States with laws requiring CPR/automated external defibrillator (AED) training in high school have higher rates of bystander CPR after out-of-hospital cardiac arrest (OHCA) than states with no CPR education laws, according to a study published May 23 in the Journal of the American College of Cardiology.

Victoria L. Vetter, MD, MPH, FACC, et al., analyzed the Cardiac Arrest Registry to Enhance Survival (CARES) dataset from Jan. 1, 2013, through Dec. 31, 2020, for all 911-activated non-traumatic OHCA events where CPR or AED use was attempted. Arrests in medical facilities, nursing homes or witnessed by 911 responders were excluded.

At the time of the study, CPR/AED training for high school students was required in 39 out of 50 states and the District of Columbia to improve bystander involvement in OHCA events. Twenty states were eligible for evaluation and placed in two separate categories: states with CPR/AED education laws and states without a CPR/AED education law. Cardiac arrests were categorized in states with laws as occurring either on or after the law was enacted (pre- and post-law enactment).

Results showed that over half of the OHCAs occurred in states with laws enacted and the rate of bystander CPR was 41.6% compared to 39.5% in states without any mandates. After tracking pre- and post-law enactment outcomes by year, rates of bystander CPR show a higher trend after the first year of state law enactment, specifically in five of the 10 states that had laws enacted during the study period. Researchers found disparities by gender and race in study, but those groups, specifically Blacks, showed the greatest improvements in outcomes in states with laws enacted.

Researchers said the findings also suggest that low economic status communities could see the greatest benefits from help in enacting CPR/AED education mandates.

"Targeting student populations in underserved and minority communities with low rates of bystander CPR should help by providing a trained group of individuals who live in the communities, decreasing these health disparities," Vetter said. "High school students will become the next generation of bystanders who can provide CPR and AED use, once they are educated. Those trained as students are likely to be in homes or community sites where cardiac arrests commonly occur."

The study authors said future research with complete state-specific data and recent implementation of legislation mandates is needed to further support adding CPR education training in schools to improve OHCA survival rates.

Clinical Topics: Arrhythmias and Clinical EP, Cardiovascular Care Team, Implantable Devices, SCD/Ventricular Arrhythmias

Keywords: Out-of-Hospital Cardiac Arrest, African Americans, Economic Status, Survival Rate, Defibrillators, Cardiopulmonary Resuscitation, Registries

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