Impact of bystander-focused public health interventions on cardiopulmonary resuscitation and survival: a cohort study

Abstract

Background Bystander cardiopulmonary resuscitation (CPR) increases an individual's chance of survival from out-of-hospital cardiac arrest (OHCA), but the frequency of bystander CPR is low in many communities. We aimed to assess the cumulative effect of CPR-targeted public health interventions in Singapore, which were incrementally introduced between 2012 and 2016. Methods We did a secondary analysis of a prospective cohort study of adult, non-traumatic OHCAs, through the Singapore registry. National interventions introduced during this time included emergency services interventions, as well as dispatch-assisted CPR (introduced on July 1, 2012), a training programme for CPR and automated external defibrillators (April 1, 2014), and a first responder mobile application (myResponder; April 17, 2015). Using multilevel mixed-effects logistic regression, we modelled the likelihood of receiving bystander CPR with the increasing number of interventions, accounting for year as a random effect. Findings The Singapore registry contained 11 465 OHCA events between Jan 1, 2011, and Dec 31, 2016. Paediatric arrests, arrests witnessed by emergency medical services, and healthcare-facility arrests were excluded, and 6788 events were analysed. Bystander CPR was administered in 3248 (48%) of 6788 events. Compared with no intervention, likelihood of bystander CPR was not significantly altered by the addition of emergency medical services interventions (odds ratio [OR] 1•33 [95% CI 0•98-1•79]; p=0•065), but increased with implementation of dispatchassisted CPR (3•72 [2•84-4•88]; p<0•0001), with addition of the CPR and automated external defibrillator training programme (6•16 [4•66-8•14]; p<0•0001), and with addition of the myResponder application (7•66 [5•85-10•03]; p<0•0001). Survival to hospital discharge increased after the addition of all interventions, compared with no intervention (OR 3•10 [95% CI 1•53-6•26]; p<0•0001). Interpretation National bystander-focused public health interventions were associated with an increased likelihood of bystander CPR, and an increased survival to hospital discharge. Understanding the combined impact of public health interventions might improve strategies to increase the likelihood of bystander CPR, and inform targeted initiatives to improve survival from OHCA.

Assessing unrealised potential for organ donation after out-of-hospital cardiac arrest

“…The incidence of OHCA has been rising every year, with crude incidence of 26.5 pmp in 2011 to 44.6 per 1000 pmp in 2016. While an increasing proportion of these survived (19.9% survived to admission, 6.5% survived to discharge in 2016) [ 26 ], a large majority did not survive to admission. All of Singapore’s 18 hospitals (8 public, 10 private) provide deceased donors for solid organ transplantation.…”

“…Improvements in pre-hospital emergency care and bystander interventions have resulted in increasing proportions of out-of-hospital cardiac arrest (OHCA) cases with short no-flow or low-flow times (Pre-hospital/Emergency Department Return of Spontaneous Circulation (ED ROSC) rates at 18.3% in 2001–04 vs 23.8% in 2015–16) [ 24 – 26 ]. In the hospital setting, the progressive adoption of extracorporeal cardiopulmonary resuscitation (ECPR) characterized by the use of extracorporeal membrane oxygenation (ECMO) during CPR not only serves to optimize the outcomes of OHCA patients but may also become a bridging intervention towards uDCD for OHCAs who do not survive [ 27 ].…”

Оцінка Стану Та Ефективності Публічного Управління Та Адміністрування Комунікативної Діяльності Громадського Здоров’я В Україні

“…Таким чином, Audrey L Blewer та співавтори вказують на частоту позалікарняних серцево-легеневих реанімацій як важливу складову громадського здоров'я. Відповідно до даних Американської асоціації серця (American heart association (AHA)) cерцево-легенева реанімація (СЛР) не медичних працівників підвищує шанс людини вижити внаслідок зупинки серця поза лікарнею, однак частота таких СЛР у більшості країн низька (приблизно 40 %) [32].…”

Protocol for a cohort study of the impact of the COVID-19 pandemic on the rate and incidence of bystander cardiopulmonary resuscitation (CPR) after out-of-hospital cardiac arrest

“…Bystander CPR rate is not a fixed feature of a region. It can be improved by interventions such as public information and training, as shown in a recent study from Asia [ 7 ].…”

“…Dispatch-assisted CPR has been implemented in many countries the last 20 years, and has in previous studies shown to improve the bystander CPR rates [ 7 ]. However major events in society may impact on bystander CPR.…”