Factors Associated with Survival of Out-of-Hospital Cardiac Arrest by Cardiopulmonary Resuscitation of Bystander in Korea

Abstract

Background: Out-of-hospital cardiac arrest (OHCA) affects more than 25,000 cases each year in Korea.
The rate of survival and neurological recovery tend to increase in Korea, but less than other developed
countries. Despite the increase in bystander cardiopulmonary resuscitation (CPR), the number of patients
who have an automated external defibrillator (AED) applied by a bystander remains low. We studied the
effect of bystander CPR on survival of OHCA in Korea. Methods: This study was conducted using the
‘Sudden Cardiac Arrest (SCA) Survey’ of Korea Centers for Disease Control & Prevention (KCDC) in 2009
to 2018. A total of 45,719 cases of OHCA patients were analyzed. We used a chi-square test, log-rank test,
multivariable logistic regression and cox-regression analysis to determine the effect of bystander CPR on
survival of OHCA, depending on various factors. Results: The rate of survival of OHCA was significantly
affected by age, past medical history, initial cardiac rhythm, pre-hospital CPR and defibrillation, transport
time and a type of bystander CPR. The survival rate of patients who received bystander CPR was 44.3%,
compare with those who did not (43.4%). In cases where bystander CPR was received, the survival rate of
patients with AED (63.1%) was higher than patients with only chest compression (44.2%). Conclusions:
With the increase in bystander CPR rates, it is difficult to expect the effect of intervention of bystanders in
Korea. Even though the education on AED and the devices itself has been spread throughout the country
since 2008, the use of AED remains low. Nevertheless, the use of AED has a positive effect on the survival
of OHCA. Improvements on the rate of AED use by bystander in Korea needs to be further elaborated on.