Abstract P170: Small Area Variations in the Provision of Bystander CPR
Background: Bystander-initiated cardiopulmonary resuscitation (CPR) can have an enormous effect on both survival and neurologic outcome after out-of-hospital cardiac arrest (OHCA). While substantial geographic variation in OHCA outcomes has been shown, the origins of that variation is unknown.
Objective: To understand the association between neighborhood and individual factors on the occurrence of OHCA and the provision of bystander CPR.
Methods: We conducted a multi-level analysis of the Cardiac Arrest Registry to Enhance Survival (CARES) for October 1, 2005 to November 30, 2008, including out-of-hospital cardiac arrest cases from Fulton County (Atlanta), Georgia.
Results: There were 1,108 cases of OHCA eligible for BCPR. 25.2% (n=279) of patients received bystander CPR. Twenty of the 41 survivors to hospital discharge received bystander CPR. Neighborhoods had consistent influences on the number of cardiac arrests, and the rates of bystander CPR. On the patient level, bystander CPR was more common for witnessed events (OR 1.76, 95% CI 1.30 –2.38, p value <0.001) and those in public locations (OR 1.68, 95%CI 1.17–2.42, p value <0.05); other individual-level characteristics (e.g., age, sex, race) were not significantly associated with CPR receipt. CPR was much more common in high-income neighborhoods than low-income neighborhoods (OR 4.98 (95%CI 1.65–15.04)) for arrests in the highest versus lowest income census tracts.
Conclusion: Neighborhoods that have high numbers of OHCA in one year are likely to have similarly high levels the next year. Patients with arrests in the highest census tract median income quintiles were most likely to have BCPR, even after controlling for individual characteristics and the type and location of the arrest.
TABLE 1: Unadjusted and HLM Adjusted Odds Ratios for Provision of Bystander CPR