Socioeconomic disparities in prehospital factors and survival after out-of-hospital cardiac arrest

Heart ◽  
2021 ◽  
pp. heartjnl-2020-317761
Author(s):  
Sidsel Møller ◽  
Mads Wissenberg ◽  
Liis Starkopf ◽  
Kristian Kragholm ◽  
Steen M Hansen ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Household Income ◽  
Socioeconomic Disparities ◽  
Lower Socioeconomic Status ◽  
Related Factors ◽  
Lower Socioeconomic ◽  
Bystander Cardiopulmonary Resuscitation ◽  
Bystander Cpr ◽  
Socioeconomic Effect ◽  
Hospital Cardiac Arrest

ObjectiveIt remains unknown whether patient socioeconomic factors affect interventions and survival after out-of-hospital cardiac arrest (OHCA), and whether a socioeconomic effect on bystander interventions affects survival. Therefore, this study examined patient socioeconomic disparities in prehospital factors and survival.MethodsFrom the Danish Cardiac Arrest Registry, patients with OHCA ≥30 years were identified, 2001–2014, and divided into quartiles of household income (highest, high, low, lowest). Associations between income and bystander cardiopulmonary resuscitation (CPR) and 30-day survival with bystander CPR as mediator were analysed by logistic regression and mediation analysis in private witnessed, public witnessed, private unwitnessed and public unwitnessed arrests, adjusted for confounders.ResultsWe included 21 480 patients. Highest income patients were younger, had higher education and were less comorbid relative to lowest income patients. They had higher odds for bystander CPR with the biggest difference in private unwitnessed arrests (OR 1.74, 95% CI 1.47 to 2.05). For 30-day survival, the biggest differences were in public witnessed arrests with 26.0% (95% CI 22.4% to 29.7%) higher survival in highest income compared with lowest income patients. Had bystander CPR been the same for lowest income as for highest income patients, then survival would be 25.3% (95% CI 21.5% to 29.0%) higher in highest income compared with lowest income patients, resulting in elimination of 0.79% (95% CI 0.08% to 1.50%) of the income disparity in survival. Similar trends but smaller were observed in low and high-income patients, the other three subgroups and with education instead of income. From 2002 to 2014, increases were observed in both CPR and survival in all income groups.ConclusionOverall, lower socioeconomic status was associated with poorer prehospital factors and survival after OHCA that was not explained by patient or cardiac arrest-related factors.

Abstract 250: Pre-Hospital Factors and Survival After Out-of-Hospital Cardiac Arrest According to Patient Income and Education; a Danish Nationwide Study

Circulation ◽  
2018 ◽  
Vol 138 (Suppl_2) ◽  
Author(s):  
Sidsel Møller ◽  
Fredrik Folke ◽  
Carolina Malta Hansen Hansen ◽  
Steen Møller Hansen ◽  
Freddy Lippert ◽  
...  
Keyword(s):  
Socioeconomic Status ◽  
Cardiac Arrest ◽  
Low Income ◽  
Heart Rhythm ◽  
Multivariable Logistic Regression Analysis ◽  
Nationwide Study ◽  
Lower Socioeconomic ◽  
Bystander Cardiopulmonary Resuscitation ◽  
Bystander Cpr ◽  
Hospital Cardiac Arrest

