This population-based registry study (NSW Ambulance OHCA registry, 2021–2024) examined whether paramedic-assessed bystander CPR (bCPR) quality — good vs. poor — affected 30-day survival compared to no bCPR, across 17,715 OHCA cases.
Any bCPR raised survival odds by 70% (aOR 1.70, 95% CI 1.24–2.34). Good-quality bCPR nearly tripled the odds (aOR 2.62, 95% CI 1.86–3.68), while poor-quality bCPR showed no survival benefit (aOR 0.99, 95% CI 0.68–1.45).
- Quality was recorded in only 62.1% of bCPR cases, introducing potential selection bias. - Quality assessment was paramedic-rated (subjective), not objectively measured (e.g., via CPR feedback devices). - Observational design limits causal inference.
Not all bystander CPR is equal — only good-quality compressions significantly improve survival, so dispatcher-assisted CPR coaching and public training should emphasize correct technique, not just initiation. EMS systems should consider real-time feedback tools and targeted community programs to raise bCPR quality, particularly in residential settings and among groups less likely to receive bystander intervention.
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