Incidence, process of care, and outcomes of out-of-hospital cardiac arrest in China: a prospective study of the BASIC-OHCA registry

Evaluation of the optimal timing for advanced airway management for adult patients with out-of-hospital cardiac arrest: A retrospective observational study from a multicenter registry

Aim

We aimed to investigate the appropriate timing for advanced airway management (AAM) in witnessed adult non-traumatic out-of-hospital cardiac arrest (OHCA) by adjusting for resuscitation time bias and limiting the analysis to witnessed OHCA.

Methods

This retrospective observational study used a multicentre OHCA registry involving 99 participating hospitals in Japan and included adult patients with witnessed non-traumatic OHCA who underwent AAM during resuscitation. The primary and secondary outcomes were favourable 30-day neurological outcomes and survival, respectively. The time from emergency medical service contact to AAM was categorised as follows: 1-5, 6-10, 11-15, 16-20, 21-25, and 26-30 min. In each group, we calculated the time-dependent propensity score using a Fine-Gray regression model. After propensity score matching, we used a generalised estimating equation (GEE).

Results

A total of 16,448 patients who underwent AAM were matched with patients at risk of requiring AAM. AAM was associated with favourable 30-day neurological outcomes when performed at 6-10 and 16-20 min with RRs (95% CIs) of 1.41 (1.12-1.78), but not at 16-20 min (0.74 [0.56-0.99]), respectively. AAM was associated with improved 30-day survival at 1-5 and 6-10 min (1.22 [1.05-1.41], 1.33 [1.16-1.54], respectively), but not at 16-20 min (0.78 [0.62-0.97].

Conclusions

Performing AAM within 10 min was associated with improved outcomes compared with those at risk of receiving AAM. However, the results were not consistent across all groups, therefore, careful interpretation is required.

How stepwise interventions in pre-hospital emergency care enhance out-of-hospital cardiac arrest management in a Megacity in China

OBJECTIVE

A series of improvements have been formulated and implemented to prompt the inadequate pre-hospital care capacity for out-of-hospital cardiac arrest (OHCA) management in China. The aim of this study is to investigate the combined association of those stepwise interventions with OHCA management in Shenzhen, as a representative city in China.

METHODS

This registry-based retrospective study included emergency medical services (EMS)-treated adult OHCA patients with presumed cardiac etiology in Shenzhen, China, covering the period from January 1, 2011 to December 31, 2022. During this period, three key interventions were implemented sequentially: a public access defibrillation (PAD) program on October 1, 2017, a civilian cardiopulmonary resuscitation (CPR) training program on July 1, 2020, and telecommunicator cardiopulmonary resuscitation (T-CPR) on November 23, 2021. The outcomes of bystander CPR and return of spontaneous circulation (ROSC) were compared with pre-intervention controls.

RESULTS

A total of 6,571 EMS-treated presumed cardiac etiology adult OHCA patients were included, among which were 623 cases with bystander-witnessed OHCA and a shockable rhythm. Across four periods, the rates of both bystander CPR (8.55 vs. 12.60 vs. 18.31 vs. 23.10%) and ROSC (6.01 vs. 5.29 vs. 9.59 vs. 8.33%) showed an increasing trend. For the rate of bystander CPR, the likelihood was significantly increased after implementation of the PAD program (OR 1.64 [95% CI 1.21-2.23]) and civilian CPR training program (OR 2.12 [95% CI: 1.52-2.95]), and after the addition of the T-CPR application (OR 3.06 [95% CI: 2.14-4.39]), compared with the pre-period. Similarly, cumulative interventions were associated with a higher ROSC (OR 0.84 [95% CI: 0.62-1.14], OR 1.52 [95% CI: 1.07-1.89], OR 1.42 [95% CI: 1.07-1.89]) when compared with the pre-period. In subgroup analysis, cumulative interventions significantly improved the rate of bystander CPR in cases where OHCA occurred in public locations, and ROSC in cases where the time from symptom onset to calling 120 was within 10 min.

CONCLUSION

Stepwise interventions in pre-hospital emergency care increased likelihood of bystander CPR and ROSC following pre-hospital resuscitation significantly. This improvement is attributed to the coordination and cumulative effect of multiple positive interventions for OHCA management.

Implementation of school-based CPR training - A systematic review and mixed-methods meta-analysis

Aim

Despite initiatives like "Kids Save Lives", CPR trainings are often poorly implemented, and bystander CPR rates remain low. This systematic review and mixed-methods meta-analysis of qualitative and quantitative studies aims to identify enablers and barriers to the implementation of school-based CPR training.

Methods

A systematic search was conducted across seven databases. Qualitative data were analyzed using thematic synthesis, and findings were evaluated with GRADE-CERQual. Quantitative data were synthesized through qualitative findings, providing deeper context using a convergent qualitative meta-integration approach.

Results

A total of 18 reports (7 qualitative and 11 quantitative) on school-based CPR training were included from an initial pool of 7914 records. Key enablers of successful school-based CPR training implementation were related either to program characteristics or to environmental factors, with both being equally important. Generally, programs are better implemented if they include high-quality resources, incur low costs in terms of funds, time and staffing, show adaptability to the setting in which they are implemented, and provide standardized training for teachers or implementers. Regarding environment factors, implementation is facilitated by broad support from school stakeholders (leadership, teachers, and parents) and is more successful where, supported by mandatory legislation and government endorsement, health is framed as a core business of schools.

Conclusion

The successful implementation of school-based CPR training depends on both program characteristics and environmental factors, operating together in a "seed and soil" manner. Addressing both aspects is essential for effective program planning. Future research should more broadly explore health outcomes beyond CPR-related measures and investigate how CPR training can be integrated into wider health-promoting school initiatives.

Association between nitrogen dioxide exposure and out-of-hospital cardiac arrest onset in China: A multicenter, time-stratified, case-crossover study

Studies on the association between nitrogen dioxide (NO2) exposure and out-of-hospital cardiac arrest (OHCA) are limited and present inconsistent results. In the context of global urbanization, a large population is exposed to high ambient NO2 pollution, highlighting the need for further clarification of NO2-related health hazards. Furthermore, previous studies mostly applied exposure data from monitoring stations, with relatively few investigations examining acute effects using high-resolution modeled data. To explore the association between NO2 and cardiac OHCA onset risk, a time-stratified case-crossover study was conducted using data from emergency medical service (EMS) systems across 23 Chinese provinces throughout 2020. Conditional logistic regression models were used to investigate the potential association between NO2 and OHCA onset. Individual-level NO2 data from both models and monitoring stations were analyzed separately to evaluate their comparability in practice. The analysis incorporated 76,263 EMS-attended cardiac OHCA onsets. The health estimates from NO2 predictions and measurements were comparable without statistically significant differences, with each 10 µg/m3 increase associated with a 1.16% (95% confidence interval [CI]: 0.38-1.94%) and 1.03% (95% CI: 0.37-1.69%) increase in the risk of OHCA onset, respectively. This nationwide multicenter study demonstrated adverse effects of NO2 exposure on OHCA onset in a large population residing in regions with higher and variable NO2 levels. These findings contribute robust epidemiological evidence to this field and offer new evidence to support global policymaking, particularly in developing countries. Additionally, modeled NO2 predictions with high resolution and coverage can serve as effective alternatives to traditional monitoring station data in epidemiological studies.

