of bystander CPR according to census tracts and factors associated herewith. ResultsIn total, 1466 patients were included (median age, 65 years [interquartile range 25]; 63.4% men). Bystander CPR by a layperson was initiated in 37.9% of these patients. High-incidence OHCA areas were characterized partly by higher population densities and higher percentages of black race as well as lower levels of education and income. Low rates of bystander CPR were associated with population composition (percent black: OR, 3.73; 95% CI, 2.00–6.97 per 1% increment in black patients; percent elderly: 3.25; 1.41–7.48 per 1% increment in elderly patients; percent living in poverty: 1.77, 1.16–2.71 per 1% increase in patients living in poverty). ConclusionsIn 3 counties in North Carolina, areas with low rates of bystander CPR can be identified using geospatial data, and education efforts can be targeted to improve recognition of cardiac arrest and to augment bystander CPR rates.

Incidence of Cardiopulmonary Resuscitation Training in the United States

Immediate provision of cardiopulmonary resuscitation (CPR) by a layperson or a health care provider may double an individual’s likelihood of surviving cardiac arrest. Despite extensive CPR tra ining programs throughout the United States, studies from a range of communities have demonstrated that fewer than one-third of individuals who experience out-of-hospital cardiac arrest receive bystander-initiated CPR before the arrival of emergency medical services personnel and that CPR delivery varies considerably between different locales.1,2 Whether such variability is the result of differences in a willingness to provide care or differences in the prevalence of CPR training remains unknown. This knowledge gap underscores a related and perhaps more fundamental question that remains unanswered some 50 years after the development of CPR: What is the rate of CPR training in the US population? To highlight the challenge of low rates of bystander CPR, a recent scientific statement from the American Heart Association called for an increased emphasis on CPR training for the lay public.3 Large-scale CPR training projects have been initiated by nonprofit organizations and academic institutions to address this deficiency, such as the HeartRescue Project, in which 6 states intend to increase survival of cardiac arrest by 50% within 5 years, with an emphasis on early, effective bystander CPR.4 Efforts have also been made to target at-risk populations by providing CPR training to family members of hospitalized patients with cardiac disease.5 In addition, school-based CPR educational projects have been undertaken to increase training prevalence.

Geospatial Analysis for Targeting Out-of-Hospital Cardiac Arrest Intervention

Bystander cardiopulmonary resuscitation (BCPR) provides an opportunity for decreasing cardiac mortality. Rates of out-of-hospital cardiac arrest (OHCA) in which resuscitation was performed vary within cities and across demographics. To identify contiguous geographic census tracts with high OHCA, low BCPR rates and high-risk demographics to effectively target culturally appropriate community-based intervention planning. In 2012, a cohort of 11,389 emergency medical services (EMS) OHCA cases from Houston TX (2004-2011) was linked to census tracts. Multivariable logistic regression analyses were used to identify demographics of contiguous geographic census tracts with the highest OHCA rates. Within these tracts, BCPR rates were evaluated. The combination of information was used to develop a plan to better target interventions. Contiguous census tracts of high OHCA rates were identified; the average rate per 100,000 within versus outside the identified tracts is 106.0 (SD 23.7) to 55.8 (SD 19.7). Tracts with a low BCPR rate (37.7%) relative to a high OHCA rate were identified. In a separate analysis, individuals at highest relative risk of OHCA were found to be African Americans, to have low income or education levels, and to be older individuals. For every 1% increase in African Americans in a census tract, there is an increase of 2.7% in the relative risk of the census tract belonging to a high-OHCA-rate region (95% CI=2.0%, 3.5%). Geospatial analysis can provide important information on the contiguous areas of high OHCA rates and low BCPR rates with the aim of more effectively targeting interventions and ultimately decreasing cardiac deaths.

