Abstract 12: Differences in the Rate of Bystander CPR Based on Location of Cardiac Arrest in the Out-of-Hospital Setting
Purpose: Bystander CPR is one of the crucial links in the chain of survival from cardiac arrest. We conducted this study to determine how often bystander CPR was performed in the out-of-hospital setting, and to test the hypothesis that there were no differences in frequency based on location.
Methods: The EMS system uses a two-tiered response of first responders/ basic life support followed by paramedics. The service responds to approximately 50,000 calls annually. All calls are handled by an emergency call center which provides prearrival instructions, including CPR prompts to the lay person. All out-of-hospital cardiac arrests (OOH-CA) that were treated by paramedics in our system during 2005 were included. Patients were excluded if the paramedics stopped resuscitative efforts on their arrival. (obvious death, DNR orders, etc.) Demographic information was collected on all patients, as was the time of day and location of arrest. Time intervals from emergency call receipt to BLS and paramedic arrival were recorded. EMS noted whether or not bystander CPR was being performed on their arrival. Statistical testing included chi-square, Mann-Whitney, and regression analysis.
Results: A total of 770 patients in cardiac arrest were studied, with 569 occurring in a private residence, and 201 in a public place. The mean age and gender composition The rate of bystander CPR was significantly lower in private residences compared with public places. (29% vs. 68%; p<0.0001) The frequency of bystander CPR was similar for each subcategory of public places. (office, street, workplace, etc.) The proportion of patients with return of spontaneous circulation (ROSC) was significantly higher in public places. (26% vs. 18%) ROSC was significantly associated with bystander CPR.
Conclusions: The rate of bystander CPR and ROSC is significantly higher in public places. Since most OOH-CA occur in the home, lay person CPR training and EMS dispatcher protocols should emphasize the importance of bystander CPR.