Provision Of Bystander Cardiopulmonary Resuscitation Research Articles

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<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.

The association of depression and patient and resuscitation characteristics with survival after out-of-hospital cardiac arrest: a cohort study.

Out-of-hospital cardiac arrest (OHCA) is a leading cause of death worldwide, with cardiovascular disease (CVD) being a key risk factor. This study aims to investigate disparities in patient/OHCA characteristics and survival after OHCA among patients with vs. without depression. This is a retrospective cohort study using data from the AmsteRdam REsuscitation Studies (ARREST) registry from 2008 to 2018. History of comorbidities, including depression, was obtained from the patient's general practitioner. Out-of-hospital cardiac arrest survival was defined as survival at 30 days post-OHCA or hospital discharge. Logistic regression models were used to obtain crude and adjusted odds ratios (ORs) for the association between depression and OHCA survival and possible effect modification by age, sex, and comorbidities. The potential mediating effects of initial heart rhythm and provision of bystander cardiopulmonary resuscitation were explored. Among 5594 OHCA cases, 582 individuals had pre-existing depression. Patients with depression had less favourable patient and OHCA characteristics and lower odds of survival after adjustment for age, sex, and comorbidities [OR 0.65, 95% confidence interval (CI) 0.51-0.82], with similar findings by sex and age groups. The association remained significant among the Utstein comparator group (OR 0.63, 95% CI 0.45-0.89) and patients with return of spontaneous circulation (OR 0.60, 95% CI 0.42-0.85). Initial rhythm and bystander cardiopulmonary resuscitation partially mediated the observed association (by 27 and 7%, respectively). Out-of-hospital cardiac arrest patients with depression presented more frequently with unfavourable patient and OHCA characteristics and had reduced chances of survival. Further investigation into potential pathways is warranted.

Long-term survival following out-of-hospital cardiac arrest in women and men: Influence of comorbidities, social characteristics, and resuscitation characteristics

AimWe aimed to study sex differences in long-term survival following out-of-hospital cardiac arrest (OHCA) compared to the general population, and determined associations for comorbidities, social characteristics, and resuscitation characteristics with survival in women and men separately. MethodsWe followed 2,452 Danish (530 women and 1,922 men) and 1,255 Dutch (259 women and 996 men) individuals aged ≥25 years, who survived 30 days post-OHCA in 2009–2015, until 2019. Using Poisson regression analyses we assessed sex differences in long-term survival and sex-specific associations of characteristics mutually adjusted, and compared survival with an age- and sex-matched general population. The potential predictive value was assessed with the Concordance-index. ResultsPost-OHCA survival was longer in women than men (adjusted incidence rate ratio (IRR) for mortality 0.74, 95%CI 0.61–0.89 in Denmark; 0.86, 95%CI 0.65–1.15 in the Netherlands). Both sexes had a shorter survival than the general population (e.g., IRR for mortality 3.07, 95%CI 2.55–3.70 and IRR 2.15, 95%CI 1.95–2.37 in Danish women and men). Higher age, glucose lowering medication, no dyslipidaemia medication, unemployment, and a non-shockable initial rhythm were associated with shorter survival in both sexes. Cardiovascular medication, depression/anxiety medication, living alone, low household income, and residential OHCA location were associated with shorter survival in men. Not living with children and bystander cardiopulmonary resuscitation provision were associated with shorter survival in women. The Concordance-indexes ranged from 0.51 to 0.63. ConclusionsWomen survived longer than men post-OHCA. Several characteristics were associated with long-term post-OHCA survival, with some sex-specific characteristics. In both sexes, these characteristics had low predictive potential.

Advantages of bystander-performed conventional cardiopulmonary resuscitation in out-of-hospital cardiac arrest presumably caused by drowning in Japan: a propensity score-matching analysis using an extended nationwide database

ObjectivesThis study aimed to determine whether the association between conventional bystander cardiopulmonary resuscitation (BCPR) and better outcomes in drowning-associated out-of-hospital cardiac arrest (OHCA) differs between young and older people or...