Increasing Cardiopulmonary Resuscitation Provision in Communities With Low Bystander Cardiopulmonary Resuscitation Rates

There are approximately 360 000 out-of-hospital cardiac arrests (OHCAs) in the United States each year, accounting for 15% of all deaths.1 Striking geographic variation in OHCA outcomes has been observed, with survival rates varying from 0.2% in Detroit, MI,2 to 16% in Seattle, WA.3 Survival variation can be explained in part by differing rates of bystander cardiopulmonary resuscitation (CPR), a vital link in improving survival for victims of OHCA. For every 30 people who receive bystander CPR, 1 additional life is saved.4 Communities that have increased rates of bystander CPR have experienced improvements in OHCA survival5,6; therefore, a promising approach to increasing OHCA survival is to increase the provision of bystander CPR. Yet provision of bystander CPR varies dramatically by locale, with rates ranging from 10% to 65% in the United States.7,8 On average, however, bystander CPR is provided in only approximately one fourth of all OHCA events in the United States despite public education campaigns and promotion of CPR as a best practice by organizations such as the American Heart Association and American Red Cross.9–11 Internationally, similar variation exists, with rates of bystander CPR reported to be as low as 1%12 and as high as 44%.13 Therefore, it is important to understand why certain communities have low bystander CPR rates and to provide recommendations for how to increase bystander CPR provision in these communities. Four critical steps are involved in providing bystander CPR as part of a coordinated community emergency response (Figure 1). First, the potential rescuer must recognize that the victim needs assistance. Early recognition may include the bystander recognizing that the victim has had a cardiac arrest, or simply that the victim needs assistance from emergency medical services (EMS). Second, the …

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More Science for the New Subspecialty

Small Area Variations in Out-of-Hospital Cardiac Arrest: Does the Neighborhood Matter?

The incidence and outcomes of out-of-hospital cardiac arrest vary widely across cities. It is unknown whether similar differences exist at the neighborhood level. To determine the extent to which neighborhoods have persistently high rates of cardiac arrest but low rates of bystander cardiopulmonary resuscitation (CPR). Multilevel Poisson regression of 1108 cardiac arrests from 161 census tracts as captured by the Cardiac Arrest Registry to Enhance Survival (CARES). Fulton County, Georgia, between 1 October 2005 to 30 November 2008. Incidence of cardiac arrest, by census tract and year and by rates of bystander CPR. Adjusted rates of cardiac arrest varied across neighborhoods (interquartile range [IQR], 0.57 to 0.73 per 1000 persons; mean, 0.64 per 1000 persons [SD, 0.11]) but were stable from year to year (intraclass correlation, 0.36 [95% CI, 0.26 to 0.50]; P < 0.001). Adjusted bystander CPR rates also varied by census tract (IQR, 19% to 29%; mean, 25% [SD, 10%]). Analysis was based on data from a single county. Surveillance data can identify neighborhoods with a persistently high incidence of cardiac arrest and low rates of bystander CPR. These neighborhoods are promising targets for community-based interventions. Robert Wood Johnson Foundation Clinical Scholars Program, National Institutes of Health, and Centers for Disease Control and Prevention.

Reducing Barriers for Implementation of Bystander-Initiated Cardiopulmonary Resuscitation

Sudden cardiac arrest (SCA) is a leading cause of death in the United States and Canada. In the United States, each year ≈330 000 people die of coronary heart disease out of the hospital or in emergency departments. Of these, >150 000 SCAs occur out of the hospital.1,2 Despite the development of electrical defibrillation and the more recent implementation of lay rescuer defibrillation programs, the vast majority of these victims do not leave the hospital alive. In studies over the past 15 years, only 1.4% of patients with out-of-hospital arrest in Los Angeles, Calif, survived to hospital discharge3; in Chicago, Ill, the number was 2%,4 and in Detroit, Mich, it was <1%.5 Conversely, a few municipalities such as Seattle, Wash, report much higher survival rates from SCA—more than 15% in 1 study6—which suggests that survival rates need not remain so low. Recent work in Europe and elsewhere has confirmed that a higher survival-to-hospital discharge rate is indeed a realistic goal, with survival rates as high as 9% reported in Amsterdam7 and 21% in Maribor, Slovenia.8 The American Heart Association (AHA) uses 4 links in the “chain of survival” to illustrate the time-sensitive actions required for victims of SCA: (1) early recognition of the emergency and activation of emergency medical services (EMS), (2) early bystander cardiopulmonary resuscitation (CPR), (3) early delivery of shock(s) from a defibrillator if indicated, and (4) early advanced life support and postresuscitation care. Immediate bystander recognition of the emergency and EMS activation are critical. In many communities, however, these actions may be followed by significant delays, because the time interval from activation of EMS to arrival of these medical personnel may be 7 to 8 minutes or longer.4 Therefore, initial care in the first critical minutes after …