Table 2.
Study interventions and outcomes.
| Study country | Interventions | Summary of Interventions (no. total duration) | B-CPR Rates (before; after) | B-AED rates (before; after) | Survival rates (before; after) | SFNO (before; after) |
|---|---|---|---|---|---|---|
|
Franek et al. (2015) Czech Republic |
Community-based 2003: DA-CPR 2003: Public promotion campaign for bystander-CPR (print and social media) Healthcare system 2008: Mechanical CPR devices added to ambulances; enhanced EMS training |
2 CBIs & 2 HSIs; 11 years | 13%; 82% | – | – | 11.6%; 16.8% |
|
Wissenberg et al. (2013) Denmark |
Community-based 2001: CPR and AED training programs; 2001–2014 ~ 175 000 CPR certificates annually; 2008–2011 ~ 300 000 CPR certificates annually 2005: Mandatory BLS courses in elementary schools 2006: Mandatory resuscitation course to acquire a driver’s license 2007: PAD program and AED dissemination; registered defibrillators increased from ~ 3000 in 2006 to ~ 15 000 in 2011 2009, 2010: DA-CPR improvements—healthcare professionals at dispatch centres to help callers identify OHCA, AED registry used to guide bystanders to nearby AEDs Healthcare system 2004: Introduction of therapeutic hypothermia in hospitals 2009: Implementation of mobile emergency care units |
6 CBIs & 2 HSIs; 9.6 years | 20%; 45% | 1.0%; 1.9% | To 30 days: 3.5%; 10.8% | – |
|
Dahan et al. (2014) France |
Community-based 2007: PAD legislation passed to allow AED use by laypersons 2007: Public information campaign regarding the chain of survival |
2 CBIs; 4 years | 23%; 31% | – | – | |
|
Ristagno et al. (2014) Italy |
Community-based 2013: “Viva!”, weeklong awareness and mass resuscitation training initiative |
2 CBIs; 1 week | 18%; 27%* | – | Survival unchanged*† | – |
|
Iwami et al. (2015) Japan |
Community-based 2004: PAD legislation passed; ~ 350 000 AEDs deployed 2005: CPR and AED training programs in community and schools; total of ~ 4 million trained/year; 1-h, 3-h, and 8-h options 2005: DA-CPR with traditional CPR instructions 2006: DA-CPR with COCPR instructions |
5 CBIs; 8 years | 35%; 47% | – | – | 1.0%; 1.9% |
|
Lai et al. (2015) Singapore |
Community-based 2001: Ongoing expansion of CPR and AED training centres and programs; more than 30 000 trained annually 2006: Widespread distribution of AEDs in public locations (airports, sports facilities, hotels, malls, etc.) 2011: Introduction of annual awareness campaign, National Life Saving Day Healthcare system 2001: Motorcycle Fast Response Paramedics (FRPs) introduced over several years 2004: Paramedics certified to give IV epinephrine and use laryngeal mask airways 2007: Introduction of therapeutic hypothermia, ECMO, and PCI 2011: Mechanical CPR devices added to ambulances |
4 CBIs & 4 HSIs; 10.7 years | 20%; 22% | 0.0%; 1.0% | To D/C: 1.6%; 3.2% | 1.2%; 1.8% |
|
Ho et al. (2020) Singapore |
Community-based* 2011: Introduction of annual awareness campaign, National Life Saving Day 2012: DA-CPR with COCPR instructions 2014: Dispatcher-Assisted first Responder (DARE) training initiative—CPR and AED training free to public and mandated for school children; ~ 50 000 trained from 2014–2016 2015: PAD program (Save-a-Life initiative) and notification system– over 360 AEDs were placed and registered in residential areas, myResponder mobile application to alert participating laypersons within 400 m of an OHCA and the location of the closest AED; participating taxi drivers equipped with AEDs within a 1.5 km radius are also alerted Healthcare system* 2011: Mechanical CPR devices added to ambulances 2012: Fire Bikers Scheme implemented where fire and rescue first responders were dispatched ahead of the ambulance in times of heavy traffic 2014: Intraosseous access was permitted in ambulances *Please also see interventions listed under Lai et al., 2015 |
7 CBIs & 3 HSIs; 15.7 years | 22%; 56% | 1.7%; 4.6% | To D/C: 3.5%; 6.5% | 1.8%; 4.4% |
|
Ro et al. (2019) South Korea |
Community-based 2012: DA-CPR implemented nationwide by the National Fire Agency 2013: CPR and AED training programs; annual layperson training numbers increased from ~ 300 000 in 2013 to ~ 600 000in 2016 (~ 2 000 000 over 4 years) Healthcare system 2013: Mandated CPR and AED training for first responders (i.e., firefighters, police, lifeguards, etc.) |
3 CBIs & 1 HSIs; 5 years | 35%; 65% | – | To D/C: 10.0%; 11.1%* | 5.4%; 7.1% |
|
Hollenberg et al. (2008) Sweden |
