Impact of bystander cardiopulmonary resuscitation on out-of-hospital cardiac arrest survival in Saudi Arabia: a retrospective multiregional analysis

Introduction: Out-of-hospital cardiac arrest (OHCA) is a major global cause of mortality, with survival heavily dependent on early intervention. Bystander cardiopulmonary resuscitation (CPR) improves survival rates but remains underutilized in many regions, including Saudi Arabia. Understanding its impact on OHCA survival is crucial for optimizing emergency response efforts. Aim: This study evaluated the effect of bystander CPR on OHCA survival across Saudi Arabia's 13 regions and identified regional disparities. Material and methods: A retrospective observational study analyzed Saudi Red Crescent Authority (SRCA) OHCA data from January 1 to June 30, 2024. Key variables included bystander CPR, patient demographics, initial cardiac rhythm, response time, and return of spontaneous circulation (ROSC). Multivariable logistic regression was adjusted for confounders. Results: Bystander CPR was performed in 12.0% of OHCA cases. ROSC occurred in 12.6%, with higher survival among those receiving bystander CPR (17.6%) versus those who did not (12.0%) (p < 0.001). However, after adjusting for confounders such as witnessed status, mechanical CPR use, and response time, bystander CPR was not independently linked to increased survival. Regional disparities were evident, with Riyadh reporting the highest bystander CPR rate (26.4%), while several regions had rates below 5%. Conclusions: While bystander CPR improved ROSC rates, its independent effect on survival was not significant. These findings underscore the need for expanded CPR training, improved EMS response times, and targeted interventions to enhance OHCA survival in Saudi Arabia.