Evaluating the effect of a regional training initiative on bystander cardiopulmonary resuscitation rates after...

We evaluated the impact of a regional, year-long bystander hands-only cardiopulmonary resuscitation (CPR) education and training initiative conducted at the community level on bystander CPR rates after out-of-hospital cardiac arrest (OHCA).

We used a difference-in-differences framework to estimate the association between the intervention and bystander CPR rates in a single large county compared with two other counties as controls. We used data from January 2022 to December 2024 from Cardiac Arrest Registry to Enhance Survival (CARES). We excluded OHCA events at health care facilities. Our primary outcome was the change in bystander CPR rates associated with the intervention; this analysis was stratified by home and public locations. Additionally, we evaluated the secondary outcomes of survival to hospital discharge and neurologically intact survival. We fit logistic regression models for each of these outcomes with fixed effects for each county.

Of 20,414 included patients; 15,417 were from the intervention region. Overall, bystander CPR rates increased from 37.4% to 42.5% in the intervention region between the pre- and post-intervention periods; however, our adjusted model did not identify a significant intervention effect (2.94 percentage-points; 95% CI -0.95 to 6.83). In public locations, our adjusted model identified a significant 8.59 percentage-point increase in bystander CPR rates associated with the intervention (95% CI 0.22-16.96), and no significant effect in home locations. We did not find a significant intervention effect on survival to hospital discharge and neurologically intact survival between the pre- and post-intervention periods.

While we observed an increasing trend in bystander CPR rates in all regions, this change was not associated with the intervention. However, we found that the intervention was associated with a significant increase in bystander CPR rates for public OHCAs.