Association Between Family Member Bystander CPR and Survival for Out-of-Hospital Cardiac Arrest

Introduction Bystander CPR is associated with higher likelihood of survival in out-of-hospital cardiac arrest (OHCA). Whether family member-administered bystander CPR is associated with higher survival is not fully understood, even though family members are often present when arrests occur at home and are best positioned to initiate CPR. Methods Within the Cardiac Arrest Registry to Enhance Survival (CARES) registry, we conducted a retrospective cohort study. Using multivariable mixed-effect logistic regression, we examined the association between family member (FM) and non-family member (non-FM) bystander CPR, as compared to those not receiving bystander CPR, with a primary outcome of survival to hospital discharge and secondary outcome of favorable neurological survival (survival without severe neurological deficits). Results We identified 824,960 non-traumatic OHCAs between 2013-2024. Mean age was 62.2 ± 17.1 years and 35.6% were female. Overall, 78,139 (9.5%) people survived to hospital discharge. Compared to those with no bystander CPR (7.3%), higher survival rates occurred in those receiving FM-bystander CPR (9.6%; adjusted OR: 1.31 [95% CI: 1.29-1.34], p<0.001) and non-FM bystander CPR (17.3%; adjusted OR: 1.58 [95% CI: 1.55-1.62], p<0.001). When directly comparing the two bystander groups, those with non-FM bystander CPR had higher rates of survival than those with FM bystander CPR (adjusted OR: 1.21 [95% CI: 1.18, 1.24], p<0.001). A similar pattern was observed with the outcome of favorable neurological survival. Conclusion Both non-FM and FM-bystander CPR were associated with higher survival outcome rates compared to no bystander CPR while non-FM CPR was associated with higher survival compared to FM-CPR.