Effect of Levosimendan Use on All-Cause Mortality in Out-of-Hospital Cardiac Arrest Survivors After Extracorporeal Cardiopulmonary Resuscitation

Background: Survivors of out-of-hospital cardiac arrest (OHCA) after external cardiopulmonary resuscitation (ECPR) have a mortality rate as high as 50-70%. The use of vasoactive inotropes worsen the mortality rate at admission. The administration of levosimendan within 72 h of ECPR facilitates extracorporeal membrane oxygenation (ECMO) weaning, so it is important to determine whether levosimendan improves mortality. Methods: This retrospective cohort study included 158 patients with OHCA of cardiac origin who had undergone ECPR and were hospitalized between January 2015 and December 2024. This study was conducted in the intensive care unit of China Medical University Hospital, Taichung, Taiwan. Twenty-three patients received levosimendan within 72 h, whereas the others did not receive levosimendan. Primary endpoints included ECMO weaning failure rate and 90-day all-cause mortality rate. Kaplan-Meier survival curve analysis was also performed. Covariates for all-cause mortality were estimated and adjusted by using Cox regression modeling. Results: The levosimendan group exhibited lower rates of ECMO weaning failure and 90-day all-cause mortality than the control group (13.0% vs. 52.6% and 17.4% vs. 57.0%, respectively; both p < 0.001). The 90-day survival curve analysis revealed that the levosimendan and control groups had survival rates of 82.6% and 43.0%, respectively (log-rank p < 0.001). Administration of levosimendan within 72 h resulted in a odds ratio of 0.36 (95% confidence interval: 0.18-0.79, p = 0.01). Conclusions: Administering levosimendan within 72 h of ECPR could be a protective factor in improving all-cause mortality.

Escalating vs Fixed Energy Defibrillation in Out-of-Hospital Cardiac Arrest Ventricular Fibrillation

Importance

There is limited evidence on whether higher-energy defibrillation is preferred in patients experiencing out-of-hospital cardiac arrest (OHCA) with shockable rhythms.

Objective

To investigate the optimal energy regimen for initial and subsequent defibrillation delivered by biphasic waveform automated external defibrillators (AEDs) in OHCA ventricular fibrillation (VF).

Design, Setting, and Participants

This cohort study was conducted in 48 cities across China, from 2017 to 2023, among 342 patients with OHCA who experienced at least 1 shock.

Exposures

Escalating higher-energy (200-300-360 J) defibrillation or fixed low-energy (200-200-200 J) defibrillation according to the AED program available for use.

Main Outcome and Measures

Sustained and transient termination of VF and establishment of an organized rhythm after defibrillations were the main clinical outcomes.

Results

A total of 342 patients with OHCA were included (mean [SD] age, 57.2 [20.6] years; 273 male [79.8%]) with 782 VF defibrillations; 218 patients (63.8%) with a total of 480 instances (61.4%) of VF rhythm received AED with escalating higher-energy regimens. Most VF episodes were effectively terminated transiently at the first shock (200 J in both groups) (94% in the escalating higher-energy group vs 93% in the fixed lower-energy group; P = .64), but only half remained terminated until the next rhythm analysis (49% vs 47%; P = .68). Comparatively, VF that received escalating higher-energy regimens were more likely to establish sustained organized rhythm (34% vs 25%; P = .008; absolute difference, 9% [95% CI, 2% to 16%]). In refractory VF rhythms, the percentage of cases where sustained organized rhythms were established was significantly greater in escalating higher-energy regimens after second shocks and above (24% vs 13%; P = .008; absolute difference, 11% [95% CI, 3% to 19%]) and third shocks and above (35% vs 18%; P = .003; absolute difference 17% [95% CI, 5% to 27%]).

Conclusions and Relevance

In this retrospective cohort study of patients experiencing OHCA-VF, both the escalating higher-energy (200-300-360 J) regimen and the fixed low-energy (200-200-200 J) regimen were effective for transient VF termination at first shock, whereas the escalating higher-energy regimens were more likely to maintain termination and restore an organized rhythm. Higher-energy regimens were associated with better outcomes after all shocks, especially in patients with refractory VF.

Application of Machine Learning for Patients With Cardiac Arrest: Systematic Review and Meta-Analysis

BACKGROUND

Currently, there is a lack of effective early assessment tools for predicting the onset and development of cardiac arrest (CA). With the increasing attention of clinical researchers on machine learning (ML), some researchers have developed ML models for predicting the occurrence and prognosis of CA, with certain models appearing to outperform traditional scoring tools. However, these models still lack systematic evidence to substantiate their efficacy.

OBJECTIVE

This systematic review and meta-analysis was conducted to evaluate the prediction value of ML in CA for occurrence, good neurological prognosis, mortality, and the return of spontaneous circulation (ROSC), thereby providing evidence-based support for the development and refinement of applicable clinical tools.

METHODS

PubMed, Embase, the Cochrane Library, and Web of Science were systematically searched from their establishment until May 17, 2024. The risk of bias in all prediction models was assessed using the Prediction Model Risk of Bias Assessment Tool.

