October 26, 2017
2 min read

Public health initiatives improve bystander response for cardiac arrest

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Public health initiatives focusing on CPR and first-responder training were associated with increases in bystander-initiated CPR and defibrillation and increased survival, study data show.

“Little is known about the influence of public health initiatives, including widespread training of laypersons in CPR and first responders in high-performance CPR and automated external defibrillator use, to improve bystander and first-responder resuscitation efforts in patients who experience at-home cardiac arrest,” Christopher B. Fordyce, MD, MHS, MSc, of the division of cardiology at the University of British Columbia in Vancouver, Canada, and colleagues wrote. “In fact, there are concerns that expanded CPR training may not correct the large fraction of cardiac arrests that occur at home.”

Fordyce and colleagues used data from 16 counties in North Carolina from 2010 to 2014 on out-of-hospital cardiac arrest to determine whether public health initiatives affected rates of resuscitation and survival.

Of the 8,269 patients with out-of-hospital cardiac arrest, 67.7% (n = 5,602; median age, 64 years; 62.2% men) had the event at home and 32.3% (n = 2,667; median age, 68 years; 61.5% men) in public.

In 2010, the HeartRescue Project initiated a series of public health initiatives in North Carolina aimed at teaching members of the general population CPR and how to use external defibrillators to improve bystander response, as well as instructing first responders about team-based CPR and dispatch centers about recognizing cardiac arrest.

CPR use increased

After public health initiatives were conducted, the proportion of patients receiving bystander CPR at home increased from 28.3% to 41.3% (P < .001) and in public from 61% to 70.5% (P = .01).

First responder defibrillation increased at home from 42.2% to 50.8% (P = .02), but did not significantly increase in the public setting (33.1% to 37.8%; P = .17).

Survival to discharge improved in those who had cardiac arrest at home (from 5.7% to 8.1%; P = .047) and in public (from 10.8% to 16.2%; P = .04).

Those with cardiac arrest at home were more likely to survive to hospital discharge if they received bystander-initiated CPR and first-responder defibrillation (OR = 1.55; 95% CI, 1.01-2.38), compared with those who received emergency medical services-initiated CPR and resuscitation. Those with cardiac arrest in public were also significantly more likely to survive if they received bystander-initiated CPR and first-responder defibrillation (OR = 4.33; 95% CI, 2.11-8.87).


“Our data indicate that coordinated, multifaceted public health initiatives targeting multiple personnel across the cardiac arrest ‘chain of survival,’ including first-responder programs, are associated with improved outcomes among individuals with at-home OHCA. This result occurs despite concerns that such initiatives were not previously associated with improved survival for at-home OHCA,” the researchers wrote.

Underuse concerning

In an accompanying editorial, Terence Valenzuela, MD, MPH, of the department of emergency medicine at the University of Arizona, Tucson, and colleagues wrote: “Despite the observed improvement in survival after OHCA in selected counties in North Carolina, there was still underuse of bystander CPR as well as layperson use of defibrillators. The observed relative improvement in overall survival was less than the improvement in patients with cardiac arrest in the home. Survival after arrest in the home remained much less than that in public places.”

This remains a concern because predominantly black neighborhoods have worse rates of bystander CPR and defibrillation, as Cardiology Today previously reported.

Valenzuela and colleagues recommended continuing to train and motivate individuals to initiate CPR and defibrillation. by Cassie Homer

Disclosures: The study was supported by HeartRescue Project, which is funded by the Medtronic Foundation. Fordyce reports he serves on the advisory board for Bayer. Please see the study for all other authors’ relevant financial disclosures. One editorial author reports he has received funding from the NIH, Agency for Health Research Quality, FDA and Zoll Medical Corp., and he serves as a consultant to Zoll Circulation.