A five-year program that trained 911 dispatchers, first responders and residents in 31 North Carolina counties did not significantly improve survival after cardiac arrest, researchers reported Sunday, Nov. 8. The RACE-CARS trial was presented at the American Heart Association’s Scientific Sessions in Chicago and published the same day in the New England Journal of Medicine, the association said.
Related: Heart Calcium Scans Cut Statin Advice by Two-Thirds in 5,772-Patient Trial, but Missed Its Goal.
What the trial found
About 9% of patients in counties with the program survived to leave the hospital with favorable brain function, the association said. The rate was 9.4% in counties without it.
Bystanders performed CPR in 44.8% of cardiac arrests in program counties and in 42.3% in the other counties, according to the release. The trial did not improve overall rates of bystander CPR or defibrillation, the association said.
Defibrillation before emergency medical services arrived occurred in 13.5% of arrests in program counties, compared with 15.3% in the others, according to the association.
One exploratory result pointed the other way. During the final year, people in program counties had 33% higher odds of receiving bystander CPR, the association said.
How the program worked
The trial ran from July 1, 2021, through June 30, 2026, in 60 counties with about 8.5 million residents, nearly 80% of the state’s population, according to the association. Researchers randomly assigned 31 counties to the education program, and 29 continued their existing practices.
The study included 22,459 adults who had a cardiac arrest outside a hospital. Of those, 11,615 were in program counties and 10,844 were in the others. Their median age was 64, the association said.
Community partners held 5,724 CPR training events that reached 201,586 people, the release said. That was 4.8% of residents in the program counties. Four counties reached more than 10% of residents, while eight reached fewer than 3%. The trial provided 405 defibrillators to the 31 counties.
What the researchers said
“Changing how an entire community responds to cardiac arrest takes time, and our findings show just how challenging that can be,” said Dr. Carolina Malta Hansen, the study’s lead author. Hansen is a cardiologist at Herlev and Gentofte Hospital and Copenhagen EMS in Denmark. She said the public should still learn CPR, call 911 immediately and follow the dispatcher’s instructions.
Dr. Christopher Granger, the trial’s principal investigator and a cardiologist at Duke University, said the late rise in bystander CPR suggests sustained outreach may be needed to improve survival.
Dr. Amrish Deshmukh of the University of Michigan Health Frankel Cardiovascular Center, who was not involved, called the results disappointing but not surprising, STAT reported.
Limitations included uneven rollout among counties, reliance on self-reported training data and staff turnover at 911 centers, the association said. The COVID-19 pandemic and Hurricane Helene also created operational problems, according to the release.
The Denmark comparison
Hansen pointed to Denmark, where about 80% of the population is trained in CPR, STAT reported. Survival there is about 16%, compared with 10% in the United States, she said. Danish drivers must show CPR certification to get a license, according to Hansen. She said the country’s training rate climbed from 20% in the early 2000s.
A separate test of smartphone alerts
A second study presented Saturday, Nov. 7, tested the PulsePoint Respond app in British Columbia and Columbus, Ohio, the association said. Bystanders gave CPR or used a defibrillator in 69% of public-location cardiac arrests with app alerts and in 72% without them. The difference was not statistically significant. That study covered 355 people and is a preliminary abstract that has not been peer-reviewed, according to the association.
About 350,000 people in the United States have a cardiac arrest outside a hospital each year, and only about 1 in 10 survive, the association said. For local emergency care coverage, see Boston EMS Welcomes 20 New EMTs at Faneuil Hall Ceremony. More reporting is in Health.
Sources
- American Heart Association: Community CPR and EMS intervention program did not increase survival after cardiac arrest
- STAT: Survival after sudden cardiac arrest didn’t improve despite training bystanders, emergency responders
- American Heart Association: Phone app alerts did not increase bystander CPR rates in study of 2 major population areas
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