RESULTS

In total, 93 studies were selected, encompassing 5,729,721 in-hospital and out-of-hospital patients. The meta-analysis revealed that, for predicting CA, the pooled C-index, sensitivity, and specificity derived from the imbalanced validation dataset were 0.90 (95% CI 0.87-0.93), 0.83 (95% CI 0.79-0.87), and 0.93 (95% CI 0.88-0.96), respectively. On the basis of the balanced validation dataset, the pooled C-index, sensitivity, and specificity were 0.88 (95% CI 0.86-0.90), 0.72 (95% CI 0.49-0.95), and 0.79 (95% CI 0.68-0.91), respectively. For predicting the good cerebral performance category score 1 to 2, the pooled C-index, sensitivity, and specificity based on the validation dataset were 0.86 (95% CI 0.85-0.87), 0.72 (95% CI 0.61-0.81), and 0.79 (95% CI 0.66-0.88), respectively. For predicting CA mortality, the pooled C-index, sensitivity, and specificity based on the validation dataset were 0.85 (95% CI 0.82-0.87), 0.83 (95% CI 0.79-0.87), and 0.79 (95% CI 0.74-0.83), respectively. For predicting ROSC, the pooled C-index, sensitivity, and specificity based on the validation dataset were 0.77 (95% CI 0.74-0.80), 0.53 (95% CI 0.31-0.74), and 0.88 (95% CI 0.71-0.96), respectively. In predicting CA, the most significant modeling variables were respiratory rate, blood pressure, age, and temperature. In predicting a good cerebral performance category score 1 to 2, the most significant modeling variables in the in-hospital CA group were rhythm (shockable or nonshockable), age, medication use, and gender; the most significant modeling variables in the out-of-hospital CA group were age, rhythm (shockable or nonshockable), medication use, and ROSC.

CONCLUSIONS

ML represents a currently promising approach for predicting the occurrence and outcomes of CA. Therefore, in future research on CA, we may attempt to systematically update traditional scoring tools based on the superior performance of ML in specific outcomes, achieving artificial intelligence-driven enhancements.

TRIAL REGISTRATION

PROSPERO International Prospective Register of Systematic Reviews CRD42024518949; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=518949.

Unveiling China's heart disease challenges: a comprehensive retrospective study on national mortality burden

BACKGROUND

Heart disease has been the leading cause of death in China since 2020. With the development of the aging population, dietary habits changes, and extreme climate conditions, this study aimed to evaluate national and sub-national changes in the heart disease burden from 2013 to 2021 in china, using data from the National Mortality Surveillance System.

METHODS

This study was mainly using the National Mortality Surveillance System, which covered 300 million, accounted for 24% of China's population, with national and provincial representativeness from 2013 to 2021. The data categories were modified in 2013 to contain individual classes for heart disease, and the classifications remained consist until 2021. Permutation test were used to identify the Joinpoints in the data. Trends for the study period were evaluated using the average annual percent change (AAPC) in mortality rates with 95% Confidence interval (CI). A decomposition analysis was used to analyse the drivers of mortality change due to heart disease.

RESULTS

The total number of heart disease related deaths increased from 277,312(2013) to 463,314(2021). The proportion of deaths due to heart disease increased from 21.81% to 25.45%. And the gender-standardized mortality of heart disease increased from 140.11/100,000 to 180.67/100,000 from 2013 to 2021. The average annual increase (AAI) was 4.46%. since 2020, the heart disease has become the leading cause of death, rising from the third place. Epidemic characteristics were as follows: First, the heart disease-related mortality was higher in males than in females. And the AAPC for males was 3.74% from 2013 to 2021 (AAPC = 3.744, 95% CI: 3.048 ~ 4.528, P < 0.01). The AAPC for females was 4.09% (AAPC = 4.088, 95% CI: 2.962 ~ 5.313, P < 0.01). Second, a rapid increase in heart disease related mortality has been observed among 15-44 years population in recent years. Third, the mortality of rural residents in the past 6 years has increased fast (from 151.19/100,000 to 188.58/100,000). The average annual increase in rural heart disease mortality was 3.49%. Fourth, heart disease mortality in Central China increased fast and reached the highest rate in China. Additionally, ischemic heart disease mortality showed the highest, with a rapidly increasing trend. Finally, most heart disease related deaths occurred from October of the first year to March of the following year, with peaks in January and February. And over 70% of these deaths occured at home or in hospital,.

CONCLUSIONS

The deaths due to heart disease indicated a remarkable continues increase in the burden of heart disease. This study results imply escalating healthcare expenses, with projections indicating even greater future challenges. These findings will also help identify gaps in heart disease healthcare and guide the prioritization of health programs dirven by the needs of China.

Effectiveness of chain of survival for out-of-hospital-cardiac-arrest (OHCA) in resource limited countries: A systematic review

Aim

Given the critical disparities in survival for out-of-hospital-cardiac-arrest (OHCA) in resource limited countries and the lack of context-specific evidence to guide resuscitation practices, we aimed to systematically evaluate the effectiveness of the chain of survival components including bystander response, emergency medical services (EMS) response, advanced life support, and post-resuscitation care on outcomes such as return of spontaneous circulation, survival to admission, survival to hospital discharge, and neurological outcomes in these settings.

Methods

This systematic review, following PRISMA guidelines, included observational and interventional studies on OHCA management from low, lower-middle, and upper-middle-income countries, published in English (2004-2023). PubMed, Embase, CINAHL, and Cochrane Library were searched using predefined terms. Two reviewers independently screened studies, extracted data using the Utstein template, and resolved conflicts with a third reviewer. Data included pre-hospital, patient, and post-resuscitation care factors, as well as short and long-term outcomes. Descriptive analysis and narrative synthesis were conducted, with return of spontaneous circulation (ROSC) rates compared across income groups using t-tests.

Results

Sixteen (16) eligible studies were included. No study was found from low-income countries. ROSC rates ranged from 0.7% to 44%, survival to discharge from 0.6% to 14.1%, and good neurological outcomes (CPC 1-2) from 0.6% to 53.8%. While upper-middle-income countries showed slightly higher ROSC rates, differences were not statistically significant. Risk of bias was moderate to high due to selection bias, inadequate confounding control, and inconsistent reporting. These findings emphasize the need for standardized reporting and further research to improve outcomes in resource limited countries.

Conclusion

This review highlights low survival rates for OHCA in resource limited countries, with significant variability and gaps in evidence. Strengthening EMS systems, adopting context-specific strategies, and standardizing reporting are critical to improving outcomes.

Incidence and temporal trends of out-of-hospital cardiac arrest in Shenzhen, China (2011-2018)

Background

Out-of-hospital cardiac arrest (OHCA) is a significant global public health issue, few studies describe characteristics and trends in China. This study examines OHCA features and trends in Shenzhen, one of the fastest-growing cities.

Methods

This retrospective study analysed data from the Shenzhen Emergency Center database (2011-2018), including ambulance dispatch and pre-hospital medical records. Descriptive statistics and temporal trends were used to examine the incidence, patients characteristics, pre-hospital treatment, and outcome.

