Potential impact upon community mortality rates of training citizens in cardiopulmonary resuscitation.

In order to estimate the impact of a community programme of training in cardiopulmonary resuscitation (CPR), we reviewed all adult deaths in the city of Cardiff (population 292,600) during a 13-week period. Of 701 deaths, 70 were cases of fatal out-of-hospital cardiac arrest due to heart disease, for whom it was felt that CPR might have been of value. Only 34 (48.6%) deaths were witnessed, and in 22 of them the witness did not start CPR. In the majority of cases the ambulance service was not summoned immediately. We calculate that a community CPR training programme may, at best, reduce the community cardiac mortality rate by 7.5%, ie saving between 24 and 56 lives per 100,000 adult population per year; but more realistically, such a programme can only achieve a reduction of 0.4%, ie saving up to six lives per 100,000 per year. Although community CPR training programmes are likely to lead to only a modest reduction in community cardiac mortality rates, because countrywide there are many deaths, the total of lives saved would be significant. Implementation of such programmes should be carefully evaluated.