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Observational Study
. 2024 Feb;17(2):e010116.
doi: 10.1161/CIRCOUTCOMES.123.010116. Epub 2023 Dec 26.

Association Between Delays in Time to Bystander CPR and Survival for Witnessed Cardiac Arrest in the United States

Dan D Nguyen  1   2 , John A Spertus  1   2 , Kevin F Kennedy  1 , Kashvi Gupta  2 , Anezi I Uzendu  1   2 , Bryan F McNally  3 , Paul S Chan  1   2
Affiliations
Observational Study

Association Between Delays in Time to Bystander CPR and Survival for Witnessed Cardiac Arrest in the United States

Dan D Nguyen et al. Circ Cardiovasc Qual Outcomes. 2024 Feb.

Abstract

Background: Prompt initiation of bystander cardiopulmonary resuscitation (CPR) is critical to survival for out-of-hospital cardiac arrest (OHCA). However, the association between delays in bystander CPR and OHCA survival is poorly understood.

Methods: In this observational study using a nationally representative US registry, we identified patients who received bystander CPR from a layperson for a witnessed OHCA from 2013 to 2021. Hierarchical logistic regression was used to estimate the association between time to CPR (<1 minute versus 2-3, 4-5, 6-7, 8-9, and ≥10-minute intervals) and survival to hospital discharge and favorable neurological survival (survival to discharge with cerebral performance category of 1 or 2 [ie, without severe neurological disability]).

Results: Of 78 048 patients with a witnessed OHCA treated with bystander CPR, the mean age was 63.5±15.7 years and 25, 197 (32.3%) were women. The median time to bystander CPR was 2 (1-5) minutes, with 10% of patients having a≥10-minute delay before initiation of CPR. Overall, 15 000 (19.2%) patients survived to hospital discharge and 13 159 (16.9%) had favorable neurological survival. There was a graded inverse relationship between time to bystander CPR and survival to hospital discharge (P for trend <0.001). Compared with patients who received CPR within 1 minute, those with a time to CPR of 2 to 3 minutes were 9% less likely to survive to discharge (adjusted odds ratio, 0.91 [95% CI, 0.87-0.95]) and those with a time to CPR 4 to 5 minutes were 27% less likely to survive (adjusted odds ratio, 0.73 [95% CI, 0.68-0.77]). A similar graded inverse relationship was found between time to bystander CPR and favorable neurological survival (P for trend <0.001).

Conclusions: Among patients with witnessed OHCA, there was a dose-response relationship between delays in bystander initiation of CPR and lower survival rates.

Keywords: cardiopulmonary resuscitation; logistic model; out-of-hospital cardiac arrest; probability; registries; survival rate.

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Conflict of interest statement

Disclosures Dr Chan receives funding from the American Heart Association and is a consultant for Optum Rx. Dr McNally is the Executive Director of the CARES, which receives funding from the American Heart Association and American Red Cross. Dr Spertus reports providing consultative services on patient-reported outcomes and evidence valuation to Alnylam, AstraZeneca, Bayer, Merck, Janssen, Bristol Meyers Squibb, Edwards, Kineksia, 4DT Medical, Terumo, Cytokinetics, Imbria, and United Healthcare. He holds research grants from Bristol Meyers Squibb, Abbott Vascular and Janssen. He owns the copyright to the Seattle Angina Questionnaire, Kansas City Cardiomyopathy Questionnaire, and Peripheral Artery Questionnaire and serves on the Board of Directors for Blue Cross Blue Shield of Kansas City. The other authors report no conflicts.

Figures

Figure 1.
Figure 1.. Time to initiation of bystander CPR for witnessed OHCAs.
Time to CPR is shown for overall cohort. Abbreviations: CPR, cardiopulmonary resuscitation; OHCA, out-of-hospital cardiac arrest.
Figure 2.
Figure 2.. Survival outcomes by time to bystander CPR.
Rates of survival to discharge (Panel A) and favorable neurological survival (Panel B) are shown by time to bystander CPR. Abbreviations: CPR, cardiopulmonary resuscitation.
See this image and copyright information in PMC

References

    1. Panchal AR, Bartos JA, Cabañas JG, Donnino MW, Drennan IR, Hirsch KG, Kudenchuk PJ, Kurz MC, Lavonas EJ, Morley PT, et al. Part 3: Adult Basic and Advanced Life Support: 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2020;142:S366–S468. doi:10.1161/CIR.0000000000000916 - DOI - PubMed
    1. Stiell IG, Wells GA, Field B, Spaite DW, Nesbitt LP, De Maio VJ, Nichol G, Cousineau D, Blackburn J, Munkley D, et al. Advanced Cardiac Life Support in Out-of-Hospital Cardiac Arrest. https://doi.org/101056/NEJMoa040325. 2004;351:647–656. doi:10.1056/NEJMOA040325 - DOI - PubMed
    1. Hasselqvist-Ax I, Riva G, Herlitz J, Rosenqvist M, Hollenberg J, Nordberg P, Ringh M, Jonsson M, Axelsson C, Lindqvist J, et al. Early Cardiopulmonary Resuscitation in Out-of-Hospital Cardiac Arrest. New England Journal of Medicine. 2015;372:2307–2315. doi:10.1056/NEJMOA1405796/SUPPL_FILE/NEJMOA1405796_DISCLOSURES.PDF - DOI - PubMed
    1. Sasson C, Rogers MAM, Dahl J, Kellermann AL. Predictors of survival from out-of-hospital cardiac arrest: a systematic review and meta-analysis. Circ Cardiovasc Qual Outcomes. 2010;3:63–81. doi:10.1161/CIRCOUTCOMES.109.889576 - DOI - PubMed
    1. Patil KD, Halperin HR, Becker LB. Cardiac Arrest. Circ Res. 2015;116:2041–2049. doi:10.1161/CIRCRESAHA.116.304495 - DOI - PMC - PubMed

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