Background: In dispatcher-assisted cardiopulmonary resuscitation program, dispatchers’ recognition of out-of-hospital cardiac arrest (OHCA) is the first step of initiation of bystander CPR. This study aimed to investigate whether CPR awareness of a community are associated with recognition of arrest, CPR instruction by dispatcher, and bystander CPR rates.
Method: A nationwide population-based observational study was conducted with OHCAs who were adult patients with cardiac etiology between 2013 and 2015. Exposure was community level awareness of CPR using the national Korean Community Health Survey database. Endpoints were recognition of arrest, CPR instruction by dispatcher, and provision of bystander CPR. Multivariable logistic regression was performed and adjusted odds ratios (AORs) per 10% increment in community CPR awareness was calculated, adjusting for potential confounders.
Results: A total of 43,875 OHCAs were included in the final analysis. Arrest was recognized in 20,182 (46.0%), and CPR instruction was given in 17,804 (40.6%). Compared with the lowest CPR awareness communities, AORs (95% CIs) for arrest recognition were 1.06 (0.96 to 1.17) in lower, 1.12 (1.02 to 1.23) in higher, and 1.19 (0.99 to 1.22) in the highest. For CPR instruction, AORs (95% CIs) were 1.13 (1.00 to 1.27) in lower, 1.25 (1.08 to 1.44) in higher, and 1.25 (1.09 to 1.44) in the highest awareness communities. Bystander CPR was done in 21,973 (50.1%) and the communities with the highest CPR awareness showed higher bystander CPR rate than the lowest (AORs (95% CIs); 1.14 (1.02 to 1.28)). AORs (95% CIs) per 10% increment in CPR awareness were 1.05 (1.00 to 1.11) for arrest recognition, 1.11 (1.06 to 1.17) for CPR instruction, and 1.07 (1.03 to 1.11) for bystander CPR.
Conclusion: Although the dispatcher’s recognition rate of OHCA patients was not different according to the community CPR awareness level, dispatcher provided more CPR instruction in communities with higher CPR awareness level. Finally, higher CPR awareness level was associated with higher provision rate of bystander CPR.

Recognizing of out-of-hospital cardiac arrest during emergency calls by community level public awareness of cardiopulmonary resuscitation: A multi-level analysis