Decreased early bystander CPR initiation despite stable overall rates: a nationwide time-to-event analysis during the COVID-19 pandemic
5 affiliations
- 1Department of Preventive Services, Graduate School of Medicine, Kyoto University, Kyoto, Japan
- 2Pre-hospital and Emergency Research Centre, Health Services and Systems Research, Duke-NUS Medical School, Singapore
- 3Department of Nephrology and Rheumatology, Kyorin University School of Medicine, Tokyo, Japan
- 4Department of Environmental Health and Global Health, Faculty of Pharmaceutical Sciences, Teikyo University, Japan
- 5Department of Implementation Science in Public Health, Kyoto University School of Public Health, Kyoto, Japan
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: Among 56,082 eligible cases (27,770 pre-pandemic; 28,312 pandemic), overall BCPR rates were stable (58.7% vs. 58.6%, p = 0.759). However, time-to-event analysis detected a modest difference in early BCPR initiation (log-rank p = 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.
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BibTeX
@article{mutalov2026decreased,
title = {{Decreased early bystander CPR initiation despite stable overall rates: a nationwide time-to-event analysis during the COVID-19 pandemic}},
author = {Boburjon Mutalov and Tomonari Shimamoto and Yohei Okada and Takefumi Tsunemitsu and Ryuta Onodera and Norihiro Nishioka and Tomohiko Imamura and Yukiko Tateyama and Yoshimitsu Takahashi and Taku Iwami},
journal = {Resuscitation Plus},
year = {2026},
month = oct,
doi = {10.1016/j.resplu.2026.101531},
url = {https://doi.org/10.1016/j.resplu.2026.101531},
note = {CC BY-NC-ND 4.0},
}
RIS
TY - JOUR
TI - Decreased early bystander CPR initiation despite stable overall rates: a nationwide time-to-event analysis during the COVID-19 pandemic
AU - Boburjon Mutalov
AU - Tomonari Shimamoto
AU - Yohei Okada
AU - Takefumi Tsunemitsu
AU - Ryuta Onodera
AU - Norihiro Nishioka
AU - Tomohiko Imamura
AU - Yukiko Tateyama
AU - Yoshimitsu Takahashi
AU - Taku Iwami
PY - 2026
DA - 2026/10/15
JO - Resuscitation Plus
DO - 10.1016/j.resplu.2026.101531
UR - https://doi.org/10.1016/j.resplu.2026.101531
AB - 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: Among 56,082 eligible cases (27,770 pre-pandemic; 28,312 pandemic), overall BCPR rates were stable (58.7% vs. 58.6%, p = 0.759). However, time-to-event analysis detected a modest difference in early BCPR initiation (log-rank p = 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.
SN - 2666-5204
ER -