Bystander Cardiopulmonary Resuscitation Rates Research Articles

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.

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

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

Rural cardiac arrest care and outcomes in Texas

IntroductionOut-of-hospital cardiac arrest (OHCA) victims in rural communities have worse outcomes despite higher rates of bystander cardiopulmonary resuscitation (CPR) than urban communities. In this retrospective cohort study we attempt to evaluate selected aspects of the continuum of care, including post-arrest care, for rural OHCA victims, and we investigated factors that could contribute to rural areas having higher rates of bystander CPR. MethodsWe analyzed 2014–2020 Texas Cardiac Arrest Registry to Enhance Survival (TX-CARES) data for adult OHCAs. We linked TX-CARES data to census tract data and stratified OHCAs into urban and rural events. We created a mixed-model logistic regression to compare cardiac arrest characteristics, pre-hospital care, and post-arrest care between rural and urban settings. We adjusted for confounders and modeled census tract as a random intercept. We then compared different regression models evaluating the association between response time and bystander CPR. ResultsWe included 1202 rural and 28,288 urban cardiac arrests. Comparing rural to urban OHCAs, rates of bystander CPR were significantly higher in rural communities (49.6% v 40.6%, aOR 1.3 95% CI 1.1–1.5). The median response time for rural (11.5 min) was longer than urban (7.3 min). The occurrence of an ambulance response time of <10 min was notably less common in rural communities when compared to urban areas (aOR 0.2, 95% CI 0.2–0.2). For post-arrest care the rates of percutaneous coronary intervention (PCI) were higher in rural than urban communities (aOR 1.7, 95% CI 1.01–2.8). The rates of AED and TTM were similar between urban and rural communities. Survival to hospital discharge was significantly lower in rural communities than urban communities (aOR 0.6, 95% CI 0.4–0.7). Although not significant, rural communities had lower rate of survival with a cognitive performance score (CPC) of 1 or 2 (aOR 0.7, 05% CI 0.6–1.003). We identified no association between response time and bystander CPR. ConclusionPatients in rural areas of Texas have lower survival after OHCA compared to patients in urban areas, despite having significantly greater rates of bystander CPR and PCI. We did not find a link between response time and bystander CPR rates.

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.

Abstract 408: Out-of-Hospital Cardiac Arrest in Children: An Epidemiological Study Based on the German Resuscitation Registry Identifying Modifiable Factors for Return of Spontaneous Circulation

Aim: This work provides an epidemiological overview of out-of-hospital cardiac arrest (OHCA) in children in Germany between 2007 and 2021. We wanted to identify modifiable factors associated with survival. Methods: Data from the German Resuscitation Registry (GRR) was used, and we included patients registered between 1 st January 2007 and 31 st December 2021. We included children aged &gt;7 days and &lt;18 years, where cardiopulmonary resuscitation (CPR) was started and treatment was continued by emergency medical services (EMS). Incidences and descriptive analyses are presented for the overall cohort and each age group. Multivariate binary logistic regression was performed on the whole cohort to determine the influence of (1) CPR with/without ventilation started by bystander, (2) OHCA witnessed status, and (3) nighttime on the outcome hospital admission with ROSC. Results: OHCA in children aged &lt;1 year had the highest incidence per 100 000 inhabitants, with 23.42, accounting for 42.0% of all included cases. Overall, hypoxia was the leading presumed cause of OHCA; whereas trauma and drowning accounted for a high proportion in children aged &gt;1 year. Bystander-witnessed OHCA and bystander CPR rate were highest in children aged 1-4 years, with 43.9% and 62.3%, respectively. In reference to EMS-started CPR, bystander CPR with ventilation were associated with an increased odds ratio for ROSC at hospital admission after adjusting for age, sex, year of OHCA and location of OHCA. Conclusion: This study provides an epidemiological overview of OHCA in children in Germany and identifies bystander CPR with ventilation as one primary factor for survival.

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.

