Saint Luke's Mid America Heart Institute, Kansas City, MO (P.S.C., K.F.K.).
University of Missouri-Kansas City (P.S.C.).
Circulation. 2024 Aug 27;150(9):677-686. doi: 10.1161/CIRCULATIONAHA.124.068732. Epub 2024 Aug 7.
Bystander cardiopulmonary resuscitation (CPR) is associated with higher survival for out-of-hospital cardiac arrest, but whether its association with survival differs by patients' sex and race and ethnicity is less clear.
Within a large US registry, we identified 623 342 nontraumatic out-of-hospital cardiac arrests during 2013 to 2022 for this observational cohort study. Using hierarchical logistic regression, we examined whether there was a differential association between bystander CPR and survival outcomes by patients' sex and race and ethnicity, overall and by neighborhood strata.
Mean age was 62.1±17.1 years, and 35.9% were women. Nearly half of patients (49.8%) were non-Hispanic White; 20.6% were non-Hispanic Black; 7.3% were Hispanic; 2.9% were Asian; and 0.4% were Native American. Overall, 58 098 (9.3%) survived to hospital discharge. Although bystander CPR was associated with higher survival in each race and ethnicity group, the association of bystander CPR compared with patients without bystander CPR in each racial and ethnic group was highest in individuals who were White (adjusted odds ratio [OR], 1.33 [95% CI, 1.30-1.37]) and Native American (adjusted OR, 1.40 [95% CI, 1.02-1.90]) and lowest in individuals who were Black (adjusted OR, 1.09 [95% CI, 1.04-1.14]; <0.001). The adjusted OR for bystander CPR compared with those without bystander CPR for Hispanic patients was 1.29 (95% CI, 1.20-1.139), for Asian patients, it was 1.27 (95% CI, 1.12-1.42), and for those of unknown race, it was 1.31 (95% CI, 1.25-1.36). Similarly, bystander CPR was associated with higher survival in both sexes, but its association with survival was higher in men (adjusted OR, 1.35 [95% CI, 1.31-1.38]) than women (adjusted OR, 1.15 [95% CI, 1.12-1.19]; <0.001). The weaker association of bystander CPR in Black individuals and women was consistent across neighborhood race and ethnicity and income strata. Similar results were observed for the outcome of survival without severe neurological deficits.
Although bystander CPR was associated with higher survival in all patients, its association with survival was weakest for Black individuals and women with out-of-hospital cardiac arrest.
旁观者心肺复苏（CPR）与院外心脏骤停患者的生存率升高相关，但旁观者 CPR 与生存率的关联是否因患者的性别、种族和民族而不同尚不清楚。
在一项大型美国注册研究中，我们纳入了 2013 年至 2022 年期间 623342 例非创伤性院外心脏骤停患者进行这项观察性队列研究。我们使用分层逻辑回归来检查旁观者 CPR 与生存结局之间是否存在差异，按患者的性别、种族和民族以及社区分层进行评估。
平均年龄为 62.1±17.1 岁，35.9%为女性。近一半的患者（49.8%）是非西班牙裔白人；20.6%是非西班牙裔黑人；7.3%是西班牙裔；2.9%是亚洲人；0.4%是美洲原住民。总体而言，58098 例（9.3%）患者存活至出院。尽管旁观者 CPR 与每组种族和民族群体的生存率升高相关，但在每个种族和民族群体中，与没有旁观者 CPR 的患者相比，旁观者 CPR 的相关性在白人（校正比值比 [OR]，1.33 [95%CI，1.30-1.37]）和美洲原住民（校正 OR，1.40 [95%CI，1.02-1.90]）中最高，在黑人（校正 OR，1.09 [95%CI，1.04-1.14]）中最低（<0.001）。与没有旁观者 CPR 的患者相比，旁观者 CPR 对西班牙裔患者的校正 OR 为 1.29（95%CI，1.20-1.139），对亚洲患者为 1.27（95%CI，1.12-1.42），对未知种族的患者为 1.31（95%CI，1.25-1.36）。同样，旁观者 CPR 与两性患者的生存率升高相关，但与女性（校正 OR，1.15 [95%CI，1.12-1.19]）相比，与男性（校正 OR，1.35 [95%CI，1.31-1.38]）的相关性更高（<0.001）。旁观者 CPR 在黑人个体和女性中的关联较弱，在不同社区种族和民族以及收入阶层中均一致。旁观者 CPR 与院外心脏骤停患者无严重神经功能缺陷生存结局的关联也有类似结果。
尽管旁观者 CPR 与所有患者的生存率升高相关，但在黑人个体和女性中，旁观者 CPR 与生存率的关联最弱。
