Global Rate of Bystander Cardiopulmonary Resuscitation in Out-of-Hospital Cardiac Arrest: A Systematic Review and Meta-Analysis.
Abstract
Background
Out-of-hospital cardiac arrest (OHCA) is a leading cause of mortality worldwide, and bystander cardiopulmonary resuscitation (BCPR) is one of determinants of survival. This systematic review and meta-analysis aimed to determine the prevalence of BCPR and investigate sources of heterogeneity.
Method
We conducted a systematic search of PubMed, Scopus, Embase, and Web of Science from inception until 1 August 2025, for observational studies that reported the incidence of BCPR in OHCA. We performed a random-effects meta-analysis to calculate the pooled prevalence of BCPR. Subgroup analyses were conducted to explore heterogeneity based on geography, income level, patient demographics, and study characteristics.
Results
Our analysis included 229 studies encompassing 4,421,570 OHCA patients from 45 countries. The pooled prevalence of receiving BCPR was 32.1% (95% confidence interval [CI] 29.7%-34.5%), with substantial heterogeneity (I2=99.9%). BCPR rates were significantly higher in high-income countries compared to low- and middle-income countries (34.9% vs 13.9%; p<0.0001) and in paediatric versus adult populations (49.2% vs 31.4%; p=0.0002). OHCAs occurring in residential settings had a 28% lower likelihood of receiving BCPR than those in public locations (risk ratio [RR] 0.72; 95% CI 0.64-0.80). Furthermore, female patients were mildly less likely to receive BCPR than male patients (RR 0.96; 95% CI 0.93-0.99). Trend analysis revealed a modest but significant increase in BCPR prevalence over time (slope 0.29% per year; p=0.016).
Conclusions
Less than one-third of individuals with OHCA receive BCPR. Despite a modest temporal increase, significant and actionable disparities persist across income levels, geographic regions, patient populations, and arrest locations. These findings highlight the need for targeted public health interventions, policy reforms, and tailored educational strategies to address these inequities and improve the global response to OHCA.