Introduction: Little is known about how patient socioeconomic status (income and education), relates to chance of bystander cardiopulmonary resuscitation (CPR) and survival after out-of-hospital cardiac arrest (OHCA). We assessed the association between patient socioeconomic status and bystander CPR as well as 30-day survival. Methods: OHCA patients ≥30 years of age and of presumed cardiac cause were identified through the nationwide Danish Cardiac Arrest Register, 2001-2014, and divided into high, medium and low subgroups according to 1) tertiles of household income from the year prior to OHCA and 2) highest degree of education according to the International Standard Classification of Education (ISCED) (<10 years, 10-12 years and >12 years of education). Associations of income and education with bystander CPR and 30-day survival were estimated using logistic multivariable logistic regression analysis adjusted for age, gender and calendar year. Results: In total, 25,233 OHCAs were included. Comparing patients in the highest group with patients in the lowest group of income and education, patients in the highest groups were younger, less often female and had less comorbidities. Patients in the highest groups were more likely to have: public arrests (income: 31.6% vs. 22.5%, education: 30.9% vs. 24.3%), witnessed arrests (income: 55.3% vs. 50.2%, education: 56.6% vs. 50.4%), bystander CPR (income: 52.4% vs. 34.7%, education: 51.6% vs. 40.9%) and an initial shockable heart rhythm (income: 37.6% vs. 22.1%, education: 35.7% vs. 24.1%), all p<0.001. High income and education compared to low were also associated with higher survival upon hospital arrival (income: 23.4% vs. 13.1%, education: 23.8% vs. 15.0%) and 30-day survival (income: 15.8% vs. 4.5%, education: 15.4% vs. 6.3%), p<0.001. Differences persisted in adjusted analyses: bystander CPR (high vs. low, income OR 1.43 95%CI 1.32-1.54, education OR 1.27 95%CI 1.17-1.39) and for 30-day survival (high vs. low, income OR 2.01 95%CI 1.74-2.31, education OR 2.08 95%CI 1.83-2.36). Conclusions: In this nationwide study of OHCA patients, higher socioeconomics status (income and education) was associated with higher rates of bystander CPR and 30-day survival, compared with those with lower socioeconomic status.

scholarly journals Bystander Cardiopulmonary Resuscitation Quality: Potential for Improvements in Cardiac Arrest Resuscitation

2021 ◽  
Author(s):  
Richard Chocron ◽  
Julia Jobe ◽  
Sally Guan ◽  
Madeleine Kim ◽  
Mia Shigemura ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Performance Metrics ◽  
Medical System ◽  
Emergency Medical System ◽  
Compression Rate ◽  
Emergency Medical ◽  
Bystander Cardiopulmonary Resuscitation ◽  
Bystander Cpr ◽  
Hospital Cardiac Arrest

Background Bystander cardiopulmonary resuscitation (CPR) is a critical intervention to improve survival following out‐of‐hospital cardiac arrest. We evaluated the quality of bystander CPR and whether performance varied according to the number of bystanders or provision of telecommunicator CPR (TCPR). Methods and Results We investigated non‐traumatic out‐of‐hospital cardiac arrest occurring in a large metropolitan emergency medical system during a 6‐month period. Information about bystander care was ascertained through review of the 9‐1‐1 recordings in addition to emergency medical system and hospital records to determine bystander CPR status (none versus TCPR versus unassisted), the number of bystanders on‐scene, and CPR performance metrics of compression fraction and compression rate. Of the 428 eligible out‐of‐hospital cardiac arrest, 76.4% received bystander CPR including 43.7% unassisted CPR and 56.3% TCPR; 35.2% had one bystander, 33.3% had 2 bystanders, and 31.5% had ≥3 bystanders. Overall compression fraction was 59% with a compression rate of 88 per minute. CPR differed according to TCPR status (fraction=52%, rate=87 per minute for TCPR versus fraction=69%, rate=102 for unassisted CPR, P <0.05 for each comparison) and the number of bystanders (fraction=55%, rate=87 per minute for 1 bystander, fraction=59%, rate=89 for 2 bystanders, fraction=65%, rate=97 for ≥3 bystanders, test for trend P <0.05 for each metric). Additional bystander actions were uncommon to include rotation of compressors (3.1%) or application of an automated external defibrillator (8.0%). Conclusions Bystander CPR quality as gauged by compression fraction and rate approached guideline goals though performance depended upon the type of CPR and number of bystanders.

scholarly journals Insights From the Ventricular Fibrillation Waveform Into the Mechanism of Survival Benefit From Bystander Cardiopulmonary Resuscitation

