References

Bridgwater: Class Professional Publishing; 2022

Barnard EBG, Sandbach DD, Nicholls TL, Wilson AW, Ercole A Prehospital determinants of successful resuscitation after traumatic and non-traumatic out-of-hospital cardiac arrest. Emerg Med J. 2019; 36:(6)333-339 https://doi.org/10.1136/emermed-2018-208165

Brown TP, Booth S, Hawkes CA Characteristics of neighbourhoods with high incidence of out-of-hospital cardiac arrest and low bystander cardiopulmonary resuscitation rates in England. Eur Heart J Qual Care Clin Outcomes. 2019; 5:(1)51-62 https://doi.org/10.1093/ehjqcco/qcy026

Brown TP, Perkins GD, Smith CM, Deakin CD, Fothergill R Are there disparities in the location of automated external defibrillators in England?. Resuscitation. 2022; 170:28-35 https://doi.org/10.1016/j.resuscitation.2021.10.037

on behalf of the Cochrane Statistical Methods Group. Chapter 10: Analysing data and undertaking meta-analyses. 2024. https://training.cochrane.org/handbook/current/chapter-10

Department for Communities and Local Government. The English Indices of Deprivation 2015. 2015. https://tinyurl.com/5n8a9znh

Dicker B, Garrett N, Wong S Relationship between socioeconomic factors, distribution of public access defibrillators and incidence of out-of-hospital cardiac arrest. Resuscitation. 2019; 138:53-58 https://doi.org/10.1016/j.resuscitation.2019.02.022

Fosbøl EL, Dupre ME, Strauss B Association of neighborhood characteristics with incidence of out-ofhospital cardiac arrest and rates of bystander-initiated CPR: implications for community-based education intervention. Resuscitation. 2014; 85:(11)1512-1517 https://doi.org/10.1016/j.resuscitation.2014.08.013

Cochrane rapid reviews. 2020. https://tinyurl.com/6wzbatek

Gräsner JT, Wnent J, Herlitz J Survival after out-ofhospital cardiac arrest in Europe—results of the EuReCa TWO study. Resuscitation. 2020; 148:218-226 https://doi.org/10.1016/j.resuscitation.2019.12.04

Lee SY, Do YK, Shin SD Community socioeconomic status and public access defibrillators: a multilevel analysis. Resuscitation. 2017; 120:1-7 https://doi.org/10.1016/j.resuscitation.2017.08.012

Lee SY, Song KJ, Shin SD A disparity in outcomes of out-of-hospital cardiac arrest by community socioeconomic status: a ten-year observational study. Resuscitation. 2018; 126:130-136 https://doi.org/10.1016/j.resuscitation.2018.02.025

Leung KHB, Brooks SC, Clegg GR, Chan TCY Socioeconomically equitable public defibrillator placement using mathematical optimization. Resuscitation. 2021; 166:14-20 https://doi.org/10.1016/j.resuscitation.2021.07.002

Moncur L, Ainsborough N, Ghose R, Kendal SP, Salvatori M, Wright J Does the level of socioeconomic deprivation at the location of cardiac arrest in an English region influence the likelihood of receiving bystander-initiated cardiopulmonary resuscitation?. Emerg Med J. 2016; 33:(2)105-108 https://doi.org/10.1136/emermed-2015-204643

Chapter 7: systematic reviews of etiology and risk. 2024. https://synthesismanual.jbi.global

Munot S, Rugel EJ, Von Huben A Out-of-hospital cardiac arrests and bystander response by socioeconomic disadvantage in communities of New South Wales, Australia. Resusc Plus. 2022; 9 https://doi.org/10.1016/j.resplu.2022.100205

Nolan J, Soar J, Eikeland H The chain of survival. Resuscitation. 2006; 71:(3)270-271 https://doi.org/10.1016/j.resuscitation.2006.09.001

Office for National Statistics. Health state life expectancies by national deprivation deciles, England: 2018 to 2020. 2022. https://tinyurl.com/4tt5ptjh

Page MJ, McKenzie JE, Bossuyt PM The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021; 372 https://doi.org/10.1136/bmj.n71

Perkins GD, Lockey AS, de Belder MA, Moore F, Weissberg P, Gray H National initiatives to improve outcomes from out-of-hospital cardiac arrest in England. Emerg Med J. 2016; 33:(7)448-451 https://doi.org/10.1136/emermed-2015-204847