Survival Factors Associated with Toilet-Related Out-of-Hospital Cardiac Arrest

Objective: To identify the factors associated with a neurologically favourable survival of out-of-hospital cardiac arrest (OHCA) occurring in toilets. Methods: We retrospectively compared neurologically favourable 1-month survival rates and survival-related factors for 330,849 non-emergency medical service-witnessed OHCAs that occurred in toilets with those that occurred elsewhere using a nationwide database. Results: Compared to outpatient or hospital admission, OHCA was more likely to be associated with toilets (crude odds ratio [cOR] [95% confidence interval [CI]]: 2.52 [2.48–2.57]). The neurologically favourable 1-month survival rate for OHCA occurring in toilets (1.8%) was significantly lower than that in other places (2.9%) (cOR [95% CI]: 0.60 [0.53–0.68]). Bystander cardiopulmonary resuscitation (CPR) and automated external defibrillator (AED) use were minimal in toilets. Neither bystander CPR (adjusted OR [95% CI]: 1.19 [0.91–1.75]) nor AED use (adjusted OR [95% CI]: 2.05 [0.65–6.41]) was associated with improved neurologically favourable 1-month survival in toilets. Conclusions: Despite the poor neurologically favourable survival rate of OHCA in toilets, the provision of bystander CPR and AED was not associated with survival. Potential contributing factors include low rates of bystander intervention and delayed patient detection. To address this issue, focusing particular attention on unwell patients who use the toilets is crucial, and preventive approaches should be promoted.

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.

Abstract 16956: Historical Neighborhood Redlining and Bystander CPR Disparities in Out-of-Hospital Cardiac Arrest

Introduction: Out-of-hospital cardiac arrest (OHCA) is associated with low survival rates. Bystander cardiopulmonary resuscitation (CPR) is essential for improving outcomes, but its utilization remains limited, particularly among racial and ethnic minorities. Historical redlining, a practice that classified neighborhoods for mortgage risk in the 1930s, may have lasting implications for social and health outcomes. Hypothesis: This study sought to investigate the influence of redlining on the provision of bystander CPR during witnessed OHCA. Methods: We conducted an analysis using data from the comprehensive Cardiac Arrest Registry to Enhance Survival (CARES), encompassing 736,066 non-traumatic OHCA cases across the United States. The Home Owners' Loan Corporation (HOLC) map shapefiles were utilized to categorize census tracts of arrests into four grades (A signifying “best”, B “still desirable”, C “declining”, and D “hazardous”). Multivariable hierarchical logistic regression models were employed to predict the likelihood of CPR provision, adjusting for various factors including age, sex, race/ethnicity, arrest location, calendar year, and state of occurrence. Additionally, we accounted for the percentage of Black residents and residents below the poverty level. Results: Among the 43,186 witnessed cases of OHCA in graded HOLC census tracts, 37.2% received bystander CPR. The rates of bystander CPR exhibited a gradual decline across HOLC grades, ranging from 41.8% in HOLC grade A to 35.8% in HOLC grade D. In fully adjusted model, we observed significantly lower odds of receiving bystander CPR in HOLC grades C (OR 0.89, 95% CI 0.81-0.98, p=0.016) and D (OR 0.86, 95% CI 0.78-0.95, p=0.002) compared to HOLC grade A (Figure). Conclusions: Redlining, a historical segregation practice, is associated with reduced contemporary rates of bystander CPR during OHCA. Targeted CPR training in redlined neighborhoods may be imperative to enhance survival outcomes.

134 Effect of highly educated neighborhoods on provision of bystander cardiopulmonary resuscitation in pediatric OHCA

134 Effect of highly educated neighborhoods on provision of bystander cardiopulmonary resuscitation in pediatric OHCA

Association between the COVID-19 pandemic in 2020 and out-of-hospital cardiac arrest outcomes and bystander resuscitation efforts for working-age individuals in Japan: a nationwide observational and epidemiological analysis

BackgroundImproving out-of-hospital cardiac arrest (OHCA) prognosis within the working-age population is important, but no studies have investigated the effects of COVID-19 pandemic specifically on the working-age population with OHCAs. We...

Interaction between bystander sex and patient sex in bystander cardiopulmonary resuscitation for Out-of-Hospital cardiac arrests

BackgroundBystander cardiopulmonary resuscitation (CPR) is a critical factor in improving out-of-hospital cardiac arrest (OHCA) survival. The aim of this study was to investigate the interaction effect of bystander sex and patient sex on the provision of bystander CPR. MethodsThis was a retrospective cohort study using national OHCA registry in Korea. The inclusion criteria were adult bystander-witnessed OHCA patients with presumed cardiac etiology from January 2016 to December 2020. The primary outcome was the provision of bystander CPR. Multivariable logistic regression and interaction analysis were conducted to evaluate the impact of bystander sex on bystander CPR provision based on patient sex. ResultsThe study included 24,919 patients with OHCA, 58.2% with male-bystanders and 41.8% with female-bystanders. Female bystanders were less likely to perform bystander CPR than male bystanders (68.0% vs. 78.8%, adjusted OR (95% CI): 0.62 (0.58–0.66)). Among patients with CPR-trained bystanders, female bystanders had lower odds of bystander CPR (0.85 (0.73–0.97)).In the interaction analysis between bystander and patient sex, a significant difference was observed in the likelihood of bystander CPR according to the patient sex. Female bystanders had lower odds of bystander CPR than male bystanders for male patients (0.47 (0.43–0.50)). However, there were no significant differences between male and female bystanders for female patients (0.91 (0.88–1.07)). ConclusionFemale bystanders have a lower likelihood of providing bystander CPR than male bystanders. Additionally, an interaction was observed between bystander sex and patient sex in the providing bystander CPR, with the association being more pronounced in male OHCA patients.