2021 ◽  
Vol 10 (19) ◽  
Author(s):  
Brooke Bessen ◽  
Jason Coult ◽  
Jennifer Blackwood ◽  
Cindy H. Hsu ◽  
Peter Kudenchuk ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Ventricular Fibrillation ◽  
Cardiopulmonary Resuscitation ◽  
Survival Benefit ◽  
Amplitude Spectrum ◽  
Peak Frequency ◽  
Spectrum Area ◽  
Bystander Cardiopulmonary Resuscitation ◽  
Bystander Cpr ◽  
Hospital Cardiac Arrest

Background The mechanism by which bystander cardiopulmonary resuscitation (CPR) improves survival following out‐of‐hospital cardiac arrest is unclear. We hypothesized that ventricular fibrillation (VF) waveform measures, as surrogates of myocardial physiology, mediate the relationship between bystander CPR and survival. Methods and Results We performed a retrospective cohort study of adult, bystander‐witnessed patients with out‐of‐hospital cardiac arrest with an initial rhythm of VF who were treated by a metropolitan emergency medical services system from 2005 to 2018. Patient, resuscitation, and outcome variables were extracted from emergency medical services and hospital records. A total of 3 VF waveform measures (amplitude spectrum area, peak frequency, and median peak amplitude) were computed from a 3‐second ECG segment before the initial shock. Multivariable logistic regression estimated the association between bystander CPR and survival to hospital discharge adjusted for Utstein elements. Causal mediation analysis quantified the proportion of survival benefit that was mediated by each VF waveform measure. Of 1069 patients, survival to hospital discharge was significantly higher among the 814 patients who received bystander CPR than those who did not (0.52 versus 0.43, respectively; P <0.01). The multivariable‐adjusted odds ratio for bystander CPR and survival was 1.6 (95% CI, 1.2, 2.1), and each VF waveform measure attenuated this association. Depending on the specific waveform measure, the proportion of mediation varied: 53% for amplitude spectrum area, 31% for peak frequency, and 29% for median peak amplitude. Conclusions Bystander CPR correlated with more robust initial VF waveform measures, which in turn mediated up to one‐half of the survival benefit associated with bystander CPR. These results provide insight into the biological mechanism of bystander CPR in VF out‐of‐hospital cardiac arrest.

P4169The crucial role of the bystander in out-of-hospital cardiac arrest resuscitation

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
T Campos ◽  
V Baert ◽  
H Hubert ◽  
E Wiel ◽  
N Benameur
Keyword(s):  
Cardiac Arrest ◽  
Survival Rate ◽  
Survival Data ◽  
Health Concern ◽  
Propensity Analysis ◽  
Bystander Cardiopulmonary Resuscitation ◽  
Bystander Cpr ◽  
The Impact ◽  
Hospital Cardiac Arrest

Abstract Background Out-of-hospital cardiac arrest (OHCA) is a major public health concern in France, given that there are 61.5 cases per 100,000 inhabitants a year. The impact of bystander action, performed before the arrival of emergency medical services (EMS), on survival has never been studied in France. Purpose Determine whether bystander cardiopulmonary resuscitation (CPR), performed before the arrival of EMS, was correlated with an increased 30-day survival rate after an OHCA. Methods 24,885 out-of-hospital cardiac arrests witnessed in France from 1 January 2012 to 1 May 2018 were analysed to determine whether CPR, performed before the arrival of EMS, was correlated with survival. Data from the Electronic Registry of Cardiac Arrests was used. The association between the effect of CPR performed before the arrival of EMS and 30-day survival rate was studied, using propensity analysis (which included variables such as age and sex of the patient, location, cause, and year of cardiac arrest, initial cardiac rhythm, EMS response time and no-flow time). Results CPR was performed before the arrival of EMS in 14,904 cases (59.9%) and was not performed in 9,981 cases (40.1%). The 30-day survival rate was 10.2% when CRP was performed by bystanders versus 3.9% when CRP was not performed before the EMS arrival (p<0.001). CPR performed by bystanders was associated with an increased 30-day survival rate (odds ratio 1.269; 1.207 to 1.334). The effect of bystander CPR on survival Conclusion Bystander CPR performed before the arrival of EMS was associated with an increased 30-day survival rate after an out-of-hospital cardiac arrest in France.