Out-of-hospital cardiac arrest in children: an epidemiological study based on the German Resuscitation Registry identifying modifiable factors for return of spontaneous circulation

AimThis work provides an epidemiological overview of out-of-hospital cardiac arrest (OHCA) in children in Germany between 2007 and 2021. We wanted to identify modifiable factors associated with survival.MethodsData from the German Resuscitation Registry (GRR) were used, and we included patients registered between 1st January 2007 and 31st December 2021. We included children aged between > 7 days and 17 years, where cardiopulmonary resuscitation (CPR) was started, and treatment was continued by emergency medical services (EMS). Incidences and descriptive analyses are presented for the overall cohort and each age group. Multivariate binary logistic regression was performed on the whole cohort to determine the influence of (1) CPR with/without ventilation started by bystander, (2) OHCA witnessed status and (3) night-time on the outcome hospital admission with return of spontaneous circulation (ROSC).ResultsOHCA in children aged < 1 year had the highest incidence of the same age group, with 23.42 per 100 000. Overall, hypoxia was the leading presumed cause of OHCA, whereas trauma and drowning accounted for a high proportion in children aged > 1 year. Bystander-witnessed OHCA and bystander CPR rate were highest in children aged 1–4 years, with 43.9% and 62.3%, respectively. In reference to EMS-started CPR, bystander CPR with ventilation were associated with an increased odds ratio for ROSC at hospital admission after adjusting for age, sex, year of OHCA and location of OHCA.ConclusionThis study provides an epidemiological overview of OHCA in children in Germany and identifies bystander CPR with ventilation as one primary factor for survival.Trial registrations German Clinical Trial Register: DRKS00030989, December 28th 2022.Graphical

Nigerian Athletes’ Previous Training, Practice and Current Knowledge of Bystander Cardiopulmonary Resuscitation

Background /Aim: The public health burden of out-of-hospital cardiac arrest (OHCA) and the need to increase the rates of bystander cardiopulmonary resuscitation (CPR) in communities including the world of sports cannot be overemphasized. The study aimed at assessing the level of previous training, practice and present knowledge of bystander CPR among Nigerian athletes.&#x0D; Methods: A national cross-sectional questionnaire-based survey of Nigerian athletes was carried out involving 25 different sporting events. The participants at the 21st National Sports Festival that held at Delta State, Nigeria filled the questionnaire, which was continued after the festival at some of their various states. The final data was analysed with the SPSS Version 25, using both descriptive and chi-square statistics, as well as one-sample t-test. The significance level was set at P &lt; .05.&#x0D; Results: In all, 419 athletes participated in the study - 278 (66.3%) males and 141(33.7%) females with age range of 11- 49 years and mean age of 23.43 + 5.66 (SD). On average, 67.86% of the athletes had never had any previous bystander CPR training while 55.73% never practiced the procedure. Significantly more of the athletes never had CPR bystander training before this study (P = .000), as well as no previous practice (P = .0000), which did not significantly differ between contact and non-contact sports athletes. Significantly more of them had poor bystander CPR theoretical knowledge (P = .000) that did not vary significantly between contact and non-contact sports athletes, with average of only 27.23% of the athletes giving correct answers.&#x0D; Conclusion: The study has revealed significantly low previous training, practice and poor knowledge of bystander CPR among Nigerian athletes. There is urgent need for organised, sustainable bystander CPR training facilities for Nigerian athletes.

Targeted temperature management after cardiac arrest

Actively avoiding fever is the only possibility to improve neurological outcome after cardiac arrest. It is uncertain if and which patients benefit from a lower target temperature. The ERC Guidelines in 2021 recommended targeted temperature management (TTM) for all patients after in- and out-of-hospital cardiac arrest with a target temperature of 32-36 °C for at least 24 hours. These recommendations were updated in 2022 by the ERC/ESICM Guidelines suggesting to avoid fever only within the first 72 hours after the event. Divergent results of recent trials lead to these guideline changes. The large TTM2 Trial in 2021 did not show a benefit neither in survival nor in neurological outcome in the group of hypothermia at 33°C compared to normothermia. Although leading to the updated guidelines, applying these study results to the German population is restricted as the rate of bystander cardiopulmonary resuscitation (CPR) or shockable rhythms is much lower in Germany. Further studies are needed to allow a better differentiation of subpopulations and to implement a more individual classification und therapy.

