1. Black and Hispanic persons were less likely than White persons to receive bystander cardiopulmonary resuscitation (CPR) at home and in public.

2. The incidence of survival to discharge was lower for Black and Hispanic persons compared to White persons for both home and public cardiac arrests.

Evidence Rating Level: 1 (Excellent)

Study Rundown: CPR is an important intervention that significantly improves the odds of survival for persons with out-of-hospital cardiac arrest. Racial and ethnic disparities in survival outcomes for cardiac arrests have been previously reported. In the current study, Black and Hispanic persons were less likely than White persons to receive bystander CPR at home and in public locations. In context analyses, the incidence of bystander CPR was lower for Black and Hispanic persons in predominantly White, predominantly Black, or Hispanic and integrated neighborhoods when the cardiac arrest occurred at home or in public. The incidence of bystander CPR was also lower for Black and Hispanic persons compared to White persons in all neighborhoods regardless of the median annual household income. Additionally, Black and Hispanic persons had a lower incidence of both survival to discharge and favorable neurologic discharge than White persons for both home and public cardiac arrests. Black and Hispanic persons were less likely than White persons to receive bystander CPR in workplace settings, recreational facilities, and public transportation centers. The strengths of this study are the numerous context variables that were analyzed including racial and ethnic makeup of the neighborhood of arrest, median household income of the neighborhood, urbanicity, and persons initiating CPR. Although, information on the race and number of bystanders was not available.

Click to read the study in NEJM

Relevant Reading: Advanced cardiac life support in out-of-hospital cardiac arrest

In-Depth [retrospective cohort]: The Cardiac Arrest Registry to Enhance Survival (CARES) is a multicenter registry of out-of-hospital cardiac arrests. This study utilized the CARES database to examine the incidence of bystander CPR in racial and ethnic groups. Analyses were stratified according to racial or ethnic makeup and the income of the neighborhood in which the arrest occurred. Multivariate logistic regression models were created for cardiac arrests that occurred at home or in public locations. These models also adjusted for age and sex, the calendar year of arrest, the cause of arrest, urbanicity, neighborhood racial and ethnic makeup, and neighborhood median income. A total of 84,296 cardiac arrests occurred at home and 25,758 arrests occurred in public. Black and Hispanic persons were less likely to receive bystander CPR at home (adjusted odds ratio [OR], 0.74; 95% Confidence interval [CI], 0.72 to 0.76) and in public (adjusted OR, 0.63; 95% CI, 0.60 to 0.66). Black and Hispanic persons were also less likely to receive CPR in predominantly White neighborhoods when cardiac arrests occurred at home (adjusted OR, 0.82; 95% CI 0.74 to 0.90) and in public (adjusted OR, 0.68; 95% CI 0.60 to 0.75). Black and Hispanic persons were also less likely to receive CPR in predominantly Black or Hispanic neighborhoods when cardiac arrests occurred at home (adjusted OR, 0.79; 95% CI 0.75 to 0.83) and in public (adjusted OR, 0.63; 95% CI 0.59 to 0.68). Black and Hispanic individuals were also less likely to survive until hospital discharge compared to White persons when they arrest at home (adjusted OR, 0.77, 95% CI, 0.73 to 0.81) and in public (adjusted OR, 0.60, 95% CI, 0.58 to 0.63). In summary, this study demonstrates that there are racial and ethnic disparities in bystander CPR during out-of-hospital cardiac arrest.

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