A multifaceted intervention to increase bystander CPR rates after out-of-hospital cardiac arrest in France: a stepped-wedge, cluster-randomised, controlled trial.
Guillaume Debaty, Simon Ribes, Patrick Ray et al.
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In 30 seconds
This stepped-wedge, cluster-randomised controlled trial assessed a coordinated intervention to increase bystander CPR before EMS arrival among adults with non-traumatic out-of-hospital cardiac arrest in France. Across 12 originally randomised EMS agencies, the intention-to-treat analysis included 1684 patients. Bystander-initiated CPR occurred in 70·9% of the intervention group and 61·4% of the control group; the adjusted odds ratio was 1·54 (95% CI 1·09-2·19; p=0·017). The estimate was sensitive to some modelling adjustments, and the intervention did not improve clinical outcomes.
Key findings
- Bystander CPR before EMS arrival occurred in 70·9% of intervention patients versus 61·4% of controls.
- The adjusted odds ratio for bystander CPR was 1·54 (95% CI 1·09-2·19; p=0·017).
- The association was no longer statistically significant after adjustment for cluster-specific secular trends or baseline characteristics.
- No intervention-related adverse events were reported, and clinical outcomes did not improve.
Why it matters
Bystander CPR is an important early response to OHCA, and this trial suggests that combining dispatcher support, volunteer activation, and agency feedback can increase its use. However, the sensitivity of the estimate to modelling choices and the absence of improved clinical outcomes mean that increased CPR rates should not be assumed to translate into better survival or other patient outcomes.
What to keep in mind
The estimated effect was sensitive to adjustment for cluster-specific secular trends and baseline characteristics. The intervention increased bystander CPR but did not improve clinical outcomes.