Purpose of the study: Two thirds of Out-of-Hospital Cardiac Arrests (OHCAs) occur at the victim’s home (‘home-CA’). As a critical point, bystander CPR (B-CPR) rates are significantly lower in home-CA compared to those in public places, even in witnessed situations. This study aimed to identify factors facilitating and impeding B-CPR in home-CA.
Materials and methods: 21 semi-structured in-depth interviews were conducted face-to-face with laypersons who had witnessed a home-CA. Interviews were transcribed verbatim and analyzed by qualitative content analysis (QCA, according to Mayring). Based on 20% of the material, four categories for the coding frame were inductively developed: ‘situation awareness’, ‘psychological factors’, ‘actions taken’ and ‘other’. All relevant comments were coded in the derived frame, sub-categories and definitions were added until saturation was reached.
Results: QCA revealed 1’343 relevant interview segments. 394 of these referred to factors facilitating B-CPR, 328 to factors impeding B-CPR, and 621 were found neutral.
As facilitating factors, bystanders reported they had ‘realized patients’ symptoms’ and ‘the emergency situation’, had felt a ‘strong commitment to help’ and ‘to initiate actions’. As factors impeding B-CPR, five conditions contributed to bystander behaviors: ‘lack of knowledge on cardiac arrest’, ‘inadequate analysis of situation’, ‘psychological barriers’, ‘difficulty to adapt to situational change’, ‘physical incapability to change initial position of the patient’.
Conclusions: Some important factors supporting and impeding B-CPR in home-CA appear specific to the home-CA setting. The privacy context may facilitate the detection of symptoms and enhance the commitment to act. Impeding factors weighing stronger in this setting include psychological barriers, adaptation to situational change and physical challenges on scene. Preparation and support of bystanders in home-CA could be improved by incorporating these findings into BLS courses and DA-CPR protocols.

Factors influencing layperson bystanders’ actions in cardiac arrests occurring at home: a qualitative in-depth interview study

Implementation of the Guidelines - How do we put the new ERC Guidelines into practice?

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