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

Yohei Okada; Ki Jeong Hong; Shir Lynn Lim; Dehan Hong; Yih Yng Ng; Benjamin Sh Leong; Kyoung Jun Song; Jeong Ho Park; Young Sun Ro; Tetsuhisa Kitamura; Chika Nishiyama; Tasuku Matsuyama; Takeyuki Kiguchi; Norihiro Nishioka; Taku Iwami; Sang Do Shin; Marcus Eh Ong; Fahad Javid Siddiqui

doi:10.1016/j.resuscitation.2024.110445

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

Resuscitation. 2024 Nov 27:110445. doi: 10.1016/j.resuscitation.2024.110445. Online ahead of print.

Authors

Yohei Okada¹, Ki Jeong Hong², Shir Lynn Lim³, Dehan Hong⁴, Yih Yng Ng⁵, Benjamin Sh Leong⁶, Kyoung Jun Song⁷, Jeong Ho Park⁸, Young Sun Ro⁹, Tetsuhisa Kitamura¹⁰, Chika Nishiyama¹¹, Tasuku Matsuyama¹², Takeyuki Kiguchi¹³, Norihiro Nishioka¹⁴, Taku Iwami¹⁵, Sang Do Shin¹⁶, Marcus Eh Ong¹⁷, Fahad Javid Siddiqui¹⁸

Affiliations

¹ Pre-hospital & Emergency Research Centre, Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore. Electronic address: yohei_ok@duke-nus.edu.sg.
² Department of Emergency Medicine, Seoul National University Hospital, Seoul National University, Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Disaster Medicine Research Center, Seoul National University Medical Research Center, Seoul, South Korea. Electronic address: emkjhong@gmail.com.
³ Disaster Medicine Research Center, Seoul National University Medical Research Center, Seoul, South Korea. Electronic address: shir.lynn.lim@nus.edu.sg.
⁴ Department of Cardiology, National University Heart Centre, Singapore, Singapore. Electronic address: HONG_Dehan@scdf.gov.sg.
⁵ Singapore Civil Defense Force, Singapore, Singapore. Electronic address: Yih_Yng_NG@ttsh.com.sg.
⁶ Department of Preventive & Population Medicine, Tan Tock Seng Hospital, Singapore, Singapore. Electronic address: Benjamin_SH_LEONG@nuhs.edu.sg.
⁷ Emergency Medicine Department, National University Hospital, Singapore, Singapore.
⁸ Department of Emergency Medicine, Seoul National University Boramae Medical Center, Seoul, South Korea.
⁹ Department of Emergency Medicine, Seoul National University Hospital, Seoul, South Korea.
¹⁰ Department of Emergency Medicine, Seoul National University Hospital, Seoul, South Korea. Electronic address: lucky_unatan@yahoo.co.jp.
¹¹ Department of Social and Environmental Medicine, Osaka University, Osaka, Japan. Electronic address: nishiyama.chika.3n@kyoto-u.ac.jp.
¹² Department of Critical Care Nursing, Graduate School of Human Health Sciences, Kyoto University, Kyoto, Japan.
¹³ Department of Emergency Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan. Electronic address: take_yuki888@yahoo.co.jp.
¹⁴ Preventive Services, Graduate School of Medicine, Kyoto University, Kyoto, Japan. Electronic address: nishioka.norihiro.26x@kyoto-u.jp.
¹⁵ Preventive Services, Graduate School of Medicine, Kyoto University, Kyoto, Japan. Electronic address: iwami.taku.8w@kyoto-u.ac.jp.
¹⁶ Preventive Services, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
¹⁷ Department of Emergency Medicine, Seoul National University Hospital, Seoul, South Korea. Electronic address: marcus.ong@duke-nus.edu.sg.
¹⁸ Pre-hospital & Emergency Research Centre, Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore.

PMID: 39613139
DOI: 10.1016/j.resuscitation.2024.110445

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".

Keywords: Attitudes; Basic cardiac life support; Bystander CPR; Cardiopulmonary resuscitation; Health knowledge; Out-of-hospital cardiac arrest; Practice.