Comparison of Out-of-Hospital Cardiac Arrest Outcomes Between Asian and White Individuals in the United States.

Background Disparities in bystander cardiopulmonary resuscitation (CPR) and survival have been reported for Black and Hispanic individuals with out-of-hospital cardiac arrest (OHCA). Whether Asian individuals have lower rates of bystander CPR and survival for OHCA, as compared with White individuals, remains unknown. Methods and Results Within the US-based CARES (Cardiac Arrest Registry to Enhance Survival), we identified 278 989 OHCAs in Asian and White individuals during 2013 to 2021. Using hierarchical Poisson logistic regression with emergency medical service agency modeled as a random effect and patient and OHCA characteristics as fixed effects, we compared rates of bystander CPR, survival to discharge, and favorable neurological survival between Asian and White individuals with OHCA. Overall, 14 835 (5.3%) OHCAs occurred in Asian individuals. Compared with White individuals with OHCA, Asian individuals were older (67.0±17.6 versus 62.8±16.9 years) and were less likely to have drug overdose as the cause of OHCA (1.3% versus 6.6%) and a shockable arrest rhythm (19.2% versus 22.4%). Layperson bystander CPR rates were similar between Asian and White individuals (42.6% versus 42.1%; adjusted relative risk for Asian individuals, 0.99 [95% CI, 0.97-1.02]; P=0.69). However, rates of survival to discharge were lower in Asian individuals with OHCA (8.2% versus 10.3%; adjusted relative risk 0.92 [0.86-0.98] P=0.006). Similarly, the rate of favorable neurological survival was lower for Asian individuals (6.5% versus 8.7%; adjusted relative risk, 0.85 [0.79-0.91]; P<0.001). Conclusions Despite similar rates of bystander CPR, Asian individuals with OHCA have lower survival rates than White individuals with OHCA. The reasons for the lower survival rate deserve further study to determine whether there are disparities in resuscitation care between Asian and White individuals with OHCA.

Impact of post-dispatch advice on bystander cardiopulmonary resuscitation in out-of-hospital cardiac arrest in Hong Kong

Background: In Hong Kong, the post-dispatch advice on cardiopulmonary resuscitation has been implemented since October 2018. Our study aimed to (1) evaluate the impact of post-dispatch advice on the bystander cardiopulmonary resuscitation rate and out-of-hospital cardiac arrest survival and (2) characterise the reasons for not providing dispatch-assisted cardiopulmonary resuscitation, which have important implications in public cardiopulmonary resuscitation education. Method: We retrospectively analysed the records of 749 adult patients with out-of-hospital cardiac arrest between 1 September 2021 and 31 October 2021. The primary outcome was survival to hospital discharge. The secondary outcomes included return of spontaneous circulation and survival to hospital admission. Results: The overall dispatch-assisted cardiopulmonary resuscitation rate was 49.6%. Patients who received dispatch-assisted cardiopulmonary resuscitation had a higher proportion of witnessed cardiac arrest (37.7% vs 24.7%, p &lt; 0.001) and a shorter time interval from recognition of cardiac arrest to chest compression (median 3.0 min vs 13.0 min, p &lt; 0.001) compared with patients without dispatch-assisted cardiopulmonary resuscitation. 16.8% of out-of-hospital cardiac arrest victims had return of spontaneous circulation before or upon arrival at the hospital. Patients who received dispatch-assisted cardiopulmonary resuscitation had a higher return of spontaneous circulation (18.3% vs 15.4%), survival to hospital admission (15.9% vs 13.3%) and survival to hospital discharge (2.7% vs 1.3%) rates compared with those who did not. However, the differences did not reach statistical significance. Conclusion: Post-dispatch advice improved the overall bystander cardiopulmonary resuscitation rate in out-of-hospital cardiac arrest and shortened the time from out-of-hospital cardiac arrest recognition to chest compression, but the improvement in survival did not reach statistical significance. Further public education on cardiac arrest recognition and dispatch-assisted cardiopulmonary resuscitation is necessary.

