The effect of bystander cardiopulmonary resuscitation on the survival of out-of-hospital cardiac arrests: a systematic review and meta-analysis

Abstract

BackgroundFor many years, bystander cardiopulmonary resuscitation (BCPR) has been considered as a favorable factor to improve survival of out-of-hospital cardiac arrests (OHCAs). To examine the effect of BCPR on the survival of OHCAs and whether BCPR might also improve survival when the initial rhythm of OHCAs is limited, we performed a meta-analysis on published observational studies.MethodsWe did a systematic review to identify all studies published up to March, 2018, in any language, that reported the relation between BCPR and the survival of OHCAs. Using standard forms, two authors independently identified studies for inclusion and extracted information. The outcome was survival. Meta-regression was done to ascertain weighted factors for the outcomes.ResultsData were extracted from 19 studies involving 232,703 patients. Firstly, pooled odds ratio (OR) from 16 cohort studies showed that BCPR was associated with improved chance of survival of OHCAs compared with NO-BCPR (OR 1.95, 95% confidence interval [CI]: 1.66–2.30). Secondly, from 8 cohort studies of OHCAs whose initial rhythm is limited, the pooled OR was 2.10 (95% CI, 1.68–2.63) of 6 articles for shockable rhythm and 1.07 (95% CI, 0.37–3.13) of 2 articles for non-shockable rhythm. Meta-regression showed a relation between the survival of OHCAs and BCPR was influenced by area (p < 0.05).ConclusionsBased on currently available evidence, the findings of this meta-analysis suggest that BCPR increases the survival of OHCAs, and it also help OHCAs whose initial rhythm is shockable. That is to say BCPR is also helpful when emergency department response time is short. Therefore global priority should be given to increasing the incidence of BCPR by evidence-based best practice.

The global survival rate among adult out-of-hospital cardiac arrest patients who received cardiopulmonary resuscitation: a systematic review and meta-analysis

“…4 Funnel plot for the incidence of survival to discharge among OHCA patients who underwent CPR Fig. 5 Funnel plot for the 1 month survival rate among OHCA patients who underwent CPR consistent with the findings of previous studies [26,[28][29][30]. This suggests that efforts, such as targeted CPR training to increase the bystander CPR rate, will have a substantial effect on improving the survival rates after OHCA [6,31].…”

“…These observed differences may in part reflect the differences in first registered arrhythmia as VT/VF, witnessed collapse, bystander CPR, and early defibrillation in various countries [4,24]. These factors were significantly associated with the survival rates of OHCA patients [25][26][27]. Another explanation is that compared with North America and Europe, and the popularization of bystander CPR has been relatively delayed in Asia; thus, the quality of bystander CPR might be lower in Asia.…”

Challenges in Managing Acute Cardiovascular Diseases and Follow Up Care in Rural Areas: A Narrative Review

“…The concept of the Chain of Survival [35] was developed over 30 years ago to highlight that there is a sequence of interdependent time-critical interventions in which bystanders have a critical role in initiating the call for an ambulance, providing life-saving first aid (CPR), and where possible, while using an automated external defibrillator (AED), when cardiac arrest occurs outside of hospital [35]. Prompt action by bystanders can help to 'buy time' until more definitive treatment is available by the ambulance paramedics, and bystander CPR in this period more than doubles the chance of survival [36,37], with differences in the rates, interventions, and survival in different regions [38]. The training of takers of emergency ambulance calls also has the potential to improve bystander contributions to survival [39].…”

A nationwide investigation of CPR courses, books, and skill retention

“…4,5 Similar trends have been observed in other European countries and the Global Resuscitation Alliance has emphasized the importance of high quality bystander CPR. 3,6,7 Evidence show that education in basic life support (BLS) and the use of an automated external defibrillator (AED) can increase survival rates of OHCA. 6,8,9 It is important to ensure a certain standard of bystander CPR quality to increase survival.…”