Did lockdown influence bystanders’ willingness to perform cardiopulmonary resuscitation? A worldwide registry-based perspective

AimBystander cardiopulmonary resuscitation (CPR) significantly increases the survival rate after out-of-hospital cardiac arrest. Using population-based registries, we investigated the impact of lockdown due to Covid-19 on the provision of bystander CPR, taking background changes over time into consideration. MethodsUsing a registry network, we invited all registries capable of delivering data from 1. January 2017 to 31. December 2020 to participate in this study. We used negative binominal regression for the analysis of the overall results. We also calculated the rates for bystander CPR. For every participating registry, we analysed the incidence per 100000 inhabitants of bystander CPR and EMS-treated patients using Poisson regression, including time trends. ResultsTwenty-six established OHCA registries reported 742 923 cardiac arrest patients over a four-year period covering 1.3 billion person-years. We found large variations in the reported incidence between and within continents. There was an increase in the incidence of bystander CPR of almost 5% per year. The lockdown in March/April 2020 did not impact this trend. The increase in the rate of bystander CPR was also seen when analysing data on a continental level. We found large variations in incidence of bystander CPR before and after lockdown when analysing data on a registry level. ConclusionThere was a steady increase in bystander CPR from 2017 to 2020, not associated with an increase in the number of ambulance-treated cardiac arrest patients. We did not find an association between lockdown and bystanders’ willingness to start CPR before ambulance arrival, but we found inconsistent patterns of changes between registries.

Three-year trends in out-of-hospital cardiac arrest across the world: Second report from the International Liaison Committee on Resuscitation (ILCOR)

BackgroundThe International Liaison Committee on Resuscitation (ILCOR) Research and Registries Working Group previously reported data on systems of care and outcomes of out-of-hospital cardiac arrest (OHCA) in 2015 from 16 national and regional registries. To describe the temporal trends with updated data on OHCA, we report the characteristics of OHCA from 2015 through 2017. MethodsWe invited national and regional population-based OHCA registries for voluntary participation and included emergency medical services (EMS)-treated OHCA. We collected descriptive summary data of core elements of the latest Utstein style recommendation during 2016 and 2017 at each registry. For registries that participated in the previous 2015 report, we also extracted the 2015 data. ResultsEleven national registries in North America, Europe, Asia, and Oceania, and 4 regional registries in Europe were included in this report. Across registries, the estimated annual incidence of EMS-treated OHCA was 30.0–97.1 individuals per 100,000 population in 2015, 36.4–97.3 in 2016, and 40.8–100.2 in 2017. The provision of bystander cardiopulmonary resuscitation (CPR) varied from 37.2% to 79.0% in 2015, from 2.9% to 78.4% in 2016, and from 4.1% to 80.3% in 2017. Survival to hospital discharge or 30-day survival for EMS-treated OHCA ranged from 5.2% to 15.7% in 2015, from 6.2% to 15.8% in 2016, and from 4.6% to 16.4% in 2017. ConclusionWe observed an upward temporal trend in provision of bystander CPR in most registries. Although some registries showed favourable temporal trends in survival, less than half of registries in our study demonstrated such a trend.

Racial, ethnic, and socioeconomic disparities in out-of-hospital cardiac arrest within the United States: Now is the time for change.

This review highlights the current evidence on racial, ethnic, and socioeconomic disparities in cardiac arrest outcomes within the United States. Several studies demonstrate that patients from Black, Hispanic, or lower socioeconomic status backgrounds suffer the most from disparities at multiple levels of the resuscitation pathway, including in the provision of bystander cardiopulmonary resuscitation, defibrillator usage, and postresuscitation therapies. These gaps in care may altogether lead to lower survival rates and worse neurological outcomes for these patients. A multisystem, culturally sensitive approach to improving cardiac arrest outcomes is suggested in this article.