Results

Among 18,772 medical cause OHCA cases, the crude incidence rate was 17.4 per 100,000 population, with an age-standardised rate of 38.4. Incidence increased over time. Resuscitation was attempted in 43.8% of cases, with a median patient age of 56 years and 73.5% being male. Most arrest (69.0%) occurred at home, and 82% were presumed to be cardiac cause.The median response time was 11.2 min. Bystander cardiopulmonary resuscitation (CPR) rates increased from 4.6% in 2011 to 14.5% in 2018, while bystander automated external defibrillator (AED) use remained low (0.2%). Pre-hospital electrocardiogram (ECG) recording improved from 40.6% to 91.9%, with shockable rhythms 2.2%. Intravenous access was established in 69.7% of patients, 51.9% received epinephrine, 19.29% received pre-hospital defibrillation, and 16.4% underwent advanced airway management. The pre-hospital Return of Spontaneous Circulation (ROSC) rate increased from 2.7% to 5.8%, with a total ROSC rate of 3.11%.

Conclusions

OHCA incidence in Shenzhen is lower than both domestic and international levels but increasing. Low bystander intervention rated and prolonged response times contribute to poor outcome, underscoring the need for system improvements.

Temporal trends of presumed cardiac origin out-of-hospital cardiac arrest incidence in Guangzhou, southern China: A 10-year consecutive analysis

Background

Despite the rising disease mortality rates, there is a dearth of studies on the incidence and trends of out-of-hospital cardiac arrests (OHCA) in China. This study aims to investigate the incidence and temporal trends of presumed cardiac origin OHCA in Guangzhou, Southern China, from 2011 to 2020.

Methods and results

In this population-based retrospective cohort study, pre-hospital data from the Guangzhou Emergency Medical Service (GZ-EMS) from 2011 to 2020 were analyzed. Crude incidence rates and age-standardized incidence rates (ASIRs) were calculated respectively. ASIRs were calculated using the 2000 national census population as the standard population. The Joinpoint software was used to calculate the Annual Percent Change (APC) and Average Annual Percent Change (AAPC) in the incidence of OHCA over the study period. From 2011 to 2020, 44,375 EMS-assessed OHCAs of presumed cardiac origin were recorded. Overall, the crude incidence rate of OHCA was 53.1 per 100,000 on average. AAPC was 7.0% (95% CI: 4.3%-9.8%). Age-standardized incidence rate(ASIR) was 38.4 per 100,000 on average, with an average annual increase of 4.8% (95% CI: 2.4%-7.3%). The crude and ASIR of OHCA increased in men, while the ASIR changed more moderately in women. The age group of ≥80 years had the highest rate of increase. The 20-29 and 70-79 age groups also demonstrated notable increases.

Conclusions

From 2011 to 2020, Guangzhou experienced a notable upward trend in both crude and ASIR of OHCA, with significant variations observed across gender and age demographics. This trend calls for a deeper investigation into the underlying factors.

Public participation willingness in out-of-hospital cardiopulmonary resuscitation: A systematic review and meta-analysis

Objective

This systematic review and meta-analysis aimed to identify the main factors influencing the public's willingness to participate in out-of-hospital emergency care.

Methods

Studies were searched in online databases, including PubMed, Embase, Web of Science, and the Cochrane Library. The articles included in this review were published from inception to July 31, 2024. The Iain Crombie assessment tool was used to assess study quality. Meta-analysis was performed using RevMan (version 5.4) software. The review protocol has been registered with PROSPERO (CRD42024570491).

Results

A total of 1,434 research articles were initially identified, among which 18 were incorporated into this study, and all of the included studies were cross-sectional. Meta-analysis results demonstrated that gender (male; OR = 1.37, 95%CI: 1.28-1.47), profession (healthcare provider; OR = 0.17, 95%CI: 0.06-0.47), knowledge and skill level (OR = 1.63, 95%CI: 1.25-2.11), willingness to undergo training (OR = 2.68, 95%CI: 1.89-3.79), interest in first aid (OR = 2.08, 95%CI: 1.60-2.69), previous training (OR = 2.14, 95%CI: 1.49-3.08), and previous first-aid experience (OR = 1.70, 95%CI: 1.37-2.11) were the principal influencing factors of the public's willingness to engage in out-of-hospital cardiopulmonary resuscitation.

Conclusion

Demographic factors, knowledge, belief, and behavior are crucial in influencing public emergency decision-making. Medical personnel could create specialized training programs based on relevant factors to enhance the public's willingness to engage in out-of-hospital CPR.

Can the digital economy foster advancements in the healthcare sector? - a case study using interprovincial data from China

BACKGROUND

As China's "Internet + Health" initiative advances, the digital economy significantly influences the quality of medical and health services. However, there is a research gap concerning the digital economy's specific impacts, mechanisms, and marginal effects on these services. This gap impedes a comprehensive understanding of the digital economy's potential in healthcare.

AIMS

This study aims to clarify the digital economy's impact mechanisms on medical and health services levels, offering a scientific foundation for more targeted and effective policy formulation, thereby fostering sustainable digital development in healthcare.

METHODS

Utilizing panel data from China's 31 provinces (2011-2020), this paper employs the Spatial Durbin Model to analyze the spatial and marginal effects of the digital economy on healthcare service levels. To ensure analysis accuracy and robustness, the study refines the spatial weight matrix and addresses model endogeneity using the Generalized Spatial Two-Stage Least Squares method. Additionally, it examines regional disparities in the digital economy's impact through SDM and explores intermediary mechanisms and threshold effects using a mediation effect model and a panel threshold model.

RESULTS

Findings indicate that the digital economy positively affects medical and health services in both local and neighboring regions, with variations across areas. The eastern region particularly benefits from the digital economy's enhancement of service levels, while the central and western regions see less impact. The digital economy enhances services by improving medical resource levels and promoting their coordinated development. However, this positive effect is moderated by the digital economy's and the region's economic development levels, with more pronounced impacts in regions with higher digital and economic development.

CONCLUSIONS

The digital economy plays a crucial role in improving medical and health services, and its full potential is beneficial for the industry's advancement and sustainability. Nonetheless, addressing the uneven digital economy development across regions is essential to ensure equitable benefits for all areas.

Revealing the decision-making practices in automated external defibrillator deployment: insights from Shanghai, China

In recent years, the government has promoted the increased deployment of automated external defibrillators (AEDs) in public places with dense crowds, which is of great significance for ensuring that residents enjoy equal health rights. However, it is still unclear what factors decision-makers take into account when formulating deployment plans and whether these factors are related to local characteristics such as population distribution and socioeconomic conditions. Taking Shanghai, China as the research area, we adopted the kernel density estimation and spatial autocorrelation analysis to explore the spatial distribution characteristics of AEDs. We constructed a geographically weighted regression (GWR) model to identify the key factors influencing AED deployment. The results showed that AEDs in Shanghai presented obvious clustering distribution characteristics. The GWR model found that the factors considered by decision-makers in different regions when deploying AEDs followed the guidance of existing policies. It was also found that decision-makers in Shanghai mainly deployed more devices in areas with a high density of the elderly population, dense transportation networks, cultural and educational places, and transportation hubs with large population flows. However, it was observed that the city center might lack sufficient preparation for the elderly group. In order to allocate emergency medical resources more reasonably, it is very important to determine the practices of decision-makers in deploying AEDs. The GWR has shown the potential to evaluate and guide the local implementation of deployment plans.

