RESEARCHERS have determined that the benefit of bystander cardiopulmonary resuscitation (CPR) on survival for out-of-hospital cardiac arrest (OHCA) is lowest in non-Hispanic Black individuals and women.
Researchers aimed to identify whether the impact of bystander CPR on survival outcomes varied by sex, race, and ethnicity, both overall and within specific neighbourhood strata. The research team used a hierarchical logistic regression model to analyse data from 623,342 nontraumatic OHCA cases recorded between 2013 and 2022. The cohort had a mean age of 62.1 years, and 35.9% were women. The racial and ethnic composition included 49.8% non-Hispanic White, 20.6% non-Hispanic Black, 7.3% Hispanic, 2.9% Asian, and 0.4% Native American individuals.
Results indicated that 9.3% of patients survived past hospital discharge. Bystander CPR was generally associated with higher survival rates across all racial and ethnic groups, with the strongest association observed in non-Hispanic White (adjusted odds ratio [OR]: 1.33; 95% CI: 1.30-1.37) and Native American (adjusted OR: 1.40; 95% CI: 1.02-1.90) individuals. Conversely, the association was weakest among non-Hispanic Black individuals (adjusted OR: 1.09; 95% CI, 1.04-1.14). Hispanic and Asian individuals had intermediate levels of association, with adjusted ORs of 1.29 and 1.27, respectively. When comparing survival outcomes by sex, the data showed that men benefited more from bystander CPR (adjusted OR: 1.35; 95% CI: 1.31-1.38) than women (adjusted OR: 1.15; 95% CI, 1.12-1.19). Notably, the reduced effectiveness of bystander CPR in Black individuals and women persisted across different neighbourhood race, ethnicity, and income levels. Similar trends were observed in the secondary outcome of survival without severe neurological deficits.
The study concludes that while bystander CPR improves survival in OHCA across all demographics, the benefit is notably less pronounced in Black individuals and women. These findings highlight the need for targeted public health interventions to address these disparities. Increasing awareness and training in diverse communities, particularly those with historically lower survival rates, could enhance the clinical impact of bystander CPR and reduce existing inequities in OHCA outcomes.
Katrina Thornber, EMJ
Reference
Chan PS et al. Race and sex differences in the association of bystander CPR for cardiac arrest. Circulation. 2024;DOI:10.1161/CIRCULATIONAHA.124.068732.
