Community basic life support training, automated external defibrillator coverage, and bystander intervention in witnessed out-of-hospital cardiac arrest.
Resuscitation · 2026-04-17 · Observational study
Abstract
BACKGROUND: This study examined the associations of community basic life support (BLS) training rates and automated external defibrillator (AED) coverage with bystander intervention in out-of-hospital cardiac arrest (OHCA). METHODS: We analyzed witnessed OHCA cases in Seoul, South Korea, between 2017 and 2021. Communities were defined as the 25 administrative districts of Seoul. Community BLS training rates were estimated from nationally representative survey data on CPR training within the past 2 years, and AED coverage was defined as the proportion of district area within 100 m of an AED. The outcomes were bystander CPR and AED use. Mixed-effects logistic regression was used to evaluate associations with bystander CPR, and Firth's penalized logistic regression was applied to assess associations with bystander AED use. The interaction between BLS training rates and AED coverage was examined for bystander AED use. RESULTS: A total of 6280 witnessed OHCA cases were included in the analysis. Of these, 67.0% (4207/6280) received bystander CPR without AED and 0.7% (47/6280) received bystander CPR with AED. OHCA patients in communities in the highest quartile of BLS training rates (31.4-37.5%) had 56% higher odds of receiving bystander CPR compared with those in the lowest quartile (19.0-25.8%)(aOR: 1.56, 95% CI = 1.14-2.14). Neither community BLS training rates nor AED coverage were associated with bystander AED use, and no significant interaction was observed. CONCLUSION: Higher community BLS training rates were associated with a higher odds of bystander CPR, whereas neither BLS training rates nor AED coverage were associated with bystander AED use.