Racial and ethnic differences in bystander cardiopulmonary resuscitation for opioid-associated out-of-hospital...

A number of research studies expose race and ethnic disparities in bystander cardiopulmonary resuscitation (bCPR) among people experiencing out-of-hospital cardiac arrest (OHCA). There is limited research on the degree of racial and ethnic bCPR disparities among people experiencing opioid-associated OHCA (OA-OHCA). The purpose of this study is to evaluate these differences.

This retrospective cohort study investigated bCPR patterns among adult OA-OHCA patients using U.S. National Emergency Medical Services Information System (NEMSIS) dataset years 2017 through 2025. We compared the primary outcome, bystander-administered CPR, across racial and ethnic subgroups. Odds ratios were calculated using multivariable logistic regression while controlling for age, sex, incident year and location, and an indicator for dispatch pre-arrival instructions.

This study examined 19,612 EMS-assessed opioid overdoses from years 2017 to 2025 involving people who also experienced OA-OHCA before EMS arrival. Compared to White patients, Black patients had significantly lower odds of receiving bCPR (AOR 0.70, 95% CI 0.63-0.77, p < 0.001) as did Hispanic patients (AOR 0.81, 95% CI 0.71-0.94, p < 0.004). However, there were not significant differences in bCPR between White patients and Asian, American Indian/Native Alaskan or Hawaiian/Pacific Islander patients. Female patients had significantly lower odds of receiving bCPR than male patients (AOR 0.89, 95% CI 0.82-0.97, p = 0.009). Hierarchical analysis showed younger patients fared better in receiving bCPR across racial/ethnic groups compared to older patients who were significantly less likely to receive bCPR. Additional hierarchical analyses examined racial and ethnic differences by pre-arrival CPR instructions from dispatch, ROSC, survival, no-flow- and low-flow-times.

Findings from this study identify specific demographic categories (e.g. age, race/ethnicity) that are significantly less likely to receive bCPR. Risk factors associated with bCPR likelihood for OA-OHCA could inform public health strategies to improve bCPR and reduce opioid overdose deaths and associated disability across all racial and ethnic groups.