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Decreased early bystander CPR initiation despite stable overall rates: a nationwide time-to-event analysis during the COVID-19 pandemic

Year: 2026

Type: article

Abstract: Background: Timely bystander cardiopulmonary resuscitation (BCPR) is critical for survival after out-of-hospital cardiac arrest (OHCA). While overall BCPR rates during the COVID-19 pandemic have been inconsistently reported, BCPR initiation timing has received limited attention. This study assessed BCPR initiation within 10 min after witnessed OHCA. Methods: This retrospective cohort study used the All-Japan Utstein registry. Adults with non-traumatic, layperson-witnessed OHCA during March 11-December 31 of 2019 and 2020 were included. The primary outcome was BCPR initiation within 10 min after witnessing. Kaplan-Meier and Cox models were used for time-to-event analyses. Exploratory logistic regression examined associations between BCPR timing and 1-month outcomes. Results: = 0.010), with a lower hazard during the pandemic (aHR 0.96; 95% CI 0.93-0.98). Among BCPR recipients, earlier initiation was associated with higher odds of a favorable neurological outcome at 1 month (aORs 3.27, 2.66, and 1.68 for 0-3, 4-7, and 8-10 min, respectively; reference >10 min). The pandemic period remained associated with lower 1-month survival after adjustment for BCPR initiation timing (aOR 0.86; 95% CI, 0.80-0.92). Conclusions: Although the overall BCPR rate remained unchanged during the pandemic, time-to-event analysis identified a modest reduction in early BCPR initiation. Earlier BCPR was associated with better outcomes, but differences in its timing did not fully explain the lower survival during the pandemic.

Source: Resuscitation Plus

DOI: 10.1016/j.resplu.2026.101531