Abstract 18304: Are Prolonged Resuscitation Efforts Worthwhile? Patient Outcomes by Time to Restoration of Spontaneous Circulation in Out-of-Hospital Cardiac Arrest Patients

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Kristian Kragholm ◽  
Monique Anderson ◽  
Carolina Malta Hansen ◽  
Phillip J. Schulte ◽  
Michael C. Kurz ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Neurological Outcome ◽  
Survival Rates ◽  
Spontaneous Circulation ◽  
Significant Survival ◽  
Bystander Cardiopulmonary Resuscitation ◽  
Bystander Cpr ◽  
Using Data ◽  
Favorable Neurological Outcome ◽  
Hospital Cardiac Arrest

Introduction: How long resuscitation attempts should be continued before termination of efforts is not clear in patients with out-of-hospital cardiac arrest (OHCA). We studied outcomes in patients with return of spontaneous circulation (ROSC) across quartiles of time from 9-1-1 call to ROSC. Hypothesis: Survival with favorable neurological outcome is seen in all time intervals from 9-1-1 call to ROSC. Methods: Using data from Resuscitation Outcomes Consortium (ROC) Prehospital Resuscitation clinical trials: IMpedance valve and an Early vs. Delayed analysis (PRIMED) available via National Institute of Health, patients with ROSC not witnessed by the emergency medical service (EMS) were identified and grouped by quartiles of time from 9-1-1 call to ROSC. We defined favorable neurological outcome as modified Rankin Scale (mRS) scores of ≤3. Results: Included were 3,431 OHCA patients with ROSC. Median time from 9-1-1 call to ROSC was 22.8 min (25%-75% 17 min–29.2 min); 953 (27.8%) survived to discharge (20.4% mRS ≤3). Significant survival and favorable neurological outcome were seen in each quartile (Figure). In patients who received bystander cardiopulmonary resuscitation (CPR), survival rates were 60.9%, 33.2%, 18.3% and 11.1% across quartiles of time to ROSC versus (vs.) 51.5%, 25.6%, 13.3% and 8.9% in patients without bystander CPR; corresponding rates of favorable neurological outcome were 50.7%, 23.8%, 12.2% and 9.1% vs. 40.1%, 16.6%, 8% and 4.8%. Correspondingly, survival rates in defibrillated patients were 70.1%, 45.9%, 25.5% and 16.4% vs. 36.3%, 9.5%, 6% and 3.4% in non-defibrillated patients; corresponding rates of favorable neurological outcome were 59.8%, 33.4%, 18.3% and 11.4% vs. 24.4%, 4.1%, 1.9% and 1.8%. Conclusions: Survival with favorable neurological outcome was seen in all quartiles of time to ROSC, even in cases without bystander CPR or shocks delivered. This suggests that EMS personnel should not terminate resuscitation efforts too early.

Abstract 139: Understanding Why Differences in the Provision of Bystander Cpr Exist for Women Versus Men: Does the Sex of the Rescuer Matter?

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_4) ◽  
Author(s):  
Sarah M Perman ◽  
Shelby Shelton ◽  
John D Rice ◽  
Christopher Knoepke ◽  
Kathryn Rappaport ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Sexual Assault ◽  
Mechanical Turk ◽  
Physical Injury ◽  
Male And Female ◽  
The Public ◽  
Bystander Cardiopulmonary Resuscitation ◽  
Bystander Cpr ◽  
Amazon's Mechanical Turk ◽  
Hospital Cardiac Arrest

