The "invisible ceiling" of bystander CPR in three Asian countries: Descriptive study of national OHCA registry.

Abstract

Background: Bystander cardiopulmonary resuscitation (CPR) for out-of-hospital cardiac arrest (OHCA) has increased in Singapore, Japan, and South Korea following the implementation of several public health, bystander-focused interventions, such as dispatcher-assisted CPR and community CPR training. It is unclear whether bystander CPR prevalence will continue on this trajectory over time. This study aimed to investigate the temporal trends of bystander CPR prevalence over a ten-year period in these three Asian countries.

Method: Using the national OHCA registries of Singapore, Japan and South Korea, we included witnessed, non-traumatic adult OHCA registered between 2010 and 2020 in Singapore and Japan, and between 2012 and 2020 in South Korea. We excluded those for whom resuscitation was not attempted or was terminated at scene. The study analysed the proportion of bystander CPR in the three countries, presenting the data annually and further breaking it down by age and gender.

Results: This study included 491,067 patients in Japan [male 59 %, median, age 79 years (Q1-Q3, 69-87)], 13,143 patients in Singapore [male 66 %, median, age 69 years (Q1-Q3, 57-80)], and 87,997 patients in South Korea [male 64 %, median age 72 years (Q1-Q3, 59-81)]. The proportion of bystander CPR in each country had increased (Japan: 39 % in 2010 to 45 % in 2015, Singapore: 22 % in 2010 to 53 % in 2015, and South Korea: 37 % in 2012 to 56 % in 2015); however, these proportions have plateaued in 2020 (Japan: 46 %, Singapore: 54 %, and South Korea: 57 %) despite continued efforts. These trends were consistent across different age groups, gender and location.

Conclusion: This study investigated the trend of bystander CPR over 10 years in three Asian countries. Although the proportion of bystander CPR has increased, it has now plateaued between 50-60 %. Further research is necessary to identify the contributing factors and advance beyond this "invisible ceiling".