Cardiopulmonary resuscitation performed by off-duty medical professionals versus laypersons and survival from out-of-hospital cardiac arrest among adult patients

• Published in: Resuscitation 2019-02, Vol.135, p.66-72
• Main Authors: Kobayashi, Daisuke, Kitamura, Tetsuhisa, Kiyohara, Kosuke, Nishiyama, Chika, Hayashida, Sumito, Matsuyama, Tasuku, Katayama, Yusuke, Shimamoto, Tomonari, Kiguchi, Takeyuki, Okabayashi, Satoe, Kawamura, Takashi, Iwami, Taku
• Format: Article
• Language: English
• Subjects: Adult; Aged; Bystander; Cardiopulmonary resuscitation; Cardiopulmonary Resuscitation - methods; Cardiopulmonary Resuscitation - standards; Cardiopulmonary Resuscitation - statistics & numerical data; Emergency Medical Services - methods; Emergency Medical Services - standards; Emergency Medical Services - statistics & numerical data; Female; Humans; Japan - epidemiology; Male; Middle Aged; Out-of-hospital cardiac arrest; Out-of-Hospital Cardiac Arrest - mortality; Out-of-Hospital Cardiac Arrest - therapy; Outcome; Outcome and Process Assessment, Health Care; Registries - statistics & numerical data; Survival Analysis
• ISSN: 0300-9572; 1873-1570
• DOI: 10.1016/j.resuscitation.2019.01.005

Cardiopulmonary resuscitation (CPR) performed by bystanders is a key factor for out-of-hospital cardiac arrest (OHCA) survival. This study aimed to evaluate the relationship between CPR performed by off-duty medical professionals vs. laypersons and one-month survival with favorable neurological outcome after OHCA. Using a population-based database of OHCA patients in Osaka City, Japan, from 2013 through 2015, we enrolled adult OHCA patients with resuscitation attempts performed by bystanders before the arrival of emergency-medical-service personnel. Multivariable logistic regression analysis was performed to assess the association between CPR performed by off-duty medical professionals vs. laypersons and the OHCA outcome after adjusting for potential confounding factors. The primary outcome measure was one-month survival with favorable neurological outcome, defined as cerebral performance category of 1 or 2. A total of 2326 subjects were eligible for our study. Among these, 365 (15.7%) patients received CPR by off-duty medical professionals and 1,961 (84.3%) received CPR by laypersons. In the multivariable analysis, there was no difference in favorable neurological outcome between off-duty medical professionals (6.3% [23/365]) and laypersons (5.1% [100/1,961]) among eligible patients (adjusted odds ratio 0.83, 95% confidence interval [0.37–2.06]). This finding was also confirmed in propensity score-matched patients. In Japan where the CPR training or bystander CPR has been widely disseminating, CPR by laypersons had similar effects compared to that by off-duty medical professionals. As this study could not assess the quality of bystander CPR, further studies are essential to verify the effects of the bystander CPR type on OHCA patients.