[Measures to improve bystander resuscitation : Kids Save Lives and public-access defibrillation]

Bystander cardiopulmonary resuscitation (CPR) and early use of automated external defibrillators (AEDs) are key measures to improve neurologically intact survival after out-of-hospital cardiac arrest (OHCA). In Germany, however, heterogeneous emergency medical service structures, insufficient legal frameworks for public-access defibrillation, and only partially implemented CPR training in schools limit the full realization of this potential. This review summarizes the available evidence on school-based CPR training, national and international programs (including "Kids Save Lives"), and innovative mobile AED strategies. As an example, a regional project in the city and district of Osnabrück is presented, in which a non-profit organization has been implementing CPR training in schools since 2020, training both teachers and students. Building on this, regional initiatives have been launched to systematically record and improve the availability of AED locations. Based on these findings, key fields of action for policymakers, emergency medical service providers, and civil society stakeholders are identified. Nationwide, legally mandated CPR training in schools, a structured public-access defibrillation concept including AED registries, and the consistent involvement of local non-profit organizations appear crucial to strengthening the early links in the chain of survival and to sustainably improving outcomes after OHCA.