Effect of Bystander CPR on Survival After Out-of-Hospital Cardiac Arrest: A Systematic Review and Meta-Analysis.
Zhiyu Leng, Jie Li, Kexin Tang et al.
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In 30 seconds
This systematic review and meta-analysis examined the association between bystander CPR and survival after out-of-hospital cardiac arrest (OHCA), pooling observational studies comparing patients who did and did not receive CPR. Across 72 studies and 2,914,595 OHCA events, bystander CPR was associated with higher odds of survival to hospital admission, discharge, and 30 days. The largest pooled association was for 30-day survival (OR, 1.50; 95% CI, 1.34-1.67). Evidence certainty was rated moderate, and estimates showed substantial heterogeneity.
Key findings
- Bystander CPR was associated with higher odds of survival to hospital admission (OR, 1.26; 95% CI, 1.09-1.46; 12 studies).
- For survival to hospital discharge, the pooled association was OR, 1.44 (95% CI, 1.33-1.56; 43 studies).
- For 30-day survival, the pooled association was OR, 1.50 (95% CI, 1.34-1.67; 23 studies).
- Associations varied by continent and were attenuated in studies with higher mean patient age and a higher proportion of female patients.
Why it matters
Survival after OHCA is associated with whether CPR begins before professional responders arrive. The findings support the clinical importance of early bystander action across several survival endpoints, while the variation between studies and populations indicates that the size of the association is not uniform. The evidence also provides a basis for considering public CPR education as part of broader efforts to improve OHCA outcomes.
What to keep in mind
The evidence comes from observational studies, so the associations do not establish causation. Heterogeneity was substantial for all reported survival outcomes, including I² = 95.6% for 30-day survival.