Resuscitation of out-of-hospital cardiac arrest in China: A systematic review and Utstein-style data analysis based on the Chain of Survival.

Aim: Out-of-hospital cardiac arrest (OHCA) contributes to substantial mortality, but its resuscitation status in China is unknown. We aimed to describe and analyze out-of-hospital cardiac arrest in terms of Chain of Survival.

Methods: We systematically collected Utstein-style publications. Scenarios were prespecified, including either emergency medical service (EMS) assessing and attending cardiac arrest, resuscitation attempted by a bystander, resuscitation attempted by EMS, or in-hospital treatment. Random-effect models were used in a meta-analysis to pool rate ratios (RRs) with 95% confidence intervals (CIs) from multiple cohorts.

Results: We analyzed 59 Chains involving 233,376 Chinese patients. The median rate of survival to discharge (interquartile range) was 0.35 % (0.06 %-0.61 %), 3.66 % (3.06 %-3.85 %), 1.23 % (0.57%-1.36%), and 2.73% (2.04%-3.42%) for four scenarios. The rate was significantly higher for bystander resuscitation than for EMS (P = 0.025) or in-hospital treatment (P = 0.301). However, only 4.8 % (1.6 %-8.2 %) of patients received bystander resuscitation, with no bystander defibrillation and a median response time of 9-15 minutes for EMS. Compared with controls without witnesses, arrest being witnessed and with bystander resuscitation increased rates of survival to discharge by 1.97 (I2 = 0, P for I2 = 0.583; pooled RR 2.97; 95% CI 1.47-6.02) and 6.79 (I2 = 0, P for I2 = 0.593; pooled RR 7.79; 95 % CI 3.40-17.84) times, following a markedly increasing trend.

Conclusions: A low probability of first aid at multiple points is linked to poor survival following OHCA. It is essential to strengthen front links in the Chain of Survival in China, including among witnesses, bystanders, and emergency response.