Which Matters More for Out‐of‐Hospital Cardiac Arrest Survival: Witnessed Arrest or Bystander Cardiopulmonary Resuscitation?
Background Despite the well‐known importance of witnessed arrest and bystander cardiopulmonary resuscitation (CPR) for out‐of‐hospital cardiac arrest outcomes, previous studies have shown significant statistical inconsistencies. We hypothesized an interaction effect and conducted stratified analyses...
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| Format: | Article |
| Language: | English |
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Wiley
2025-02-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
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| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.124.038427 |
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| author | Cheng‐Yi Fan Ya‐Ting Liang Edward Pei‐Chuan Huang Jiun‐Wei Chen Wen‐Chu Chiang Charlotte Wang Chih‐Wei Sung |
| author_facet | Cheng‐Yi Fan Ya‐Ting Liang Edward Pei‐Chuan Huang Jiun‐Wei Chen Wen‐Chu Chiang Charlotte Wang Chih‐Wei Sung |
| author_sort | Cheng‐Yi Fan |
| collection | DOAJ |
| description | Background Despite the well‐known importance of witnessed arrest and bystander cardiopulmonary resuscitation (CPR) for out‐of‐hospital cardiac arrest outcomes, previous studies have shown significant statistical inconsistencies. We hypothesized an interaction effect and conducted stratified analyses to investigate whether witnessed arrest is more important than bystander CPR. Methods This study enrolled patients with out‐of‐hospital cardiac arrest between January 2010 and December 2022 in 3 emergency medical service (systems in Taiwan). Data were extracted from emergency medical service dispatch reports, including patient characteristics, witnessed arrest, bystander CPR, time for each dispatch, and prehospital interventions. The outcome measure was prehospital return of spontaneous circulation (ROSC). Patients were categorized into 4 groups: witnessed and bystander CPR present (W+B+), witnessed present but bystander CPR absent (W+B−), witnessed absent but bystander CPR present (W−B+), and witnessed and bystander CPR absent (W−B−). Multiple logistic regression on prehospital ROSC were performed in the 4 subgroups separately. Results A total of 14 737 patients with out‐of‐hospital cardiac arrest were identified, of whom 977 (6.6%) achieved prehospital ROSC. The W+B+ group exhibited the highest prehospital ROSC rate (14.0%). Stratification confirmed a statistically significant interaction between witnessed arrest and bystander CPR. Defibrillation, endotracheal intubation, and epinephrine administration were significantly associated with prehospital ROSC in all subgroups. Most explanatory variables significant in the witnessed arrest group were adjusted for in the nonwitnessed arrest group. Younger age was associated with prehospital ROSC only in the W+B+ group. Conclusions Witnessed arrest and bystander CPR may interact to predict prehospital ROSC in out‐of‐hospital cardiac arrest, with witnessed arrest likely having more significant impact on outcomes. |
| format | Article |
| id | doaj-art-7287c3b9e3db41369b90db3f9d26a6c8 |
| institution | OA Journals |
| issn | 2047-9980 |
| language | English |
| publishDate | 2025-02-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj-art-7287c3b9e3db41369b90db3f9d26a6c82025-08-20T02:16:48ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802025-02-0114410.1161/JAHA.124.038427Which Matters More for Out‐of‐Hospital Cardiac Arrest Survival: Witnessed Arrest or Bystander Cardiopulmonary Resuscitation?Cheng‐Yi Fan0Ya‐Ting Liang1Edward Pei‐Chuan Huang2Jiun‐Wei Chen3Wen‐Chu Chiang4Charlotte Wang5Chih‐Wei Sung6Department of Emergency Medicine National Taiwan University Hospital Hsin‐Chu Branch Hsinchu TaiwanInstitute of Epidemiology and Preventive Medicine, College of Public Health National Taiwan University Taipei TaiwanDepartment of Emergency Medicine National Taiwan University Hospital Hsin‐Chu Branch Hsinchu TaiwanDepartment