Bystander Cardiopulmonary Resuscitation: Training, Delivery, And Measurement Error
Degree type
Graduate group
Discipline
Subject
Cardiopulmonary Resuscitation
Education
Sudden Cardiac Arrest
Epidemiology
Public Policy
Funder
Grant number
License
Copyright date
Distributor
Related resources
Author
Contributor
Abstract
Bystander-delivered cardiopulmonary resuscitation (B-CPR) is an essential treatment for sudden cardiac arrest (SCA), yet less than one-third of victims receive B-CPR. Few studies have examined disparities in either layperson CPR training or B-CPR delivery. Furthermore, the association between CPR training and B-CPR delivery, and the potential impact of Dispatch-assisted CPR (D-CPR), has been inadequately quantified, partially due to limited observational datasets. We performed a nationally representative survey to measure estimated CPR training prevalence in the United States. We acquired clinical SCA and B-CPR data from the Resuscitation Outcomes Consortium (ROC) national registry and from Seattle King County (SKC) Emergency Medical Services (EMS) to enable inquiry into D-CPR and missing data within ROC. We assessed the differences in estimated CPR training prevalence, disparities in B-CPR, the association of community-level CPR training and B-CPR, and the impact of missing data. Aim 1: Between 09/2015-11/2015, 9,022 individuals completed the national CPR training survey; 18% reported current training in CPR, and 65% reported prior training. Aim 2: In the ROC cohort, 19,331 out-of-hospital cardiac arrests were assessed. In public locations, 39% (272/694) of females and 45% (1,170/2,600) of males received B-CPR (p<0.01), whereas in private settings, 35% (2,198/6,328) of females and 36% (3,364/9,449) of males received B-CPR (p=ns). Aim 3: From survey and ROC data analysis (n=17,883), increased community CPR training was associated with B-CPR delivery (OR: 1.21(95% CI: 1.04-1.39)), but this relationship was modified by site (p=ns). Aim 4: The ROC D-CPR variable had 80% missingness; multiple imputation (MI) was used and provided comparable results to the complete SKC dataset on the association of D-CPR on B-CPR (ROC MI RR: 3.84 (95% CI: 2.97-4.98) vs EMS complete case RR: 3.51 (95% CI: 3.22-3.83)). MI was verified in Missing Completely at Random and Missing at Random simulated datasets. In conclusion, rates of public CPR training and B-CPR delivery were low in the US. Males were more likely to receive B-CPR in public locations. The association of community-level CPR training on B-CPR delivery was modified by site. Future work is required to understand the role of D-CPR in encouraging CPR delivery.