Racial and Ethnic Differences in Bystander CPR for Witnessed Cardiac Arrest

Garcia, Raul Angel; Spertus, John A.; Girotra, Saket; Nallamothu, Brahmajee K.; Kennedy, Kevin F.; McNally, Bryan; Breathett, Khadijah; Rios, Marina Del; Sasson, Comilla; Chan, Paul S.

doi:10.1056/nejmoa2200798

Cited by 76 publications

(45 citation statements)

References 27 publications

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“…CPR is an emergency procedure consisting often of chest compressions with a goal of supplying the brain with blood flow until more definitive care can be provided. Recent research shows that in witnessed out of hospital cardiac arrests, the likelihood of receiving bystander CPR was found to be less among Black or Hispanic people when compared to White persons (Garcia et al, 2022 ). One neglected area for layperson CPR training are correctional facilities.…”

Section: Introductionmentioning

confidence: 99%

CPR in correctional facilities: a missed opportunity?

et al. 2022

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In the incarcerated population, the largest ethnic and racial group is Black people. Heart disease is known as the leading causes of death in the United States which can lead to cardiac arrest. Layperson cardiopulmonary resuscitation (CPR) has been shown to provide a benefit and increase likelihood of return of spontaneous circulation (ROSC). Recent research shows that in witnessed out of hospital cardiac arrests, the likelihood of receiving bystander CPR was found to be less among Black or Hispanic people when compared to White persons. One neglected area for layperson CPR training are these correctional facilities. This population is known to have higher rates of diabetes, high blood pressure and coronary artery disease, all of which contribute to an increased risk of acute coronary syndrome.A search was performed of the NEMSIS database. When comparing witnessed cardiac arrest, incidents without bystander interventions occurred more frequently than expected if the arrest was witnessed by a family member or other lay person. These interventions included bystander CPR or AED placement with or without defibrillation.The data presented shows that there is an unmet need of additional lay person CPR training in correctional facilities which could be implemented for little cost.

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Section: Introductionmentioning

confidence: 99%

CPR in correctional facilities: a missed opportunity?

et al. 2022

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“…Many aspects in the cascade of cardiac arrest care, from prevention to hospital-based postarrest care, are attributed to these variations in outcomes. Patient race, ethnicity, and socioeconomic position (SEP) are also all associated with unacceptable disparities in OHCA outcomes. Attempting to disentangle the interconnectedness of cardiac arrest care modalities with SEP is undeniably complex, but Choi et al present a unique, eloquent, and meaningful approach to isolating factors that might be associated with SEP-related disparities in OHCA outcomes.…”

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confidence: 99%

“…Choi et al performed a retrospective study of the Korean nationwide OHCA registry, which is linked to a national health insurance database. The authors defined SEP on the basis of insurance premiums, a surrogate for patient income that is frequently used in other studies that examine SEP and OHCA. The authors evaluated the association between SEP and the care and outcomes of patients who experienced OHCA using logistic regression models.…”

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confidence: 99%

Disentangling the Complex Web of Out-of-Hospital Cardiac Arrest Socioeconomic Disparities

Huebinger

Rios

2023

JAMA Netw Open

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Out-of-hospital cardiac arrest (OHCA) is a time sensitive and highly mortal condition with substantial variation in survival rates globally. 1 Optimizing OHCA outcomes requires complex coordination of multiple care systems and treatment modalities. Many aspects in the cascade of cardiac arrest care, from prevention to hospital-based postarrest care, are attributed to these variations in outcomes.Patient race, ethnicity, and socioeconomic position (SEP) 2 are also all associated with unacceptable disparities in OHCA outcomes. Attempting to disentangle the interconnectedness of cardiac arrest care modalities with SEP is undeniably complex, but Choi et al 3 present a unique, eloquent, and meaningful approach to isolating factors that might be associated with SEP-related disparities in OHCA outcomes.Choi et al 3 performed a retrospective study of the Korean nationwide OHCA registry, which is linked to a national health insurance database. The authors defined SEP on the basis of insurance premiums, a surrogate for patient income that is frequently used in other studies 2,4,5 that examine SEP and OHCA. The authors 3 evaluated the association between SEP and the care and outcomes of patients who experienced OHCA using logistic regression models. One approach infrequently used in prior studies is the use of mediation analysis and structural equation modeling to investigate possible mediating factors between SEP and OHCA outcome disparities.Consistent with prior research, patients from the lowest SEP group (medical aid) had poorer OHCA outcomes. Less than one-half of patients with OHCA in the medical aid group survived with good neurological recovery in comparison with the highest SEP group (first quartile). Interestingly though, outcome rates were similar between the 4 higher SEP groups (first through fourth quartiles).These findings somewhat differ from other studies of SEP, 4,5 where there is a more consistent linear association between SEP and survival outcomes. Witnessed arrest, bystander cardiopulmonary resuscitation (CPR), initial shockable rhythm, sustained return of spontaneous circulation, emergency department (ED) level of care, coronary angiography, and targeted temperature management (TTM) were all identified as mediators between lower SEP and poorer OHCA outcomes.In their attempt to quantify mediation proportion, they found that witness status (11.8%), initial rhythm (56.2%), coronary angiography (20.2%), TTM (4.2%), and ED level of care (10.7%) to have the largest independent mediation proportions among patients who survived to hospital admission.These findings shed important light on modifiable factors amenable to public health interventions to mitigate disparities in OHCA outcomes. As an example, the authors 3 state that witness status may be a product of the lower rate of cardiac arrests in public locations for the lowest SEP group. Public safety net programs are proposed as an intervention to decrease the rates of unwitnessed cardiac arrest, but what cost would be necessary to ensure the presence of an ...

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“…Only in Hispanic patients, the proportion of bystander CPR decreased from 53.1% to 45.0% from pre-pandemic to pandemic. A lower proportion of bystander CPR in other racial or ethnic populations compared to whites has consequently been shown in other regions 7 , 8 , but was earlier not reported for Ventura county 4 . With the lower proportion of bystander CPR and with very little AED use (in 1.1% of OHCA in Hispanic individuals), the proportion of shockable rhythm in Hispanic patients was significantly lower.…”

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confidence: 99%

“…A shorter response time in Hispanic patients might have (partly) counterbalanced the effect on survival. And although the proportion of bystander CPR is lower in Hispanic patients in Ventura County, it is still higher than the overall reported proportion of bystander CPR reported across the US 7 . As the authors discuss, Ventura County has conducted multiple community wide efforts to improve resuscitation characteristics.…”

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confidence: 99%