Factors associated with the provision of bystander cardiopulmonary resuscitation and outcomes across the Pan Asian communities
Journal
Resuscitation
Journal Volume
216
Start Page
110860
ISSN
0300-9572
Date Issued
2025-11
Author(s)
Chou, Fan-Ya
Rovaniyaw, Lenglengman
Abstract
Background: Out-of-hospital cardiac arrest (OHCA) is a leading cause of death globally, with survival heavily dependent on bystander cardiopulmonary resuscitation (BCPR). This study explores multifactorial determinants of BCPR provision, emphasizing ethnicity, across the Pan Asian communities to address outcome disparities.
Methods: This retrospective analysis utilized the Pan-Asian Resuscitation Outcomes Study (PAROS) registry (2009–2018), a prospective cohort initiated in 2009 and expanded in 2013, covering thirteen Asia-Pacific countries. The cohort included adult OHCA patients (≥18 years) requiring immediate CPR or advanced life support. Analyzed variables included demographics (age, sex, race), event characteristics (initial rhythm, trauma), temporal factors (month, time of day), and arrest location. Ethnicity was derived from race data, where it was recorded in the registry. If not, the majority race was assumed if >95 % ethnic homogeneity. City-level median household income served as the proxy of socioeconomic status (SES), categorized per World Bank Classification (lower-middle, upper-middle, high income). The primary outcome was BCPR provision, assessed via multivariable logistic regression for independent predictors. Secondary outcomes were survival and favorable neurologic outcomes (Cerebral Performance Category 1 or 2) at 30 days or hospital discharge, assessed via univariate analysis. Sensitivity analysis replaced ethnicity with country as predictor.
Results: Of 181,135 cases, 72,071 (39.8 %) received BCPR, with higher odds among ethnic groups like Thai (odds ratio [OR] 6.824, 95 % confidence interval [CI] 4.680–9.950) and Eurasian (OR 6.541, 95 % CI 3.781–11.318) (vs. Chinese living in Mainland China), and lower in upper-middle-income areas (OR 0.479, 95 % CI 0.423–0.542; no BCPR in lower-middle-income) (vs. High-Income). Other predictors included older age, female sex, ventricular fibrillation, non-trauma etiology, and recreational locations. BCPR was associated with higher survival (7.4 % vs. 3.8 %, p < 0.001) and favorable neurologic outcomes (4.5 % vs. 1.8 %, p < 0.001). Sensitivity analysis with country showed similar variations. Conclusion: Ethnicity and SES predict BCPR provision in Pan-Asian OHCA. BCPR is associated with improved survival and favorable neurologic outcomes. Certain ethnic groups and lower SES are linked to reduced BCPR, underscoring the need for targeted CPR education to mitigate disparities and enhance outcomes.
Subjects
Bystander CPR
Ethnicity
Out-of-Hospital cardiac arrest
Socioeconomic status
SDGs
Publisher
Elsevier BV
Type
journal article