"Shrink back is not my intention": a qualitative exploration of Chinese security guards' experiences with bystander CPR

BACKGROUND

Out-of-hospital cardiac arrest (OHCA) is a major public health burden worldwide. Promoting bystander cardiopulmonary resuscitation (B-CPR) is a key element in improving the survival rate of OHCA. The security guard is a specific population in China that plays a significant role as bystanders in public settings. However, less is known about their experiences regarding B-CPR intention and performance. This study aimed to explore the experiences and perspectives of Chinese security guards regarding B-CPR and identify barriers to its performance.

METHODS

Fifteen in-depth interviews were conducted with security guards in various public settings, including hospitals, residential living areas, office buildings, and public transportation stations. All interviews were audio recorded. Two researchers independently analyzed the transcripts through deductive and inductive content analysis. Informed by the "Intention-focused" model of B-CPR performance, deductive content analysis was initially performed to identify categories that align with the theoretical framework and thereby validate the theory. Subsequently, inductive content analysis was applied to code newly discovered content, therefore enriching the theory.

RESULTS

An "intention & performance-focused" model of B-CPR was developed. It was revealed that security personnel were more inclined to perform CPR without hesitation when the victim was a trusted individual. However, when faced with unfamiliar individuals, they tended to shrink back due to various barriers. Specifically, four layers of barriers to CPR performance were identified, encompassing security personnel factors, victim-related factors, organizational factors, and societal factors. Participants also shared their perspectives on the desired CPR training, including trainers, training contents, training formats, and training incentives.

CONCLUSION

Security guards should receive comprehensive CPR training to maximize their occupational value. In addition to strengthening CPR-related training, which includes theoretical knowledge and hands-on practice, psychological coping skills for managing overwhelming emotions and understanding relevant laws are also essential training elements that cannot be overlooked. When developing relevant intervention strategies, policies, and regulations, it's critical to consider the country's context and the cooperation of the organization where the security guard is employed. The model developed in this study can provide a reference for designing interventions and policy to improve the B-CPR intention and performance for other specific groups.

Effectiveness of dispatcher-assisted cardiopulmonary resuscitation in private home versus public locations for out-of-hospital cardiac arrest patients - A retrospective cohort study

BACKGROUND

Dispatcher-assisted cardiopulmonary resuscitation (DACPR) significantly improves the survival of out-of-hospital cardiac arrest (OHCA) patients. However, the effectiveness of DACPR may vary depending on the location of the cardiac arrest. This study compares DACPR outcomes in private homes versus public places.

METHODS

This retrospective cohort study included all OHCA incidents with emergency medical service (EMS) activation in Taichung City, Taiwan, from May 1, 2021, to April 30, 2022. Trained dispatch reviewers analyzed audio recordings of the included cases to extract DACPR indicators. The primary outcome was the number of successful chest compressions performed. Secondary outcomes included the proportion of OHCA recognition, call-to-chest compression time, call-to-OHCA recognition time, reasons for failure to identify OHCA, and reasons for failure to perform chest compressions or complete instructions. A subgroup analysis examined the caller-patient relationship in both locations.

RESULTS

The study included 1,160 OHCA patients, with 1,009 cases occurring in private homes and 151 in public places. Patients in public places were younger (60 vs 75 years), more often male (81.5 % vs 59.9 %), and had a higher rate of witnessed collapse compared to those in private homes (40.4 % vs 26.7 %, p < 0.001). Chest compressions were less frequently administered in public places (41.1 % vs 65.5 %, adjusted odds ratio [aOR]: 0.48 [0.31 to 0.75]). Public place cases had a lower proportion of OHCA recognition (51.9 % vs 76.9 %) and longer call-to-OHCA recognition times (108 vs 79 s) than those in private homes. Callers in public places more often encountered hazardous environments or physical barriers (16.4 % vs 8.3 %) and refused to execute instructions (11.0 % vs 4.1 %), but faced fewer emotional or psychological obstacles (0 % vs 8.3 %). Family members in private homes had a higher proportion of chest compressions (67.1 % vs 53.8 %, aOR: 1.81 [1.15 to 2.83]) and shorter times to chest compression (160 s vs 171 s, adjusted beta: -30 s [-55.6 to -6.3]) compared to non-family members.

CONCLUSION

This study demonstrated reduced DACPR effectiveness in public places compared to private homes, potentially influenced by caller factors, environmental conditions, and the caller-patient relationship. Developing location-specific strategies is essential to enhance DACPR effectiveness.

Epidemiology, Process of Care, and Associated Outcomes of Pediatric Out-of-Hospital Cardiac Arrest in China: Results From a Prospective, Multicenter, Population-Based Registry

OBJECTIVES

To comprehensively describe the incidence, process of care, outcomes, and variation among different age groups of pediatric out-of-hospital cardiac arrest (OHCA) in China.

DESIGN

The Baseline Investigation of Out-of-Hospital Cardiac Arrest (BASIC-OHCA) is a prospective, multicenter, population-based registry of emergency medical services (EMS)-assessed OHCA in China.

SETTING

A total of 25 monitoring sites of all seven geographical regions were included, covering a pediatric population (age ≤ 19) of around 22.3 million in China.

PATIENTS

Pediatric patients enrolled in BASIC-OHCA from August 2019 to December 2020 were included.

INTERVENTIONS

None.

MEASUREMENTS AND MAIN RESULTS

A total of 1493 pediatric patients with EMS-assessed OHCA were enrolled, and resuscitation was attempted in 651 cases (43.6%). The crude incidence of EMS-assessed and EMS-treated OHCA was 5.5 (95% CI, 5.2-5.9) and 2.4 (95% CI, 2.2-2.6) per 100,000 pediatric population. Among 651 EMS-treated OHCA cases, 434 patients (66.7%) were male, and 353 (54.2%) had nonmedical causes (trauma, asphyxia, and drowning being the most common). There were 396 patients (60.8%) who collapsed at home, and the proportion of cases that occurred in public places such as streets and schools increased with age. There were 26 patients (4.0%) who had an initial shockable rhythm. For 626 non-EMS-witnessed patients, 152 patients (24.3%) received bystander cardiopulmonary resuscitation (CPR), 68 (10.9%) received dispatcher-assisted CPR, and 3 (0.5%) had automated external defibrillator applied. The survival to discharge or 30 days was 3.5% (23/651), and the favorable neurologic prognosis was 3.1% (20/651), with no differences among age groups.