Abstract 142: Community-wide Bystander-focused Interventions And Sex Disparities In The Receipt Of Bystander Cardiopulmonary Resuscitation In Public

Introduction: Female sex is associated with lower receipt of bystander cardiopulmonary resuscitation (BCPR) in public. Telephone-assisted CPR (TCPR) may attenuate this known sex difference. It is unknown whether the introduction of community-wide, bystander-focused interventions may reduce this known sex difference and improve outcomes for females. Objectives: We sought to assess whether implementation of bystander-focused, out-of-hospital cardiac arrest (OHCA) interventions attenuated the sex difference seen in receipt of BCPR. We hypothesized that implementation of bystander-focused interventions would reduce the known difference observed in males compared to females in receipt of BCPR in public. Methods: We conducted a retrospective study of adult, non-traumatic OHCAs from the Singapore OHCA registry (1/2011-12/2020). Bystander-focused interventions included TCPR (7/2012 - present), CPR/AED training (04/2014 - present), and myResponder (4/2015 - present). We examined the differences between males vs females in receipt of BCPR in public using descriptive statistics, a sex-intervention interaction term, and hierarchical regression modeling. Results: The registry contained 19,321 events (2011-2020). Excluding pediatric, traumatic, EMS witnessed, and healthcare facility arrests, 18,925 events were analyzed. Of these, mean age was 68±16 and 64% were male. BCPR was administered in 56% of the events, with 61% of males and 54% of females receiving BCPR in public (p-value &lt;0.01). Females had a 29% decreased odds of receiving BCPR compared to males in public (OR: 0.72 (95% CI: 0.58-0.90), p-value &lt;0.01). With inclusion of implementation of bystander-focused interventions as an interaction term with sex, the difference in receipt of BCPR between males and females was no longer observed (p-value: ns). The sex-intervention interaction term was statistically significant (p-value&lt;0.01). No sex differences were observed when modelling survival as an outcome. Conclusion: The introduction of community-wide, bystander-focused interventions may lessen differences seen in receipt of BCPR by males and females in public. Further research on OHCA interventions is needed to increase provision of BCPR and consider addressing this disparity.

Nursing Home Versus Community Resuscitation After Cardiac Arrest: Comparative Outcomes and Risk Factors.

To investigate the characteristics and outcomes of patients who experienced cardiac arrest in nursing homes compared with those in private residences and determine prognostic factors for survival. This was a retrospective study that analyzed data from an Utstein-style registry of the Tokyo Fire Department. We identified patients aged ≥65years who experienced cardiac arrest in a nursing home or private residence from the population-based registry of out-of-hospital cardiac arrests in Tokyo, Japan, from 2014 to2018. Patients were grouped into the nursing home or the private residence groups according to their cardiac arrest location. We compared the characteristics and outcomes between the 2 groups and determined prognostic factors for survival in the nursing home group. The primary outcome was 1-month survival after cardiac arrest. In total, 37,550 patient records (nursing home group= 6271; private residence group= 31,279) were analyzed. Patients in the nursing home group were significantly older and more often had witnessed arrest, bystander cardiopulmonary resuscitation (CPR), and shock delivery using an automated external defibrillator. The 1-month survival rate was significantly higher in the nursing home group (2.6% vs 1.8%, P < .001). In the best scenario (daytime emergency call, witnessed cardiac arrest, bystander CPR provided), the 1-month survival rate after cardiac arrest in the nursing home group was 8.0% (95% confidence interval 6.4-9.9%), while none survived if they had neither witness nor bystander CPR. Survival outcome was significantly better in the nursing home group than in the private residence group and was well stratified by 3 prognostic factors: emergency call timing, witnessed status, and bystander CPR provision. Our results suggest that a decision to withhold vigorous treatment solely based on nursing home residential status is not justified, while termination of resuscitation may be determined by considering significant prognostic factors.

Bystander CPR and Survival Following Out-of-Hospital Cardiac Arrest

Out-of-hospital cardiac arrest (OHCA) is a major public challenge associated with high mortality and morbidity. The role of bystander cardiopulmonary resuscitation (CPR) is a key determinant of outcome. We evaluated patients presenting with OHCA and determined outcomes according to provision of bystander CPR.

Location of out-of-hospital cardiac arrest and the awareness time interval: a nationwide observational study

AimsA short awareness time interval (ATI, time from witnessing the arrest to calling for help) and bystander cardiopulmonary resuscitation (CPR) are important factors affecting neurological recovery after out-of-hospital cardiac arrest...

