b'CARES 2022 Annual ReportResearch Highlights Racial and Ethnic Differences in Bystander CPR for Witnessed Cardiac Arrest By Paul S. Chan, MD, MSc, Professor of Internal Medicine, Saint Lukes Mid America Heart Institute and the University of Missouri-Kansas CityBystander cardiopulmonary resuscitation (CPR) increases the odds of survival for patients with out-of-hospital cardiac arrest (OHCA) and is a critical link in the Chain of Survival. However, most cardiac arrest victims do not receive bystander CPR, despite its potential to improve survival and limit anoxic brain injury.Prior studies have found that Black and Hispanic patients are less likely to survive an OHCA - this is due, in part, to lower rates of bystander CPR in Black and Hispanic communities. However, prior studies on disparities in bystander CPR have largely focused on differences in CPR rates between neighborhoods. What has not been well described is the difference in bystander CPR rates between Black/Hispanic and White individuals when examined within neighborhood. Moreover, whether differences exist only for arrests at home, where relatives and friends are most likely to initiate CPR, or also in public, where there may be more potential bystanders, is unknown. We set out to understand the magnitude of racial/ethnic differences in bystander CPR for patients with a witnessed OHCA in CARES separately for OHCAs which occurred at home or in public locations. We hypothesized that Black and Hispanic patients with an OHCA would be less likely to receive bystander CPR at home given already known lower rates of CPR training in these communities, but this treatment difference would be smaller for arrests occurring in public, as there are likely more bystanders to initiate CPR.To do this, we identified 110,054 witnessed OHCAs in patients of White, Black or Hispanic race/ethnicity within CARES between 2013 and 2019. To adjust for confounding, we used hierarchical models so that we could compare bystander CPR rates between Black/Hispanic and Whites individuals with OHCA within each census tract and EMS agency. We examined for differences in CPR rates for OHCAs occurring at home and in public locations.Of 110,054 witnessed OHCAs, 35,469 (32.2%) occurred in Black (27,205 [24.7%]) or Hispanic (8264 [7.5%]) patients. Overall, 84,296 (76.6%) cardiac arrests occurred at home and 25,758 (23.4%) in public. As compared with White patients, Black/Hispanic patients were less likely to receive bystander CPR at home (38.5% vs. 47.4%; adjusted OR, 0.83 [95% CI: 0.79, 0.87]) and in public (45.6% vs. 60.0%; adjusted OR, 0.76 [0.71, 0.82]). When examined by a neighborhoods race/ethnic composition, bystander CPR rates were lower for Black/Hispanic patients at home and in public locations, whether this was in predominantly White neighborhoods (where 80% of residents are of White race), majority Black/Hispanic neighborhoods (where 50 % of residents are of Black race or Hispanic ethnicity), and integrated neighborhoods (all other neighborhoods in between)see Table 1. A similar pattern was found for home and public OHCAs when we compared rates of bystander CPR for Black/Hispanic vs. White individuals with OHCA by a neighborhoods income (median household income $40,000, between $40,000 and $80,000, and $80,000)see Table 1. In almost every instance, the racial/ethnic disparity in bystander CPR rates was as large, if not larger for OHCAs occurring in public locations, as compared with those at home which was contrary to our a priori hypothesis. Finally, we examined bystander CPR rates by public location type. Black/Hispanic patients were less likely to receive bystander CPR in every public location category, including workplace settings (53.2% vs. 61.8%; adjusted OR, 0.82 [0.74, 0.91]), recreational facilities (55.8% vs. 74.4%; adjusted OR, 0.54 [0.42, 0.70]) and public transportation centers (48.3% vs. 69.6%; adjusted OR, 0.50 [0.30, 0.83])see Table 2. Notably, the disparity was greatest at the public location where the bystander was most likely a stranger (e.g., transport center or recreational site), even though these sites would have potentially the largest number of potential bystanders who could have initiated CPR. 3Garcia RA, Spertus JA, Girotra S, Nallamothu BK, Kennedy KF, McNally BF, Breathett K, Del Rios M, Sasson C, Chan PS. Racial and Ethnic Differences in Bystander CPR for Witnessed Cardiac Arrest. N Engl J Med. 387(17):1569-1578.Figures used with permission of Elsevier from Garcia et al. Racial and Ethnic Differences in Bystander CPR for Witnessed Cardiac Arrest. N Engl J Med. 387(17):1569-1578 (2022). Permission conveyed through Copyright Clearance Center Inc.22'