An update on the impact of bystander cardiopulmonary resuscitation on favorable neurological outcomes of patients with out-of-hospital cardiac arrest accounting for effect modification by witnessed arrest: a post hoc analysis of the SOS-KANTO 2017 study

IF 2.4 Q3 CRITICAL CARE MEDICINE

Resuscitation plus Pub Date : 2025-08-19 DOI:10.1016/j.resplu.2025.101066

Hideki Endo , Takahiro Miyoshi , Hiroyuki Yamamoto , Nobuya Kitamura , Takashi Tagami , Kiyotsugu Takuma , Kiyoshi Murata

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Abstract

Aim

To investigate the role of witnessed arrest as an effect modifier on neurological outcomes following bystander cardiopulmonary resuscitation (CPR) in patients with out-of-hospital cardiac arrest (OHCA).

Methods

This cohort study was conducted using an OHCA patient registry collected between September 2019 and March 2021 in Japan. The effect modification by witnessed arrest was analyzed using additive and multiplicative interactions with risk adjustment. The main outcome was a cerebral performance category of 1 or 2 at 30 days after OHCA.

Results

A total of 7496 patients from 42 hospitals were analyzed. Witnessed arrest and bystander CPR occurred in 3053 (40.7 %) and 3152 (42.0 %) patients, respectively. The adjusted odds ratio (OR) of witnessed arrest and bystander CPR for favorable neurological outcomes was 11.36 (95 % confidence interval [CI]: 7.10–18.17). The ORs for bystander CPR within each stratum of witnessed arrest were 2.38 (95 % CI: 1.34–4.24) for non-witnessed arrest and 3.80 (95 % CI: 2.61–5.55) for witnessed arrest. The additive interaction was 7.01 (95 % CI: 3.34–10.68) and the multiplicative interaction was 1.60 (95 % CI: 0.80–3.17). In the non-home arrest setting, bystander CPR had an adjusted OR of 1.23 (95 % CI: 0.58–2.62) for non-witnessed arrest and 2.77 (95 % CI: 1.69–4.53) for witnessed arrest. The additive interaction was 4.98 (95 % CI: 1.67–8.29) and the multiplicative interaction was 2.25 (95 % CI: 0.91–5.53).

Conclusions

The interaction effect of bystander CPR and witnessed arrest exhibited the second strongest form of interaction. The non-significant effect of bystander CPR in non-witnessed arrest in the non-home cardiac arrest setting warrants further investigation.

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旁观者心肺复苏对院外心脏骤停患者有利的神经系统预后影响的最新进展，考虑到目击者骤停的效果改变：SOS-KANTO 2017研究的事后分析

目的探讨目睹骤停对院外心脏骤停（OHCA）患者旁观者心肺复苏（CPR）后神经系统预后的影响。方法本队列研究使用2019年9月至2021年3月在日本收集的OHCA患者登记处进行。利用风险调整的加性和乘性相互作用分析了目击逮捕的效果修正。主要结果是OHCA后30天的脑功能分类为1或2。结果共对42家医院7496例患者进行分析。分别有3053例（40.7%）和3152例（42.0%）患者发生了目击骤停和旁观者心肺复苏术。经校正的优势比（OR）为11.36（95%可信区间[CI]: 7.10-18.17）。在目击逮捕的各个阶层中，旁观者CPR的or值为非目击逮捕的2.38 （95% CI: 1.34-4.24）和目击逮捕的3.80 （95% CI: 2.61-5.55）。加性相互作用为7.01 (95% CI: 3.34 ~ 10.68)，乘性相互作用为1.60 （95% CI: 0.80 ~ 3.17）。在非家庭逮捕的情况下，旁观者CPR对无证人逮捕的调整OR为1.23 (95% CI: 0.58-2.62)，对有证人逮捕的调整OR为2.77 （95% CI: 1.69-4.53）。加性相互作用为4.98 (95% CI: 1.67 ~ 8.29)，乘性相互作用为2.25 （95% CI: 0.91 ~ 5.53）。结论旁观者CPR与目击者骤停的交互作用表现为第二强的交互作用形式。在非家庭心脏骤停的情况下，旁观者CPR在无证人骤停中的非显著效果值得进一步调查。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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