Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Mar 1;6(3):e233338.
doi: 10.1001/jamanetworkopen.2023.3338.

Training in Basic Life Support and Bystander-Performed Cardiopulmonary Resuscitation and Survival in Out-of-Hospital Cardiac Arrests in Denmark, 2005 to 2019

Theo Walther Jensen  1   2   3 , Annette Kjær Ersbøll  3   4 , Fredrik Folke  2   3   5 , Signe Amalie Wolthers  1   2 , Mikkel Porsborg Andersen  6 , Stig Nikolaj Blomberg  1   2   3 , Lars Bredevang Andersen  1 , Freddy Lippert  2   3 , Christian Torp-Pedersen  6   7 , Helle Collatz Christensen  1   2   8
Affiliations

Training in Basic Life Support and Bystander-Performed Cardiopulmonary Resuscitation and Survival in Out-of-Hospital Cardiac Arrests in Denmark, 2005 to 2019

Theo Walther Jensen et al. JAMA Netw Open. .

Abstract

Importance: Strategies to improve survival from out-of-hospital cardiac arrest (OHCA) include mass education of laypersons with no official duty to respond to OHCA. In Denmark, basic life support (BLS) course attendance has been mandated by law in October 2006 for obtaining a driver's license for all vehicles and in vocational education programs.

Objectives: To examine the association between yearly BLS course participation rate and bystander cardiopulmonary resuscitation (CPR) and 30-day survival from OHCA and to examine if bystander CPR rate acted as a mediator on the association between mass education of laypersons in BLS and survival from OHCA.

Design, setting, and participants: This cohort study included outcomes for all OHCA incidents from the Danish Cardiac Arrest Register between 2005 and 2019. Data concerning BLS course participation were supplied by the major Danish BLS course providers.

Main outcomes and measures: The main outcome was 30-day survival of patients who experienced OHCA. Logistic regression analysis was used to examine the association between BLS training rate, bystander CPR rate, and survival, and a bayesian mediation analysis was conducted to examine mediation.

Results: A total of 51 057 OHCA incidents and 2 717 933 course certificates were included. The study showed that the annual 30-day survival from OHCA increased by 14% (odds ratio [OR], 1.14; 95% CI, 1.10-1.18; P < .001) when BLS course participation rate increased by 5% in analysis adjusted for initial rhythm, automatic external defibrillator use, and mean age. An average mediated proportion of 0.39 (95% QBCI, 0.049-0.818; P = .01). In other words, the last result indicated that 39% of the association between mass educating laypersons in BLS and survival was mediated through an increased bystander CPR rate.

Conclusions and relevance: In this cohort study of Danish BLS course participation and survival, a positive association was found between annual rate of mass education in BLS and 30-day survival from OHCA. The association of BLS course participation rate on 30-day survival was mediated by the bystander CPR rate; approximately 60% of the association of BLS course participation rate on 30-day survival was based on factors other than increased CPR rates.

PubMed Disclaimer

Conflict of interest statement

Conflict of Interest Disclosures: Dr Lippert reported receiving grants from Laerdal Foundation and grants from Trygfoundation outside the submitted work. Dr Torp-Pedersen reported receiving grants from Bayer and Novo Nordisk for studies outside the submitted work. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Directed Acyclic Graphs Model Visualizations
AED indicates automatic external defibrillator; BLS, basic life support; EMS, emergency medical services; OHCA, out-of-hospital cardiac arrest; T-CPR, cardiopulmonary resuscitation. Pale lines represent relationships between main independent and dependent variables.
Figure 2.
Figure 2.. Distribution of Basic Life Support (BLS) Certificates in the Danish Population and Survival From Out-of-Hospital Cardiac Arrest (OHCA), From 2005 to 2019
In 2011 the Danish emergency medical services dispatch system was transformed to include health care educated personnel as dispatchers with standard protocols for telephone-assisted cardiopulmonary resuscitations guidance.
Figure 3.
Figure 3.. Forest Plot of Models Presenting Association of Training With 30-day Survival From Out-of-Hospital Cardiac Arrest
This forest plot presents several models including and excluding variables from mediation analysis. AED indicates automatic external defibrillator; BLS, basic life support; CPR, cardiopulmonary resuscitation; OR, odds ratio.
Figure 4.
Figure 4.. Potential Mediators of the Association Between OHCA Survival and BLS Certification
AED indicates automatic external defibrillator; BLS, basic life support; CPR, cardiopulmonary resuscitation; EMS, emergency medical services; OHCA, out-of hospital cardiac arrest.
See this image and copyright information in PMC

References

    1. Gräsner JT, Herlitz J, Tjelmeland IBM, et al. . European Resuscitation Council guidelines 2021: Epidemiology of cardiac arrest in Europe. Resuscitation. 2021;161:61-79. doi:10.1016/j.resuscitation.2021.02.007 - DOI - PubMed
    1. Eisenberg M, Lippert FK, Castren M, et al. . Acting on the Call: 2018 Update from the Global Resuscitation Alliance. April 2018. Accessed February 18, 2022. http://www.globalresuscitationalliance.org/wp-content/pdf/acting_on_the_...
    1. Kiguchi T, Okubo M, Nishiyama C, et al. . Out-of-hospital cardiac arrest across the World: first report from the International Liaison Committee on Resuscitation (ILCOR). Resuscitation. 2020;152:39-49. doi:10.1016/j.resuscitation.2020.02.044 - DOI - PubMed
    1. Jensen TW, Blomberg SN, Folke F, et al. . The National Danish Cardiac Arrest Registry for Out-of-Hospital Cardiac Arrest—a registry in transformation. Clin Epidemiol. 2022;14:949-957. doi:10.2147/CLEP.S374788 - DOI - PMC - PubMed
    1. Danish Cardiac Arrest Register, annual report 2020. Report in Danish. Danish Cardiac Arrest Registry . Accessed November 27, 2021. https://hjertestopregister.dk/wp-content/uploads/2022/01/Dansk-Hjertesto...