Background: Prompt initiation of bystander cardiopulmonary resuscitation (CPR) is critical to survival for out-of-hospital cardiac arrest (OHCA). However, the association between delays in bystander CPR and OHCA survival is poorly understood. Methods: In this observational study using a nationally representative US registry, we identified patients who received bystander CPR from a layperson for a witnessed OHCA from 2013 to 2021. Hierarchical logistic regression was used to estimate the association between time to CPR (<1 minute versus 2–3, 4–5, 6–7, 8–9, and ≥10-minute intervals) and survival to hospital discharge and favorable neurological survival (survival to discharge with cerebral performance category of 1 or 2 [ie, without severe neurological disability]). Results: Of 78 048 patients with a witnessed OHCA treated with bystander CPR, the mean age was 63.5±15.7 years and 25, 197 (32.3%) were women. The median time to bystander CPR was 2 (1–5) minutes, with 10% of patients having a≥10-minute delay before initiation of CPR. Overall, 15 000 (19.2%) patients survived to hospital discharge and 13 159 (16.9%) had favorable neurological survival. There was a graded inverse relationship between time to bystander CPR and survival to hospital discharge ( P for trend <0.001). Compared with patients who received CPR within 1 minute, those with a time to CPR of 2 to 3 minutes were 9% less likely to survive to discharge (adjusted odds ratio, 0.91 [95% CI, 0.87–0.95]) and those with a time to CPR 4 to 5 minutes were 27% less likely to survive (adjusted odds ratio, 0.73 [95% CI, 0.68–0.77]). A similar graded inverse relationship was found between time to bystander CPR and favorable neurological survival ( P for trend <0.001). Conclusions: Among patients with witnessed OHCA, there was a dose-response relationship between delays in bystander initiation of CPR and lower survival rates.

中文翻译：

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在美国，旁观者实施心肺复苏的时间延迟与目击心脏骤停患者的生存率之间的关系

背景：旁观者及时启动心肺复苏 (CPR) 对于院外心脏骤停 (OHCA) 的生存至关重要。然而，人们对旁观者心肺复苏延迟与 OHCA 存活率之间的关系知之甚少。 方法：在这项使用具有全国代表性的美国登记处的观察性研究中，我们确定了 2013 年至 2021 年期间因目睹 OHCA 而接受非专业人士旁观者心肺复苏的患者。使用分层逻辑回归来估计心肺复苏时间之间的关联（<1 分钟与 2 分钟） 3、4-5、6-7、8-9 和 ≥10 分钟间隔）以及出院存活率和良好的神经系统存活率（脑功能类别 1 或 2 的出院存活率 [即，没有严重的神经功能障碍] ）。 结果：在 78 048 名目击 OHCA 患者中接受旁观者 CPR 治疗的患者中，平均年龄为 63.5±15.7 岁，其中 25, 197 名 (32.3%) 为女性。旁观者进行心肺复苏的中位时间为 2 (1-5) 分钟，10% 的患者在开始心肺复苏之前延迟了≥10 分钟。总体而言，15 000 名患者 (19.2%) 存活至出院，13 159 名患者 (16.9%) 神经系统存活率良好。旁观者进行心肺复苏的时间与出院生存率之间存在分级负相关关系（磷趋势<0.001）。与 1 分钟内接受 CPR 的患者相比，接受 CPR 时间为 2 至 3 分钟的患者存活出院的可能性要低 9%（调整后的比值比，0.91 [95% CI，0.87–0.95]）心肺复苏时间为 4 至 5 分钟的患者生存可能性降低 27%（调整后的比值比，0.73 [95% CI，0.68–0.77]）。在旁观者进行心肺复苏的时间与良好的神经系统存活率之间发现了类似的分级逆关系（磷趋势<0.001）。 结论：在目睹 OHCA 的患者中，旁观者启动 CPR 的延迟与较低的生存率之间存在剂量反应关系。