Introduction: Women who suffer an out of hospital cardiac arrest receive bystander cardiopulmonary resuscitation (bCPR) less often than men. We sought to determine if there were differences in potential deterrents to providing CPR if the rescuer was a man or a woman. Methods: We surveyed participants via Amazon’s Mechanical Turk, a national crowdsourcing platform, to query why women receive less bCPR than men based on the sex of the rescuer. We asked participants to rank five themes previously identified. Eligible participants were ≥18 years, US residents, and correctly defined CPR. Participants were asked to rank the 5 following themes if the sex of the rescuer was unidentified sex, male, and female: 1) Rescuers are afraid to injure or hurt women; 2) Rescuers might have a misconception that women don’t suffer cardiac arrest; 3) Rescuers are afraid to be accused of sexual assault or sexual harassment; 4) Rescuers have a fear of touching women or that the touch might be inappropriate; 5) Rescuers think that women are “faking it” or being “overdramatic.” Results: In total, 576 participants were surveyed, and 520 responses were formally analyzed. The respondents were 42.3% female, 74.2% Caucasian, 10.4% African American, and 6.7% Hispanic. To determine a “consensus” ranking, a statistical model that finds the mode of the rankings was used, generating separate results for each of the categories of rescuer. This method determined that the modal ranking for respondents asked about a female rescuer was Hurt/Injure, Touch, Overdramatic, Misconception, Sexual Assault/Harassment. By contrast, when respondents were asked about a male rescuer, the modal ranking was found to be Touch, Sexual Assault/Harassment, Hurt/Injure, Misconception, Overdramatic. When the sex of the rescuer was not identified, the modal ranking was identical to that for the male rescuer question. Conclusion: When querying the public as to why women receive less-bystander CPR than men, there were differences in response based on the sex of the rescuer. Participants reported that a male rescuer would potentially be hindered by fears of accusation of sexual assault/harassment or inappropriate touch, while female rescuers would be more deterred due to fears of causing physical injury or harm.

scholarly journals Comorbidity and bystander cardiopulmonary resuscitation in out-of-hospital cardiac arrest

Heart ◽  
2020 ◽  
Vol 106 (14) ◽  
pp. 1087-1093
Author(s):  
Geir Hirlekar ◽  
Martin Jonsson ◽  
Thomas Karlsson ◽  
Maria Bäck ◽  
Araz Rawshani ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Multiple Logistic Regression ◽  
Multivariable Model ◽  
National Patient Registry ◽  
National Patient ◽  
Bystander Cardiopulmonary Resuscitation ◽  
Bystander Cpr ◽  
Comorbidity Index ◽  
Hospital Cardiac Arrest

​ObjectiveCardiopulmonary resuscitation (CPR) performed before the arrival of emergency medical services (EMS) is associated with increased survival after out-of-hospital cardiac arrest (OHCA). The aim of this study was to determine whether patients who receive bystander CPR have a different comorbidity compared with patients who do not, and to determine the association between bystander CPR and 30-day survival when adjusting for such a possible difference.​MethodsPatients with witnessed OHCA in the Swedish Registry for Cardiopulmonary Resuscitation between 2011 and 2015 were included, and merged with the National Patient Registry. The Charlson Comorbidity Index (CCI) was used to measure comorbidity. Multiple logistic regression was used to examine the effect of CCI on the association between bystander CPR and outcome.​ResultsIn total, 11 955 patients with OHCA were included, 71% of whom received bystander CPR. Patients who received bystander CPR had somewhat lower comorbidity (CCI) than those who did not (mean±SD: 2.2±2.3 vs 2.5±2.4; p<0.0001). However, this difference in comorbidity had no influence on the association between bystander CPR and 30-day survival in a multivariable model including other possible confounders (OR 2.34 (95% CI 2.01 to 2.74) without adjustment for CCI and OR 2.32 (95% CI 1.98 to 2.71) with adjustment for CCI).​ConclusionPatients who undergo CPR before the arrival of EMS have a somewhat lower degree of comorbidity than those who do not. Taking this difference into account, bystander CPR is still associated with a marked increase in 30-day survival after OHCA.

