Community Initiatives to Promote Basic Life Support Implementation—A Scoping Review

Abstract

Introduction: Early intervention of bystanders (the first links of the chain of survival) have been shown to improve survival and good neurological outcomes of patients suffering out-of-hospital cardiac arrest (OHCA). Many initiatives have been implemented to increase the engagement of communities in early basic life support (BLS) and cardiopulmonary resuscitation (CPR), especially of lay people with no duty to respond. A better knowledge of the most effective initiatives might help improve survival and health system organization. Aim of the scoping review: To assess the impact of specific interventions involving lay communities on bystander BLS rates and other consistent clinical outcomes, and to identify relevant knowledge gaps. Methods: This scoping review was part of the continuous evidence evaluation process of the International Liaison Committee on Resuscitation (ILCOR), and was performed following the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews. We performed a literature search using the PubMed, EMBASE, and Cochrane databases until 1 February 2021. The screening process was conducted based on predefined inclusion/exclusion criteria, and for each included study, we performed data extraction focusing on the type of intervention implemented, and the impact of these interventions on the specific OHCAs outcomes. Results: Our search strategy identified 19 eligible studies, originating mainly from the USA (47.4%) and Denmark (21%). The type of intervention included in 57.9% of cases was a community CPR training program, in 36.8% bundled interventions, and in 5.3% mass-media campaigns. The most commonly reported outcome for OHCAs was bystander CPR rate (94.7%), followed by survival to hospital discharge (36.8%), proportion of people trained (31.6%), survival to hospital discharge with good neurological outcome (21%), and Return of Spontaneous Circulation (10.5%). Community training programs and bundled interventions improved bystander CPR in most of the included studies. Conclusion: Based on the results of our scoping review, we identified the potential benefit of community initiatives, such as community training in BLS, even as part of bundled intervention, in order to improve bystander CPR rates and patient outcomes.

Factors Influencing Self-Confidence and Willingness to Perform Cardiopulmonary Resuscitation among Working Adults—A Quasi-Experimental Study in a Training Environment

“…This mainly applies to communities with a low bystander CPR rates [ 4 , 6 ]. Increasing bystanders’ readiness to respond to cardiac arrest is of critical importance for improving survival [ 6 , 7 , 8 , 9 , 10 , 11 ]. Resuscitation training programs that focus not only on improving practical skills but also increasing the readiness and willingness of bystanders to undertake resuscitation may directly contribute to an increased survival in OHCA [ 10 , 11 ].…”

“…Immediate and high-quality bystander cardiopulmonary resuscitation (CPR) after effective identification of SCA, which is the second link, can increase the chance of survival from OHCA. It is currently known that such measures can be associated with up to a threefold increase in survival and, extremely importantly, favorable neurological outcomes [ 6 , 7 , 8 , 9 , 10 ].…”

Improving community-based first response to out of hospital cardiac arrest (FirstCPR): protocol for a cluster randomised controlled trial

“… 51 Also, a recent scoping review identified 19 studies from the USA, Denmark, Republic of Korea and Japan and Singapore, and noted community interventions were mainly provision of instructor-led training and mass media or public campaigns. 52 …”

“…A recent systematic review and meta-analysis of community interventions designed to increase bystander response to OHCA (with or without changes in health services in the area) identified 15 studies and reported associations with better survival rates and bystander CPR in the areas of intervention; however, limitations included heterogenous, and poorly described interventions 51. Also, a recent scoping review identified 19 studies from the USA, Denmark, Republic of Korea and Japan and Singapore, and noted community interventions were mainly provision of instructor-led training and mass media or public campaigns 52…”

“…None of the community-based initiatives identified to date have targeted community organisations, groups or clubs as a means of increasing training and willingness to respond to OHCA in the community, and this may be a way of improving the reach of public-orientated campaigns. As a result of literature review and multiple meetings with peak bodies and stakeholder groups (partnered in this project) including NSW Health, NSW Ambulance and other organisations with an interest in improving outcomes from OHCA, the FirstCPR concept arose 51 52…”