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Medicine, Nursing and Health Sciences
Regions with low rates of bystander CPR also have lower rates of residents with CPR training in Victoria, Australia Janet Bray, Lahn Straney, Karen Smith, Susie Cartledge, Rosalind Case, Stephen Bernard & Judith Finn Australian Resuscitation Outcomes Consortium (Aus-ROC) Monash University, Curtin University and Ambulance Victoria https://www.ausroc.org.au
@Dr_JBray @aus_roc
Background Bystander CPR doubles the
chances of surviving an OHCA
Considerable regional variation in bystander CPR rates 62.7% to 73.2% witnessed OHCA (Straney et al. Plos One 2015).
Common characteristics of underlying populations (Sasson NEJM 2012; 367:1607-15; Fosbol Resuscitation 2014;85:1512–17)
Victorian variation not explained by population characteristics (Straney et al. BMJ Open 2016).
Could there be a regional variation in CPR training?
Andersen JAMA Intern Med. 2014;174:194-201
Major CPR providers -1 year
Regional variation in CPR training
Ro et al. Resus 2016;102:17–24.
Korea -OHCA registry and community surveys
More like to receive CPR in communities with higher proportions of residents with CPR training
Methods Data: CPR training survey & VACAR CPR training survey conducted on 404
adult Victorians in 2015 –including residential postcode (Bray et al. EMA 2017;29:58-164)
Victorian Ambulance Cardiac Arrest Registry -bystander CPR rate for adult, bystander witnessed, presumed cardiac OHCAs (n=7,127)
Categorised each survey respondent’s postcode as either a low or high bystander CPR region using the median
Compared CPR training data of the respondents from regions with low and high bystander CPR.
Results Of the 404 adults surveyed, 223 (55%) resided in regions with low CPR.
Characteristics Regions with low bystander CPR
n=223
Regions with high bystander CPR
n=181
univariate p-value
Female, n (%) 124 (56) 113 (62) 0.16
Age, n (%) 18-34 35-54 55-74 75 or older
22 (10) 73 (33) 93 (42) 35 (16)
25 (14) 68 (38) 51 (34) 27 (15)
0.29
Born in Australia, n (%) 163 (73) 122 (67) 0.81
Born in English-speaking country, n (%) 174 (78) 143 (79) 0.99
Resides in rural region, n (%) 61 (27) 49 (27) 0.3 Level of education, n (%)
Primary or some high school High school Tertiary
40 (18) 92 (41) 91 (41)
38 (21) 63 (35) 80 (44)
0.40
CPR training data
62%
76%
29%
49% 56%
75%
84%
28%
54%
42%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
CPRtraining
CPR knowledge time since 1 year time since >5 years Heard of hands-onlyCPR
Pro
porti
on o
f res
pond
ents
Low bystander CPR region High bystander CPR region
p=0.03
p=NS
p=0.009
p=NS
p=0.04
Reasons for not receiving training
58%
61%
27%
20%
15%
13%
7%
13%
7%
13%
0% 20% 40% 60% 80% 100% 120%
Low bystander CPR
High bystander CPR
Never considered Time Didn't know where Cost Other
Willing to learn via a CPR training kit at home 50% high bystander CPR 44% low bystander CPR
Willingness to perform CPR
91% 86% 88%
85%
67%
88% 84% 84% 85%
67%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Close family Distant family Friend Unrelated child Stranger
Pro
porti
on o
f res
pond
ents
Low bystander CPR region High bystander CPR region
Similar data for hands only CPR
Limitations
0%
5%
10%
15%
20%
25%
Survival
Low bystander CPR regionHigh bystander CPR region
survey data is subject to recall and potentially responder bias (13% performed CPR) witnessed OHCA of
presumed cardiac aetiology Categorisation of high
and low regions
15.7%
(95% CI: 15.3-16.1%)
17.0%
(95% CI: 16.4-17.6%)
Conclusion and implications This study found lower rates of
CPR training in regions with lower rates of bystander CPR.
No difference in willingness
Listening to calls (Dr Rosalind Case –Session 3 at 3pm).
Targeting these regions with CPR training programs may have potential to improve bystander CPR rates and OHCA outcomes
Questions??
Heart Foundation Vanguard Grant
Australian Resuscitation Outcomes Consortium (Aus-ROC) – an Australian National Health and Medical Research Council (NHMRC) Centre of Research Excellence (#1029983)
NHMRC/National Heart Foundation Early Career Fellowship
www.ausroc.org.au
Dr_JBray @aus_roc
Prehospital Emergency Care NHMRC Centre of Research Excellence 2017-2021 The right care, in the right place, at the right time
3 Full-time PhD scholarships ($33,313/year tax free for 3-years)
– Monash University (EOI still open) – Flinders University (EOI still open) – Curtin University (already filled)
• Chief Investigators: Prof Peter Cameron, Prof Judith Finn, Prof Stephen Bernard, Prof Hugh Grantham, Prof Karen Smith, Prof Daniel Fatovich, A/Prof Glenn Arendts, A/Prof Janet Bray, Dr Dion Stub, Prof Gavin Perkins
• Associate Investigators: A/Prof Paul Bailey, Mr Deon Brink, Dr Cindy Hein, Dr Judy Lowthian, Dr Ziad Nehme, Dr Cathrin Parsch, Dr Tony Smith, Mr Michael Stephenson, Prof Just Stoelwinder, Dr Teresa Williams
@prehosp_CRE
Contact:
Prof Peter Cameron
Dr Janet Bray
Knowledge Barriers
CPR-trained individuals are more willing and more likely to perform bystander CPR
Case et al. 2017 Skill deficits – Lack of basic CPR knowledge / skills – Lack of confidence – Sense of incompetence due to lack of exposure
"None of us would know how to do CPR to be honest"