scholarly journals Trend in survival after out-of-hospital cardiac arrest and its relationship with bystander cardiopulmonary resuscitation: a six-year prospective observational study in Beijing

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Yuling Chen ◽  
Peng Yue ◽  
Ying Wu ◽  
Jia Li ◽  
Yanni Lei ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Survival Rate ◽  
Cardiopulmonary Resuscitation ◽  
Observational Study ◽  
Indirect Effect ◽  
Prospective Observational Study ◽  
Shockable Rhythm ◽  
Bystander Cardiopulmonary Resuscitation ◽  
Bystander Cpr ◽  
Hospital Cardiac Arrest

Abstract Background Out-of-hospital cardiac arrest (OHCA), a global health problem with a survival rate ranging from 2 to 22% across different countries, has been a leading cause of premature death for decades. The aim of this study was to evaluate the trends of survival after OHCA over time and its relationship with bystander cardiopulmonary resuscitation (CPR), initial shockable rhythm, return of spontaneous circulation (ROSC), and survived event. Methods In this prospective observational study, data of OHCA patients were collected following the “Utstein style” by the Beijing, China, Emergency Medical Service (EMS) from January 2011 (data from February to June in 2011 was not collected) to October 2016. Patients who had a cardiac arrest and for whom an ambulance was dispatched were included in this study. All cases were followed up to determine hospital discharge or death. The trend of OHCA survival was analyzed using the Chi-square test. The relationship among bystander CPR, initial shockable rhythm, ROSC, survived event, and OHCA survival rate was analyzed using multivariate path analyses with maximum standard likelihood estimation. Results A total of 25,421 cases were transferred by the Beijing EMS; among them, 5042 (19.8%) were OHCA (median age: 78 years, interquartile range: 63–85, 60.1% male), and 484 (9.6%) received bystander CPR. The survival rate was 0.6%, which did not improve from 2012 to 2015 (P = 0.569). Overall, bystander CPR was indirectly associated with an 8.0% (β = 0.080, 95% confidence interval [CI] = 0.064–0.095, P = 0.002) increase in survival rate. The indirect effect of bystander CPR on survival rate through survived event was 6.6% (β = 0.066, 95% CI = 0.051–0.081, P = 0.002), which accounted for 82.5% (0.066 of 0.080) of the total indirect effect. With every 1 increase in survived event, the possibility of survival rate will directly increase by 53.5% (β = 0.535, 95% CI = 0.512–0.554, P = 0.003). Conclusions The survival rate after OHCA was low in Beijing which has not improved between 2012 and 2015. The effect of bystander CPR on survival rate was mainly mediated by survived event. Trial registration Chinese Clinical Trial Registry: ChiCTR-TRC-12002149 (2 May, 2012, retrospectively registered). http://www.chictr.org.cn/showproj.aspx?proj=7400

scholarly journals Can Mobile Videocall Assist Laypersons’ Use of Automated External Defibrillators? A Randomized Simulation Study and Qualitative Analysis

2020 ◽  
Vol 2020 ◽  
pp. 1-7
Author(s):  
Jun Young Bang ◽  
Youngsuk Cho ◽  
Gyu Chong Cho ◽  
Jongshill Lee ◽  
In Young Kim
Keyword(s):  
Cardiac Arrest ◽  
Time Interval ◽  
Mobile Video ◽  
Time Intervals ◽  
Automated External Defibrillators ◽  
Significant Difference ◽  
Bystander Cardiopulmonary Resuscitation ◽  
Bystander Cpr ◽  
Voice Calls ◽  
Hospital Cardiac Arrest

