Researchers conducted a large randomized controlled trial to test whether comprehensive community education on cardiac arrest response could improve survival outcomes. The study, presented at the American Heart Association’s scientific sessions and published in the New England Journal of Medicine, enrolled participants across 60 counties in North Carolina starting in 2021.
The intervention group received multifaceted training directed at multiple segments of the emergency response system. Dispatchers were trained to rapidly recognize cardiac arrest and guide bystanders through CPR instructions. First responders received education on using automated external defibrillators before emergency services arrived. Community members in workplaces, religious organizations, government offices, and other settings received CPR training. The control group continued with standard emergency response practices.
During the five-year study period, 22,459 adult residents experienced out-of-hospital cardiac arrest across the counties, with 11,615 cases in the intervention group and 10,844 in the control group. The median age was 64, with 37% female, 33% Black, and 29% living in rural areas. Despite the extensive educational efforts reaching approximately 8.5 million people, the intervention did not result in higher survival rates compared to usual care. However, an exploratory analysis in the trial’s fourth year indicated the percentage of patients who received bystander CPR increased in the intervention counties, suggesting that particular component showed promise.
Study authors noted that Denmark achieved substantially better outcomes through different methods. Denmark maintains a bystander CPR rate of 80% and a defibrillation rate of 11%, compared to 2% in the United States, with survival rates of approximately 16% versus 10%. Denmark requires CPR certification to obtain a driver’s license, which researchers suggested represents an efficient population-wide training approach. Study leaders indicated longer-term follow-up and sustained community engagement may be necessary to determine whether the interventions eventually improve survival outcomes.
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