Community-based 1992: CPR training program; utilized a train-the-trainer approach; shortened from 3 h to 35 min in 2006; ~ 2 000 000 trained; AED content added in 1996 1997: School based CPR and AED training programs initiated 1997: DA-CPR Healthcare system ALS training for critical care nursing staff Higher rates of post-resuscitation interventions (hypothermia, revascularization) |
4 CBIs & 2 HSIs; 14 years | 31%; 50% | – | To 30 days: 4.8%; 7.3% | – |
|
Mauri et al. (2010) Switzerland |
Community-based 2006: Early Resuscitation and Defibrillation Program—CPR and AED training, layperson notification system 2006: Compulsory CPR training in school youth |
4 CBIs; 3.6 years | 11%; 18% | – | To D/C: 2.0%; 6.1% | – |
|
Lin et al. (2016) Taiwan |
Community-based 2012: COCPR training for laypersons 2013: PAD and Good Samaritan legislation passed 2013: DA-CPR |
3 CBIs; 4 years | 25%; 33% | – | To D/C: 5.7%; 7.6% | 1.7%; 3.2% |
|
Lick et al. (2011) United States |
Take Heart America (THA) program A community-wide, systems-based approach based on the 2005 American Heart Association (AHA) CPR and Emergency Cardiovascular Care guidelines Community-based 2006: Initiation of several CPR and AED training initiatives (laypersons, high school students and their families, family members of patients who recently experienced an OHCA); 28 041 trained from September 2006 to December 2008 2006: AED distribution in high-traffic public buildings (132 AEDs deployed) 2006: More than 60 media publications on OHCA (print, radio, television) 2008: “CPR Goes to College” pilot program at local university; ~ 10 000 trained Healthcare system AEDs placed in all first-responder vehicles (fire, police); first-responders trained in high performance CPR Introduction of therapeutic hypothermia and enhanced rates of advanced hospital interventions at specialized cardiac arrest centers (CACs) |
5 CBIs & 3 HSIs; 3 years | 20%; 29% | – | To D/C: 8.5%; 19.4% | SFNO unchanged*,† |
|
Bergamo et al. (2016) United States |
Community-based 2008: Launch of the TAKE10 Program (under the Take Heart America organization) – CPR training program using a train-the-trainer approach to deliver 10-min sessions to learn COCPR (~ 2000 trained annually) 2011: Awareness campaign endorsed by community officials |
2 CBIs; 5.2 years | 42%; 47% | – | – | – |
|
van Diepen et al. (2017) United States |
HeartRescue Project 2010: Various community-based and healthcare interventions started at different times across the 5 participating States (Arizona, Minnesota, North Carolina, Pennsylvania, and Washington) Community-based For example, CPR and AED training, PAD programs, DA-CPR, mass events, and awareness campaigns Healthcare system For example, enhanced EMS training, collaboration, and coordination among resuscitation centres |
6 CBIs & 2 HSIs; 5 years | 42%; 43% | 3.2%; 5.6% | To D/C: 13.7%; 10.5% | 10.4%; 8.9% |
|
Uber et al. (2018) United States |
Community-based May 21, 2014: One-day mass COCPR training event at 7 public locations; trained a convenience sample of 2253 individuals |
1 CBI; 1 day | 37%; 36%* | – | To D/C: 9.9%; 10.1%* | 8.3%; 8.7%* |
|
Del Rios et al. (2019) United States |
Community-based 2013: Illinois Heart Rescue Program (ILHR) – CPR training programs initiated, specifically targeting communities with high OHCA incidence and low bystander-CPR rates (~ 9000 trained annually); public awareness campaign 2014: DA-CPR training and protocol update (“no, no, go” method); DA-CPR was initially implemented prior to the study period Healthcare system 2013: Updated hospital designations to ensure patient transport to the appropriate facility 2015: Updated ROSC protocol in the hospital |
3 CBIs & 2 HSIs; 3.3 years | 11%; 19% | 0.9%; 1.3%* | To D/C: 7.3%; 9.9%* | 4.3%; 6.4% |
30 days 30 days following OHCA, AED automated external defibrillator, ALS advanced life support, B-AED bystander AED use, B-CPR bystander CPR, BLS basic life support; CBIs community-based intervention, COCPR compression only CPR, CPC Cerebral Performance Category, CPR cardiopulmonary resuscitation, D/C discharge from hospital, DA-CPR dispatcher-assisted CPR, EMS emergency medical services, HSIs health system interventions, OHCA out-of-hospital cardiac arrest, PAD public access defibrillation, ROSC return of spontaneous circulation.
*Rate change not statistically significant.
†Study reports that rates were not significantly changed. No exact rates provided for before or after periods.