Popay J, Roberts H, Sowden ALancaster: University of Lancaster; 2006 https://doi.org/10.13140/2.1.1018.4643

Resuscitation Council (UK). Epidemiology of cardiac arrest guidelines. 2021. https://www.resus.org.uk/library/2021-resuscitation-guidelines/epidemiology-cardiac-arrestguidelines

Sasson C, Rogers MA, Dahl J, Kellermann AL Predictors of survival from out-of-hospital cardiac arrest: a systematic review and meta-analysis. Circ Cardiovasc Qual Outcomes. 2010; 3:(1)63-81 https://doi.org/10.1161/CIRCOUTCOMES.109.889576

Sasson C, Magid DJ, Chan P Association of neighborhood characteristics with bystanderinitiated CPR. N Engl J Med. 2012; 367:(17)1607-1615 https://doi.org/10.1056/NEJMoa1110700

Skelly AC, Dettori JR, Brodt ED Assessing bias: the importance of considering confounding. Evid Based Spine Care J. 2012; 3:(1)9-12 https://doi.org/10.1055/s-0031-1298595

UK Health Security Agency. Health matters: preventing cardiovascular disease. 2021. https://ukhsa.blog.gov.uk/2019/02/14/health-matters-preventing-cardiovasculardisease/

Wang YM, Lin LT, Jiang JH, Jiang Y, Jin XQ Public knowledge and attitudes toward automated external defibrillators use among first aid eLearning course participants: a survey. J Cardiothorac Surg. 2022; 17:(1) https://doi.org/10.1186/s13019-022-01863-1

Warwick Clinical Trials Unit. Out-of-Hospital Cardiac Arrest Outcomes Registry Epidemiology and Outcomes 2021. 2022. https://tinyurl.com/2s3ujpx2

Warwick Clinical Trials Unit. Out-of-Hospital Cardiac Arrest Outcomes Registry epidemiology and outcomes 2022. 2023. https://tinyurl.com/mv9kndc4

Deprivation links to bystander cardiopulmonary resuscitation and defibrillation rates

02 August 2024
Research
02 August 2024
Volume 16 · Issue 8

Abstract

Background:

Public access defibrillators and cardiopulmonary resuscitation (CPR) have been at the forefront of public health campaigns and public education and are key links in the chain of survival. Despite this, survival rates for out-of-hospital cardiac arrest (OHCA) in 2024 in the UK are lower than in comparable countries.

Aims:

This study aimed to critically review research in the UK to identify whether a patient's level of socioeconomic deprivation impacts their chances of receiving bystander CPR and defibrillation.

Methods:

A rapid evidence review was conducted with literature searches from 2013 to July 2023 carried out. Five studies were identified.

Findings:

OHCA incidence was lowest in areas of least deprivation, while the most deprived populations had lower rates of bystander CPR (BCPR) with higher OHCA incidences. Automated external defibrillator (AED) provision did not correlate with OHCA incidence.

Conclusion:

Research is needed to look at areas with a high incidence of OHCA associated with low rates of BCPR, with the aim to target high-risk areas of low BCPR and high OHCA incidences for public education and AED installation, including qualitative research into the population's thoughts and knowledge of CPR and defibrillation.

The annual incidence of out-of-hospital cardiac arrest (OHCA) in England is approximately 55 per 100000 people (Resuscitation Council (UK) (RCUK), 2021). Recently published data have shown a decrease in survival-to-discharge rates, with fewer than 7.8% of OHCA patients surviving beyond 30 days in 2022 compared to 8.5% in 2021 (Warwick Clinical Trials Unit, 2022; 2023).

The chain of survival has four factors that maximise survival chances in an OHCA including early cardiopulmonary resuscitation (CPR) and early defibrillation (Nolan et al, 2006). Across the UK, bystander cardiopulmonary resuscitation (BCPR) is attempted in 70% of OHCAs and survival can be two to four times more likely with this (Perkins et al, 2016). Additionally, defibrillation within the first 5 minutes of collapse can produce survival rates as high as 70%; however, in 2021, public access defibrillators were deployed in fewer than 6% of OHCAs although this improved to 8.5% in 2022. (Perkins et al, 2016; Warwick Clinical Trials Unit, 2022; 2023).

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Out-of-hospital cardiac arrest
Bystander cardiopulmonary resuscitation
Public access defibrillators
Automated external defibrillators
Public health
Socioeconomic deprivation