Background and Importance. The rate of bystander cardiopulmonary resuscitation (CPR) in out-of-hospital cardiac arrest (OHCA) has increased rapidly in the past 10 years. However, laypersons’ use of automated external defibrillator (AED) is still low in comparison with bystander CPR. Objective. To investigate the feasibility of mobile videocall guidance to facilitate AED use by laypersons. Design, setting, and participants. A total of 90 laypersons were randomized into three groups: the mobile video call-guided, voice call-guided, and non-guided groups. Participants were exposed to simulated cardiac arrest to use an AED, and guided by video calls, voice calls, or were not guided. We recorded the simulation experiments as a videoclip, and other researchers who were blinded to the simulation assessed the performance according to the prespecified checklist after simulations. Outcomes measure and analysis. We compared the performance score and time intervals from AED arrival to defibrillation among the three groups and analyzed the common errors. Results. There was no significant difference among the three groups in terms of baseline characteristics. Performance scores in the checklist for using AED were higher in the mobile video call-guided group, especially in the category of “Power on AED” and “Correctly attaches pads” than in the other groups. However, the time interval to defibrillation was significantly longer in the mobile video call-guided group. Conclusions. Mobile video call guidance might be an alternative method to facilitate AED use by laypersons. Therefore, further well-designed research is needed to evaluate the feasibility of this approach in OHCA.

5225Bystander cardiopulmonary resuscitation and survival in out-of-hospital cardiac arrest of non-cardiac origin

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
D M Christensen ◽  
S Rajan ◽  
K Kragholm ◽  
K B Sondergaard ◽  
O M Hansen ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Temporal Trends ◽  
Patient Characteristics ◽  
Ohca Patient ◽  
Significant Difference ◽  
Bystander Cardiopulmonary Resuscitation ◽  
Study Population ◽  
Bystander Cpr ◽  
Hospital Cardiac Arrest

Abstract Background Knowledge about the effect of bystander cardiopulmonary resuscitation (CPR) in out-of-hospital cardiac arrest (OHCA) of non-cardiac origin is lacking. We aimed to investigate the association between bystander CPR and survival in OHCA of presumed non-cardiac origin. Methods From the Danish Cardiac Arrest Registry and through linkage with national Danish healthcare registries we identified all adult patients with OHCA of presumed non-cardiac origin in Denmark (2001–2014). These were categorized further into OHCA of medical and non-medical cause. We analyzed temporal trends in bystander CPR and 30-day survival during the study period. Multiple logistic regression was used to examine the association between bystander CPR and 30-day survival and reported as standardized 30-day survival chances with versus without bystander CPR standardized to the prehospital OHCA-factors and patient characteristics of all patients in the study population. Results We identified 10,761 OHCAs of presumed non-cardiac origin. Bystander CPR was associated with an increased 30-day survival chance of 3.4% (95% confidence interval [CI]: 2.9–3.9) versus 1.8% (95% CI: 1.4–2.2) with no bystander CPR, corresponding to a significant difference of 1.6% (95% CI: 0.9–2.3). During the study period, the overall bystander CPR rates increased from 13.6% (95% CI: 11.2–16.5) to 62.7% (95% CI: 60.2–65.2). 30-day survival increased overall from 1.3% (95% CI: 0.7–2.6) to 4.0% (95% CI: 3.1–5.2). Similar findings were observed in subgroups of medical and non-medical OHCA. Table 1. Patient and arrest characteristics according to cause of out-of-hospital cardiac arrest Overall Medical OHCA Non-medical OHCA Patient characteristics   Total patients 10761 7625 3136   Median age,y 67 70 50   Male, n (%) 6357 (59.1) 4154 (54.5) 2204 (70.4) OHCA factors   Witnessed arrest, n (%) 4306 (40.0) 3574 (46.9) 732 (23.3)   Public location, n (%) 6979 (64.9) 5494 (72.1) 1485 (47.4) OHCA, out-of-hospital cardiac arrest; CPR, cardiopulmonary resuscitation. Figure 1. Temporal trends Conclusion Bystander CPR was associated with a higher chance of 30-day survival among OHCA of presumed non-cardiac origin regardless of the underlying cause (medical/non-medical). Rates of bystander CPR and 30-day survival improved during the study period.

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