Estimating bystander CPR using a strict documentation-based definition: a multiregional EMS registry analysis.

Area of Science:

• Emergency Medicine
• Public Health Surveillance

Background:

• Bystander cardiopulmonary resuscitation (CPR) is critical for out-of-hospital cardiac arrest (OHCA) survival but has low and regionally variable engagement.
• Accurate estimation of bystander CPR prevalence relies on consistent emergency medical services (EMS) registry documentation, which is limited in Saudi Arabia.

Purpose of the Study:

• To determine the prevalence of documented bystander CPR in Saudi Arabia.
• To assess data completeness and identify predictors of bystander CPR in OHCA cases attended by the Saudi Red Crescent Authority (SRCA).
• To examine regional variations in bystander CPR documentation.

Main Methods:

• Retrospective analysis of the SRCA OHCA registry (January-June 2024).
• Bystander CPR defined strictly as documented initiation before EMS arrival by a non-EMS individual.
• Multivariable logistic regression used to identify predictors of bystander CPR.

Main Results:

• Bystander CPR was documented in 12.3% of 5,271 classifiable OHCA cases.
• Witnessed arrest (aOR=5.15) and male sex (aOR=1.26) were associated with higher odds of bystander CPR.
• Longer EMS response time (aOR=0.98 per minute) was associated with lower odds, and significant regional disparities were observed.

Conclusions:

• Bystander CPR engagement in SRCA-attended OHCA cases is low and unevenly distributed across regions.
• Inconsistent documentation highlights the need for standardized reporting to improve surveillance.
• Enhancing dispatcher-assisted CPR, public training, and registry harmonization can improve resuscitation outcomes.