Advantage of CPR-first over call-first actions for out-of-hospital cardiac arrests in nonelderly patients and of noncardiac aetiology

Abstract Aim To assess the benefit of immediate call or cardiopulmonary resuscitation (CPR) for survival from out-of-hospital cardiac arrests (OHCAs). Methods Of 952,288 OHCAs in 2005–2012, 41,734 were bystander-witnessed cases without prehospital involvement of physicians but with bystander CPR (BCPR) on bystander's own initiative. From those OHCAs, we finally extracted the following three call/BCPR groups: immediate Call + CPR ( N = 10,195, emergency call/BCPR initiated at 0 or 1 min after witness, absolute call–BCPR time interval = 0 or 1 min), immediate Call-First ( N = 1820, emergency call placed at 0 or 1 min after witness, call-to-BCPR interval = 2–4 min), immediate CPR-First ( N = 5446, BCPR initiated at 0 or 1 min after witness, BCPR-to-call interval = 2–4 min). One-month neurologically favourable survivals were compared among the groups. Critical comparisons between Call-First and CPR-First groups were made considering arrest aetiology, age, and bystander–patient relationship after confirming the interactions among variables. Results The overall survival rates in immediate Call + CPR, Call-First, and CPR-First groups were 11.5, 12.4, and 11.5%, respectively without significant differences ( p = 0.543). Subgroup analyses by multivariate logistic regression following univariate analysis disclosed that CPR-first group is more likely to survive in subgroups of noncardiac aetiology (adjusted odds ratio; 95% confidence interval, 2.01; 1.39–2.98) and of nonelderly OHCAs (1.38; 1.09–1.76). Conclusions Immediate CPR-first action followed by an emergency call without a large delay may be recommended when a bystander with sufficient skills to perform CPR witnesses OHCAs in nonelderly people and of noncardiac aetiology.