Bystander CPR: The Time to Act is Now

Bystander CPR: The Time to Act is Now

A study just published in Circulation: Cardiovascular Quality and Outcomes (Audrey Blewer, MPH et al) reveals that male victims of sudden cardiac arrest had an increased likelihood of receiving CPR from bystanders (BCPR) in public settings, compared with females. An analysis of the Resuscitation Outcomes Consortium registry (n=19,331) indicates layperson BCPR was administered in 37 percent of events, males were more likely to receive BCPR, and males had a 23 percent increased odds of survival compared with females. The study is the first to identify gender disparities as a factor that affects survival.

As Blewer notes, “It is possible that these measured disparities reflect inherent biases among the responder population that delivered BCPR. These findings could inform future messaging to lay responders, healthcare providers, and dispatchers about public BCPR delivery.”

Other research:

  1. Confirms that immediate CPR can double or triple the rates of survival to hospital discharge, since it provides sufficient blood flow to buy critical time until advanced cardiac life support can be delivered by emergency medical responders
  2. Identifies four critical steps that lead to the provision of bystander CPR, namely sudden cardiac arrest must be recognized, bystanders must call 911, dispatchers must recognize the need for CPR, bystanders must be willing to perform CPR
  3. Identifies barriers to bystander intervention, which include concern for hurting the victim, lack of confidence, belief another is more confident, and liability concerns. Research also suggests that another barrier is reluctance to bare a woman's chest.

Blewer et al state that barriers to intervention can largely be overcome through scripted dispatch-assisted CPR instructions. However, research in minority and immigrant communities has identified language barriers and distrust of law enforcement as additional hurdles. Thus, optimization of BCPR delivery may require integration of cultural competency training for dispatchers and the development and testing of culturally and language-appropriate educational interventions.

In a related editorial, Marina Del Rios Rivera, MD, MSc notes that the National Academy of Medicine report Strategies to Improve Cardiac Arrest Survival: A Time to Act (2015) highlighted BCPR as one of the most important modifiable determinants of OHCA survival outcomes. The Blewer study presents a call to action from the resuscitation community, says Del Rios Rivera.

“We must move beyond describing health disparities to finding solutions to the problem,” she said. “The urgent nature of cardiac arrest and the risks of mortality and disability imply a moral obligation to accelerating research in implementation science with an intentional focus on equitable access to lifesaving interventions at each link in the chain of survival. In the era of community resuscitation systems of care, eliminating disparities in out-of-hospital cardiac arrest survival is within reach. The time to act is now."


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The mission of the Sudden Cardiac Arrest (SCA) Foundation is to prevent death and disability from sudden cardiac arrest. The vision of the SCA Foundation is to increase awareness about sudden cardiac arrest and influence attitudinal and behavioral changes that will reduce mortality and morbidity from SCA.

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