CONCLUSIONS

This study provides the first national exploration of pediatric OHCA in China. The high proportion of nonmedical causes underscores the importance of preventing accidents in children. Gaps in the chain of survival and patient outcomes provide a focus for improving the treatment of pediatric OHCA in China and other developing countries.

Intraosseous and Intravenous Epinephrine Administration Routes in Out-of-Hospital Cardiac Arrest: Survival and Neurologic Outcomes

BACKGROUND

The rate of survival after out-of-hospital cardiac arrest varies depending on the timeliness and effectiveness of prehospital interventions. This study was conducted to compare out-of-hospital cardiac arrest outcomes between intravenous and intraosseous routes and between upper and lower extremity routes for drug administration.

METHODS AND RESULTS

We retrospectively analyzed data (collected using the Utstein template) from 1220 patients who had experienced out-of-hospital cardiac arrest in Taiwan's Taoyuan City between January 2021 and August 2023. The patients were stratified into intravenous and intraosseous groups by treatment approach and upper and lower extremity access groups by access site. The study outcomes were survival to discharge, favorable neurologic outcomes (Cerebral Performance Category score 1 or 2), and survival for >2 hours. The study groups were statistically compared before and after propensity score matching. Significant pre-propensity score matching differences were observed between intravenous and intraosseous groups, and the aforementioned study outcomes were better in the intravenous group than in the intraosseous group. However, the between-group differences became nonsignificant after propensity score matching. Furthermore, lower extremity access and delayed epinephrine administration were associated with worse outcomes. Survival rates fell below 12.6% when time to treatment exceeded 15 minutes, particularly in the cases of intraosseous access and lower extremity access.

CONCLUSIONS

This study highlights the benefits of early intervention and upper extremity access for drug administration in patients with out-of-hospital cardiac arrest. Intraosseous access may serve as a viable alternative to intravenous access. Timely administration of essential drugs during resuscitation can improve clinical outcomes and thus has implications for emergency medical service training.

Benzodiazepine use and incident risk of sudden cardiac arrest in patients with cardiovascular diseases

BACKGROUND

Benzodiazepines (BZDs) are commonly prescribed as adjunctive drugs for patients with cardiovascular diseases (CVDs), particularly those who experience anxiety or insomnia. However, the relationship between the use of BZDs and incident risk of sudden cardiac arrest (SCA) has not been well investigated. In this study, we aimed to examine the association between the use of BZDs and the incident risk of SCA among patients with CVD.

METHOD

In this retrospective cohort study, a total of 74,715 eligible patients with new-onset CVD as a primary cause of hospitalization between July 2016 and August 2022 were included from the health information platform in Shenzhen, China. Among them, 61,761 BZD non-initiators were identified and matched to 12,954 BZD initiators by propensity score at a maximum ratio of 5:1. Propensity score-matched Cox proportional hazard models were used to estimate the hazard ratios (HRs) and 95% confidence intervals (CIs).

RESULTS

Over a 12-month follow-up period, 29 (2.24 per 1000 person-years) and 137 (2.22 per 1000 person-years) SCA cases occurred among propensity score-matched BZD initiators and non-initiators, respectively. Patients who initiated BZD treatment were associated with a 101% increased risk of SCA incidence compared with patients without BZD treatment (adjusted HR: 2.01, 95% CI: 1.42, 2.83). Furthermore, compared with the non-use (0 defined daily dose, DDD), the adjusted HR was 1.43 (95% CI: 1.32, 1.56) for the BZD consumption of ≤1 DDD and 2.58 (95% CI: 2.37, 2.81) for the BZD consumption of >1 DDD (P for trend < 0.001) within a 12-month follow-up period.

CONCLUSION

This study provides evidence that BZD initiation may be associated with an increased incident risk of SCA in patients with CVD. Our finding highlights the importance of cautious prescribing BZDs in the health management of patients with CVD.

Incidence, characteristics, and prehospital outcomes of out-of-hospital cardiac arrest in Qatar: a nationwide gender-based investigation

BACKGROUND

Research on incidence and characteristics of Out-of-Hospital Cardiac Arrest (OHCA) in the Middle East is limited. We assessed the incidence, prehospital characteristics, and outcomes of OHCA in Qatar, a Middle Eastern country. Subsequently, we performed gender-specific analysis.

METHODS

This was a retrospective examination of data obtained from the OHCA registry at Hamad Medical Corporation (HMC) in Qatar from 2017 to 2022. We included adults, non-traumatic, EMS-treatment OHCA. We calculated the incidence of adult OHCA and conducted descriptive analyses for prehospital characteristics, and prehospital outcomes presented by return of spontaneous circulation (ROSC). We evaluated gender differences in prehospital characteristics and ROSC using Student's t-test and the Chi-Square test as appropriate. Furthermore, we conducted a multivariable logistic regression analysis to investigate the correlation between gender and achieving ROSC.

RESULTS

We included 4,306 adult OHCA patients, with 869 (20.2%) being females. The mean annual incidence of adult OHCA was 27.4 per 100,000 population-year. Males had a higher annual incidence of OHCA than females. Among all cases, 36.3% occurred in a public location, 25.8% had an initial shockable rhythm, and 28.8% achieved ROSC. Males had a higher proportion of bystander CPR, arrests in public locations, and initial shockable rhythms. While unadjusted analysis showed no significant gender differences in achieving ROSC, adjusted analysis revealed that male gender was associated with higher odds of achieving ROSC (adjusted OR male vs. female 1.38, 95% CI 1.15-1.66, p < 0.001).

CONCLUSIONS

Approximately 720 adults undergo non-traumatic OHCA in Qatar every year, with a higher incidence observed in males. Male gender was associated with higher odds of achieving ROSC. Further gender-specific research in OHCA intervention and outcome in the Middle East is required.

