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    Views 2,853
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    Original Investigation
    Emergency Medicine
    July 1, 2020

    Assessment of Community Interventions for Bystander Cardiopulmonary Resuscitation in Out-of-Hospital Cardiac Arrest: A Systematic Review and Meta-analysis

    Author Affiliations
    • 1Department of Emergency, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, China
    • 2Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
    • 3Department of Cardiology, West China Hospital of Sichuan University, China
    • 4The George Institute for Global Health, UNSW, Sydney, New South Wales, Australia
    • 5Department of Cardiology, Westmead Hospital, Sydney, New South Wales, Australia
    JAMA Netw Open. 2020;3(7):e209256. doi:10.1001/jamanetworkopen.2020.9256
    Key Points español 中文 (chinese)

    Question  Are community interventions aimed to improve bystander cardiopulmonary resuscitation associated with outcomes of out-of-hospital cardiac arrest in the communities that received interventions?

    Findings  This systematic review and meta-analysis of 9 studies including 21 266 out-of-hospital cardiac arrests found that community interventions were associated with better out-of-hospital cardiac arrest survival and bystander cardiopulmonary resuscitation rates; the difference for both outcomes was approximately 1.3-fold with vs without community interventions. Despite moderate to high interstudy heterogeneity, sensitivity analyses supported the main result.

    Meaning  The results of this study suggest that community interventions may be associated with better rates of bystander cardiopulmonary resuscitation and patient survival after out-of-hospital cardiac arrest.


    Importance  Outcomes from out-of-hospital cardiac arrests (OHCAs) remain poor. Outcomes associated with community interventions that address bystander cardiopulmonary resuscitation (CPR) remain unclear and need further study.

    Objective  To examine community interventions and their association with bystander CPR and survival after OHCA.

    Data Sources  Literature search of the MEDLINE, Embase, and the Cochrane Library databases from database inception to December 31, 2018, was conducted. Key search terms included cardiopulmonary resuscitation, layperson, basic life support, education, cardiac arrest, and survival.

    Study Selection  Community intervention studies that reported on comparisons with control and differences in survival following OHCA were included. Studies that focused only on in-hospital interventions, patients with in-hospital cardiac arrest, only dispatcher-assisted CPR, or provision of automated external defibrillators were excluded.

    Data Extraction and Synthesis  Pooled odds ratios (ORs) and 95% CIs were estimated using a random-effects model. This study followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline.

    Main Outcomes and Measures  Thirty-day survival or survival to hospital discharge and bystander CPR rate.

    Results  A total of 4480 articles were identified; of these, 15 studies were included for analysis. There were broadly 2 types of interventions: community intervention alone (5 studies) and community intervention combined with changes in health services (10 studies). Four studies involved notification systems that alerted trained lay bystanders to the location of the OHCA in addition to CPR skills training. Meta-analysis of 9 studies including 21 266 patients with OHCA found that community interventions were associated with increased survival to discharge or 30-day survival (OR, 1.34; 95% CI, 1.14-1.57; I2 = 33%) and greater bystander CPR rate (OR, 1.28; 95% CI, 1.06-1.54; I2 = 82%). Compared with community intervention alone, community plus health service intervention was associated with a greater bystander CPR rate compared with community alone (community plus intervention: OR, 1.74; 95% CI, 1.26-2.40 vs community alone: OR, 1.06; 95% CI, 0.85-1.31) (P = .01). Survival rate, however, was not significantly different between intervention types: community plus health service intervention OR, 1.71; 95% CI, 1.09-2.68 vs community only OR, 1.26; 95% CI, 1.05-1.50 (P = .21).

    Conclusions and Relevance  In this study, while the evidence base is limited, community-based interventions with a focus on improving bystander CPR appeared to be associated with improved survival following OHCA. Further evaluations in diverse settings are needed to enable widespread implementation of such interventions.