Creation of a Sudden Cardiac Arrest Safety Net

Background: More than 350,000 episodes of out-of-hospital cardiac arrest (OHCA) occur annually in the United States, with less than half of the victims receiving bystander cardiopulmonary resuscitation (CPR). Provision of bystander CPR has been noted to increase survival rates two to three-fold; however, bystander CPR is initiated in less than 50 % of out of OHCA episodes in the United States.Aim: The purpose of this pilot study was to create a sudden cardiac arrest safety net on a college campus. The American Heart Association (AHA) CPR in Schools Program© was provided to college students, athletes, faculty and staff.Method: A multi-group educational intervention with a pre- and post-test design. Results: Participant knowledge level of CPR and AED use significantly improved on the post test. Additionally, after attending the sessions participants reported an increase in comfort level performing CPR and improved knowledge of the locations of the AEDs on campus. As a result of the program, nine additional AED’s have been placed in high-traffic areas on campus.Conclusion: Empowering laypersons with the skills and knowledge to respond to potential episodes of OHCA are integral steps towards improving patient outcomes.

Effects of telephone-assisted cardiopulmonary resuscitation on the sex disparity in provision of bystander cardiopulmonary resuscitation in public locations

PurposeTelephone-assisted cardiopulmonary resuscitation (TA-CPR) is an effective community intervention to increase bystander CPR rates. This study evaluated the effect of TA-CPR on the provision of bystander CPR as a function of the patient’s sex. MethodsAdult (aged ≥ 18 years) patients who collapsed in a public location between January 2013 and December 2017 and received emergency medical service (EMS) treatment for out-of-hospital cardiac arrest (OHCA) of presumed cardiac aetiology were included in the study. The main exposures were TA-CPR and the patients’ sex. The primary outcome was the implementation of bystander CPR by laypersons. Multivariable logistic regression analysis was conducted, stratified based on the provision of TA-CPR, to examine the effect on bystander CPR according to patient sex. ResultsIn the final analysis, 15,840 patients with OHCAs were included. Patients who received TA-CPR accounted for 32.6% (5167/15,840) of the sample. Overall, 84.4% (814/964) of the women and 86.9% (3653/4203) of the men received bystander CPR in the TA-CPR group (P < 0.001). In the non-TA-CPR group, 40.5% (912/2252) of women and 47.3% (3653/8421) of men received bystander CPR (P < 0.001). In the multivariable logistic regression analysis, there was no significant difference in the odds ratio (OR) of bystander CPR according to patient sex in the TA-CPR group (adjusted OR [AOR], 0.83; 95% confidence interval [CI], 0.68–1.01). Women were less likely to receive bystander CPR if the bystanders are not directed by TA-CPR (AOR: 0.79; 95% CI, 0.70–0.87). ConclusionsTA-CPR attenuated the sex disparity in bystander CPR provided in public places.

Type of bystander and rate of cardiopulmonary resuscitation in nursing home patients suffering out-of-hospital cardiac arrest.

We investigated bystander cardiopulmonary resuscitation (CPR) provision rate and survival outcomes of out-of-hospital cardiac arrest (OHCA) patients in nursing homes by bystander type. A population-based observational study was conducted for nursing home OHCAs during 2013-2018. The exposure was the bystander type: medical staff, non-medical staff, or family. The primary outcome was bystander CPR provision rate; the secondary outcomes were prehospital return of spontaneous circulation (ROSC) and survival to discharge. Multivariable logistic regression analysis which corrected for various demographic and clinical characteristics evaluated bystander type impact on study outcomes. Bystander CPR rate trend was investigated by bystander type. Of 8281 eligible OHCA patients, 26.0%, 70.8%, and 3.2% cases were detected by medical staff, non-medical staff, and family, respectively. Provision rate of bystander CPR was 69.9% and rate of bystander defibrillation was 0.4% in total. Bystander CPR was provided by medical staff, non-medical staff, and families in 74.8%, 68.9%, and 52.1% respectively. Total survival rate was 2.2%, out of which, 3.3% was for medical staff, 3.2% for non-medical staff, and 0.6% for family. Compared to the results of detection by medical staff, the adjusted odds ratios (95% CIs) for provision of bystander CPR were 0.56 (0.49-0.63) for detection by non-medical staff and 0.33 (0.25-0.44) for detection by family. The bystander CPR rates of all three groups increased over time, and among them, the medical staff group increased the most. For prehospital ROSC and survival to discharge, no significant differences were observed according to bystander type. Although OHCA was detected more often by non-medical staff, they provided bystander CPR less frequently than the medical staff did. To improve survival outcome of nursing home OHCA, bundle interventions including increasing the usage of automated external defibrillators and expanding CPR training for non-medical staff in nursing home are needed.