This cross-sectional study used U.S. NEMSIS data (2017–2025) to evaluate racial and ethnic disparities in bystander CPR (bCPR) among 19,612 adult patients who experienced opioid-associated out-of-hospital cardiac arrest (OA-OHCA) before EMS arrival, adjusting for age, sex, incident year/location, witness type, and dispatch pre-arrival instructions.
Black patients had 30% lower odds of receiving bCPR vs. White patients (AOR 0.70, 95% CI 0.63–0.77), and Hispanic patients had 19% lower odds (AOR 0.81, 95% CI 0.71–0.94). Female patients were also less likely to receive bCPR than male patients (AOR 0.89, 95% CI 0.82–0.97). No significant differences were found for Asian, American Indian/Alaska Native, or Hawaiian/Pacific Islander patients vs. White patients.
- Cross-sectional design limits causal inference. - NEMSIS data quality varies by EMS agency; opioid involvement is based on EMS assessment, which may misclassify some cases. - Bystander race/ethnicity and neighborhood-level socioeconomic context were not captured, limiting understanding of mechanism.
Targeted bystander CPR training and dispatch pre-arrival instruction programs in Black and Hispanic communities may help close the gap in OA-OHCA survival. Clinicians and public health teams should advocate for equity-focused CPR outreach as part of opioid overdose response strategies.
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