Addressing out-of-hospital cardiac arrest with current technology advances: Breaking the deadlock with a mobile network

Out-of-hospital cardiac arrest (OHCA) is a global public health problem, with survival rates remaining low at around 10% or less despite widespread cardiopulmonary resuscitation (CPR) training and availability of automated external defibrillators (AEDs). This is partly due to the challenges of knowing when and where a sudden OHCA occurs and where the nearest AED is located. In response, countries around the world have begun to use network technology-based smartphone applications. These applications are activated by emergency medical service dispatchers and alert preregistered volunteer first responders (VFRs) to nearby OHCAs using Global Positioning System localization. Accumulating evidence, although mostly from observational studies, shows their effectiveness in increasing the rate of bystander CPR, defibrillation, and patient survival. Current guidelines recommend the use of these VFR alerting systems, and the results of ongoing randomized trials are awaited for further dissemination. This article also proposed the concept of a life-saving mobile network (LMN), which uses opportunistic network and wireless sensor network technologies to create a dynamic mesh network of potential victims, rescuers, and defibrillators. The LMN works by detecting a fatal arrhythmia with a wearable sensor device, localizing the victim and the nearest AED with nearby smartphones, and notifying VFRs through peer-to-peer communication. While there are challenges and limitations to implementing the LMN in society, this innovative network technology would reduce the tragedy of sudden cardiac death from OHCA.

Effectiveness of virtual and augmented reality for cardiopulmonary resuscitation training: a systematic review and meta-analysis

BACKGROUND

Virtual reality (VR) and augmented reality (AR) are emerging technologies that can be used for cardiopulmonary resuscitation (CPR) training. Compared to traditional face-to-face training, VR/AR-based training has the potential to reach a wider audience, but there is debate regarding its effectiveness in improving CPR quality. Therefore, we conducted a meta-analysis to assess the effectiveness of VR/AR training compared with face-to-face training.

METHODS

We searched PubMed, Embase, Cochrane Library, Web of Science, CINAHL, China National Knowledge Infrastructure, and Wanfang databases from the inception of these databases up until December 1, 2023, for randomized controlled trials (RCTs) comparing VR- and AR-based CPR training to traditional face-to-face training. Cochrane's tool for assessing bias in RCTs was used to assess the methodological quality of the included studies. We pooled the data using a random-effects model with Review Manager 5.4, and assessed publication bias with Stata 11.0.

RESULTS

Nine RCTs (involving 855 participants) were included, of which three were of low risk of bias. Meta-analyses showed no significant differences between VR/AR-based CPR training and face-to-face CPR training in terms of chest compression depth (mean difference [MD], -0.66 mm; 95% confidence interval [CI], -6.34 to 5.02 mm; P = 0.82), chest compression rate (MD, 3.60 compressions per minute; 95% CI, -1.21 to 8.41 compressions per minute; P = 0.14), overall CPR performance score (standardized mean difference, -0.05; 95% CI, -0.93 to 0.83; P = 0.91), as well as the proportion of participants meeting CPR depth criteria (risk ratio [RR], 0.79; 95% CI, 0.53 to 1.18; P = 0.26) and rate criteria (RR, 0.99; 95% CI, 0.72 to 1.35; P = 0.93). The Egger regression test showed no evidence of publication bias.

CONCLUSIONS

Our study showed evidence that VR/AR-based training was as effective as traditional face-to-face CPR training. Nevertheless, there was substantial heterogeneity among the included studies, which reduced confidence in the findings. Future studies need to establish standardized VR/AR-based CPR training protocols, evaluate the cost-effectiveness of this approach, and assess its impact on actual CPR performance in real-life scenarios and patient outcomes.

TRIAL REGISTRATION

CRD42023482286.

Implementation of basic life support education for the lay public in China: barriers, enablers, and possible solutions

Background

Education for the lay public in basic life support (BLS) is critical for increasing bystander cardiopulmonary resuscitation (CPR) rates and improving survival from out-of-hospital cardiac arrest (OHCA). Despite years of implementation, the BLS training rate in China has remained modest. The aim of this study was to investigate the factors influencing the implementation of BLS training programs in emergency medical service (EMS) centers in China and to identify specific barriers and enablers.

Methods

Qualitative interviews were conducted with key informants from 40 EMS centers in Chinese cities. The participants included 11 directors/deputy directors, 24 training department leaders, and 5 senior trainers. The interview guide was based on the Exploration, Preparation, Implementation, Sustainment (EPIS) framework. Thematic content analysis was used to identify themes and patterns across the interviews.

Results

We identified 16 factors influencing the implementation of BLS training programs encompassing the outer content, inner context, innovation and bridging factors. Some factors acted as either barriers or enablers at different EPIS stages. The main implementation barriers included limited external leadership, insufficient government investment, low public awareness, a shortage of trainers, an absence of incentives, an absence of authoritative courses and guidelines, a lack of qualification to issue certificates, limited academic involvement, and insufficient publicity. The main enablers were found to be supportive government leaders, strong public demand, adequate resources, program champions, available high-quality courses of high fitness within the local context, the involvement of diverse institutions, and effective publicity and promotion.

Conclusion

Our findings emphasize the diversity of stakeholders, the complexity of implementation, and the need for localization and co-construction when conducting BLS training for lay public in city EMS centers. Improvements can be made at the national level, city level, and EMS institutional level to boost priority and awareness, promote legislation and policies, raise sustainable resources, and enhance the technology of BLS courses.

The development history, current state, challenges, and future directions of the BASIC-OHCA registry in China: A narrative review

Out-of-hospital cardiac arrest is a major public health problem worldwide due to its high burden and poor outcomes. Despite progress in treatment, patient outcomes remain unsatisfactory, particularly in low-resource settings. The establishment of a registry is the first step towards gaining a comprehensive understanding of prevailing local conditions and identifying potential opportunities for improving patient survival. Here, we provide a narrative review of the BASeline Investigation of Out-of-hospital Cardiac Arrest (BASIC-OHCA), the first national OHCA registry in China, to introduce its development history, current state, challenges and future directions. We aim to enhance cross-cultural understanding by providing insights from China, while also serving as a reference for the implementation of large-scale registries in low-resource settings.

The role of magnesium in cardiac arrest

Cardiac arrest is a leading cause of death globally. Only 25.8% of in-hospital and 33.5% of out-of-hospital individuals who achieve spontaneous circulation following cardiac arrest survive to leave the hospital. Respiratory failure and acute coronary syndrome are the two most common etiologies of cardiac arrest. Effort has been made to improve the outcomes of individuals resuscitated from cardiac arrest. Magnesium is an ion that is critical to the function of all cells and organs. It is often overlooked in everyday clinical practice. At present, there have only been a small number of reviews discussing the role of magnesium in cardiac arrest. In this review, for the first time, we provide a comprehensive overview of magnesium research in cardiac arrest focusing on the effects of magnesium on the occurrence and prognosis of cardiac arrest, as well as in the two main diseases causing cardiac arrest, respiratory failure and acute coronary syndrome. The current findings support the view that magnesium disorder is associated with increased risk of cardiac arrest as well as respiratory failure and acute coronary syndrome.