Dispatch of Volunteer Responders to Out-of-Hospital Cardiac Arrests

BackgroundSystems for dispatch of volunteer responders to collect automated external defibrillators and/or to provide cardiopulmonary resuscitation (CPR) in cases of nearby out-of-hospital cardiac arrest (OHCA) are widely implemented. ObjectivesThis study aimed to investigate whether the activation of a volunteer responder system to OHCAs was associated with higher rates of bystander CPR, bystander defibrillation, and 30-day survival vs no system activation. MethodsThis was a retrospective observational analysis within the ESCAPE-NET (European Sudden Cardiac Arrest network: Towards Prevention, Education, New Effective Treatment) collaborative research network. Included were cases of OHCA between 2015 and 2019 from 5 European sites with volunteer responder systems. At all sites, systems were activated by dispatchers at the emergency medical communication center in response to suspected OHCA. Exposed cases (system activation) were compared with nonexposed cases (no system activation). Risk ratios (RRs) were calculated for the outcomes of bystander CPR, bystander defibrillation, and 30-day survival after inverse probability treatment weighting. Missing data were handled using multiple imputation. ResultsIn total, 9,553 cases were included. In 4,696 cases, the volunteer responder system was activated, and in 4,857 it was not. The pooled RRs were 1.30 (95% CI: 1.15–1.47) for bystander CPR, 1.89 (95% CI: 1.36–2.63) for bystander defibrillation, and 1.22 (95% CI: 1.07–1.39) for 30-day survival. ConclusionsActivation of a volunteer response system in cases of OHCA was associated with a higher chance of bystander CPR, bystander defibrillation, and 30-day survival vs no system activation. A randomized controlled trial is necessary to determine fully the causal effect of volunteer responder systems.

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.

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.

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.

Cardiopulmonary Resuscitation Performed by Bystanders: A Systematic Review

Cardiopulmonary resuscitation (CPR) is the most popular treatment for unexpected cardiac arrest. In order to enhance the survival and neurological prognosis of out of hospital cardiac arrest patients, both healthcare practitioners and lay rescuers must learn this technique. Millions of people die each year as a result of sudden cardiac arrest across the world due to ineffective CPR performed by bystander. The aim of this review is to identify the existing literature on knowledge, attitude and practice of the community at the out of hospital cardiac arrest level. Guided by the PRISMA Statement review checklist, a systematic review of the Scopus and Web of Science database and Science Direct has identified 332 related studies. The articles were assessed and analysed after evaluation using The Critical Appraisal Skills Programme Qualitative checklist. Total article accepted were n=11. We reviewed 1150 articles and selected 332 for complete evaluation. We included 11 of the 332 papers in this review that was published since 2018. We classified 11 recommendations; those with the highest scores were 1) Knowledge assisted CPR among bystander CPR remain poor, 2) CPR challenge on stranger, 3) CPR challenge on barrier, 4) The impact on quality CPR on survival rate and 5) Conventional CPR with mouth to mouth vs chest-compression only - CPR. CPR at out-of-hospital cardiac arrest, with several factors that influences such as knowledge, attitude, practice of community bystander CPR. While, the willingness (self-efficacy), the barriers and reluctant of bystander CPR still not clear. The targeted group for CPR training and tailored of training CPR for the bystander CPR give the effect and quality of CPR performance. Furthermore, the motivating factors to begin CPR at the out-of-hospital cardiac arrest level that emerged from a study of these publications. Recommendations not supported by evidence include mass training events, pulse taking prior to CPR by community and CPR using chest compressions alone. We evaluated and classified the potential impact of interventions that have been proposed to improve bystander CPR rates. Our results may help communities design interventions to improve their bystander CPR rates.

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.

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.