of Emergency Medicine National Taiwan University Hospital Hsin‐Chu Branch Hsinchu TaiwanDepartment of Emergency Medicine National Taiwan University Hospital Taipei TaiwanMaster of Public Health Program, College of Public Health National Taiwan University Taipei TaiwanDepartment of Emergency Medicine National Taiwan University Hospital Hsin‐Chu Branch Hsinchu TaiwanBackground Despite the well‐known importance of witnessed arrest and bystander cardiopulmonary resuscitation (CPR) for out‐of‐hospital cardiac arrest outcomes, previous studies have shown significant statistical inconsistencies. We hypothesized an interaction effect and conducted stratified analyses to investigate whether witnessed arrest is more important than bystander CPR. Methods This study enrolled patients with out‐of‐hospital cardiac arrest between January 2010 and December 2022 in 3 emergency medical service (systems in Taiwan). Data were extracted from emergency medical service dispatch reports, including patient characteristics, witnessed arrest, bystander CPR, time for each dispatch, and prehospital interventions. The outcome measure was prehospital return of spontaneous circulation (ROSC). Patients were categorized into 4 groups: witnessed and bystander CPR present (W+B+), witnessed present but bystander CPR absent (W+B−), witnessed absent but bystander CPR present (W−B+), and witnessed and bystander CPR absent (W−B−). Multiple logistic regression on prehospital ROSC were performed in the 4 subgroups separately. Results A total of 14 737 patients with out‐of‐hospital cardiac arrest were identified, of whom 977 (6.6%) achieved prehospital ROSC. The W+B+ group exhibited the highest prehospital ROSC rate (14.0%). Stratification confirmed a statistically significant interaction between witnessed arrest and bystander CPR. Defibrillation, endotracheal intubation, and epinephrine administration were significantly associated with prehospital ROSC in all subgroups. Most explanatory variables significant in the witnessed arrest group were adjusted for in the nonwitnessed arrest group. Younger age was associated with prehospital ROSC only in the W+B+ group. Conclusions Witnessed arrest and bystander CPR may interact to predict prehospital ROSC in out‐of‐hospital cardiac arrest, with witnessed arrest likely having more significant impact on outcomes.https://www.ahajournals.org/doi/10.1161/JAHA.124.038427bystander CPRcardiopulmonary resuscitationreturn of spontaneous circulationstratified analysiswitnessed arrest |
| spellingShingle | Cheng‐Yi Fan Ya‐Ting Liang Edward Pei‐Chuan Huang Jiun‐Wei Chen Wen‐Chu Chiang Charlotte Wang Chih‐Wei Sung Which Matters More for Out‐of‐Hospital Cardiac Arrest Survival: Witnessed Arrest or Bystander Cardiopulmonary Resuscitation? Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease bystander CPR cardiopulmonary resuscitation return of spontaneous circulation stratified analysis witnessed arrest |
| title | Which Matters More for Out‐of‐Hospital Cardiac Arrest Survival: Witnessed Arrest or Bystander Cardiopulmonary Resuscitation? |
| title_full | Which Matters More for Out‐of‐Hospital Cardiac Arrest Survival: Witnessed Arrest or Bystander Cardiopulmonary Resuscitation? |
| title_fullStr | Which Matters More for Out‐of‐Hospital Cardiac Arrest Survival: Witnessed Arrest or Bystander Cardiopulmonary Resuscitation? |
| title_full_unstemmed | Which Matters More for Out‐of‐Hospital Cardiac Arrest Survival: Witnessed Arrest or Bystander Cardiopulmonary Resuscitation? |
| title_short | Which Matters More for Out‐of‐Hospital Cardiac Arrest Survival: Witnessed Arrest or Bystander Cardiopulmonary Resuscitation? |
| title_sort | which matters more for out of hospital cardiac arrest survival witnessed arrest or bystander cardiopulmonary resuscitation |
| topic | bystander CPR cardiopulmonary resuscitation return of spontaneous circulation stratified analysis witnessed arrest |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.124.038427 |
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