Time Is Life: Golden Ten Minutes on Scene-EuReCa_Serbia 2014-2023

Background and Objectives: This study analyzed the frequency of factors influencing the course and outcomes of out-of-hospital cardiac arrest (OHCA) in Serbia and the prediction of pre-hospital outcomes and survival. Materials and Methods: Data were collected during the period from 1 October 2014, to 31 September 2023, according to the protocol of the EuReCa_One study (clinical trial ID number NCT02236819). Results: Overall 9303 OHCA events were registered with a median age of 71 (IQR 61-81) years and 59.7% of them being males. The annual OHCA incidence was 85.60 ± 20.73/100,000. Within all bystander-witnessed cases, bystander-initiated cardiopulmonary resuscitation in 15.3%. Within the resuscitation-initiated group, return-of-spontaneous circulation (ROSC) on scene (any ROSC) was present in 1037/4053 cases (25.6%) and ROSC on admission to the nearest hospital in 792/4053 cases (19.5%), while 201/4053 patients survived to hospital discharge (5.0%). Predictive potential on pre-hospital outcomes was shown by several factors. Also, of all patients having any ROSC, 89.2% were admitted to the hospital alive. The probability of any ROSC dropped below 50% after 17 min passed after the emergency call and 10 min after the EMS scene arrival. These time intervals were significantly associated with survival to hospital discharge (p < 0.001). Five-minute time intervals between both emergency calls and any ROSC and EMS scene arrival and any ROSC also had a significant predictive potential for survival to hospital discharge (p < 0.001, HR 1.573, 95% CI 1.303-1.899 and p = 0.017, HR 1.184, 95% CI 1.030-1.361, respectively). Conclusions: A 10-min time on scene to any ROSC is a crucial time-related factor for achieving any ROSC, and indirectly admission ROSC and survival to hospital discharge, and represents a golden time interval spent on scene in the management of OHCA patients. A similar effect has a time interval of 17 min from an emergency call. Further investigations should be focused on factors influencing these time intervals, especially time spent on scene.

Survival After Out-of-Hospital Cardiac Arrest Before and After Legislation for Bystander CPR

Importance

The lack of evidence-based implementation strategies is a major contributor to increasing mortality due to out-of-hospital cardiac arrest (OHCA) in developing countries with limited resources.

Objective

To evaluate whether the implementation of legislation is associated with increased bystander cardiopulmonary resuscitation (CPR) and automated external defibrillator (AED) use and improved clinical outcomes for patients experiencing OHCA and to provide policy implications for low-income and middle-income settings.

Design, Setting, and Participants

This observational cohort study analyzed a prospective city registry of patients with bystander-witnessed OHCA between January 1, 2010, and December 31, 2022. The Emergency Medical Aid Act was implemented in Shenzhen, China, on October 1, 2018. An interrupted time-series analysis was used to assess changes in outcomes before and after the law. Data analysis was performed from May to October 2023.

Exposure

The Emergency Medical Aid Act stipulated the use of AEDs and CPR training for the public and provided clear legal guidance for OHCA rescuing.

Main Outcomes and Measures

The primary outcomes were rates of bystander-initiated CPR and use of AEDs. Secondary outcomes were rates of prehospital return of spontaneous circulation (ROSC), survival to arrival at the hospital, and survival at discharge.

Results

A total of 13 751 patients with OHCA (median [IQR] age, 59 [43-76] years; 10 011 men [72.83%]) were included, with 7858 OHCAs occurring during the prelegislation period (January 1, 2010, to September 30, 2018) and 5893 OHCAs occurring during the postlegislation period (October 1, 2018, to December 31, 2022). The rates of bystander-initiated CPR (320 patients [4.10%] vs 1103 patients [18.73%]) and AED use (214 patients [4.12%] vs 182 patients [5.29%]) increased significantly after legislation implementation vs rates before the legislation. Rates of prehospital ROSC (72 patients [0.92%] vs 425 patients [7.21%]), survival to arrival at the hospital (68 patients [0.87%] vs 321 patients [5.45%]), and survival at discharge (44 patients [0.56%] vs 165 patients [2.80%]) were significantly increased during the postlegislation period. Interrupted time-series models demonstrated a significant slope change in the rates of all outcomes.

Conclusions and Relevance

These findings suggest that implementation of the Emergency Medical Aid Act in China was associated with increased rates of CPR and public AED use and improved survival of patients with OHCA. The use of a systemwide approach to enact resuscitation initiatives and provide legal support may reduce the burden of OHCA in low-income and middle-income settings.

Racial and ethnic disparities in bystander resuscitation for out-of-hospital cardiac arrests

INTRODUCTION

Bystander-provided cardiopulmonary resuscitation (CRP) influences the survival rates of out-of-hospital cardiac arrests (OHCAs). Disparities on bystander resuscitation measures between Black, Hispanic, Asians and Non-Hispanic White OHCAs is unclear. Examining racial and ethnic differences in bystander resuscitations is essential to better target interventions.

METHODS

15,542 witnessed OHCAs were identified between April 1, 2011, and June 30, 2015 using the Resuscitation Outcomes Consortium Epidemiologic Registry 3, a multi-center, controlled trial about OHCAs in the United States and Canada. Multivariable logistic regression model was used to analyze the differences in bystander resuscitation (bystander CRP [B-CPR], CPR plus ventilation, automated external defibrillators/defibrillator application [B-AED/D], or delivery of shocks) and clinical outcomes (death at the scene or en route, return of spontaneous circulation upon first arrival at the emergency department [ROSC-ED], survival until ED discharge [S-ED], survival until hospital discharge [S-HOS], and favorable neurological outcome at discharge) between Black, Hispanic, or Asian victims and Non-Hispanic White victims.

RESULTS

Compared to OHCA victims in Non-Hispanic Whites, Black, Hispanic, and Asians were less likely to receive B-CPR (adjusted OR: 0.79; 95 % CI: 0.63-0.99), and B-AED/D (adjusted OR: 0.80; 95 % CI: 0.65-0.98) in public locations. And, Black, Hispanic, and Asian OHCAs were less likely to receive bystander resuscitation in street/highway locations and public buildings, and less likely to have better clinical outcomes, including ROSC-ED, S-ED and S-HOS.

CONCLUSION

Black, Hispanic and Asian victims with witnessed OHCAs are less likely to receive bystander resuscitation and more likely to get worse outcomes than Non-Hispanic White victims.