Effects of Bystander CPR at OHCA
Effects of Bystander CPR at OHCA
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Chapter One: Introduction
1.1 Background
After an out-of-hospital cardiac arrest (OHCA), bystander cardiopulmonary resuscitation (CPR) is associated with a greater probability of hospital discharge survival. Cardiac arrest is one of the leading causes of death worldwide (WHO, 2023), and despite numerous initiatives, the overall survival rate remains below 12% (Mozaffarian, 2016). OHCA is a major cause of death in the Western world, according to Riva and Hollenberg (2021). According to Giacoppo (2019), there are about 275 000 OHCAs in Europe each year, with a frequency of 38 EMS-treated occurrences per 100,000 people.
Emergency Medical Services (EMS) calls are frequently made for various reasons, but one of the most frequent ones is OHCA. Patient survival chances are 10% worse for each minute that cardiopulmonary resuscitation is delayed. Data on OHCA are still lacking, and survival rates are low in the Middle East (Alabdali et al., 2022). A low likelihood of survival exists for those with OHCA, affecting more than 350 000 people in Europe each year (Hirlekar et al., 2020). Defibrillation is postponed, and cardiopulmonary resuscitation is performed every minute (Eberhard et al., 2021). Although the process may be reversed, the likelihood of recovery is low, according to Geri et al. (2017), making OHCA a major public health issue. Emergency medical professionals try to revive victims of more than 30,000 OHCA annually in the UK. The survival rate is low. Nevertheless, fewer than 1 in 10 people in the UK recover from an OHCA (British Heart Foundation, 2022). However, the fundamental inquiry in this thesis is "What are the effects of bystander CPR on outcomes in OHCA cases?"
1.1.1 Importance of Bystander CPR
In the chain of survival for OHCA patients, Bystander CPR is essential. The term "chain of survival" refers to a series of steps that can increase a person's chance of surviving a cardiac arrest (Bouland et al., 2017). The essential elements of this chain include early cardiac arrest recognition, early emergency response system activation, early CPR, and early defibrillation (Kim et al.,2021). Bystander CPR is frequently the first and most crucial stage in this process because it keeps the victim's blood flowing and oxygenated until more advanced medical assistance can be provided. Bystander CPR has improved survival rates in numerous trials (Brinkrolf et al., 2018). According to research, OHCA patients' chances of survival can increase by doubling or even tripling if bystanders start CPR immediately. Bystander CPR gives the heart and brain instant support, buying vital time until professional help arrives (Wnent et al., 2021). Early CPR can also increase the success of later, more sophisticated medical procedures like defibrillation.
1.1.2 Factors Influencing Bystander CPR
Bystander CPR rates are still comparatively low in many communities, despite their significance. Several variables can affect whether or not bystanders perform CPR in OHCA scenarios (Brinkrolf et al., 2018). Improving the survival rates in OHCA cases requires understanding these elements and creating solutions to get around obstacles (Nord, 2017). The general public's lack of awareness and skills significantly impacts bystander CPR. Due to inadequate training or knowledge, many people need more confidence to do CPR (Bouland et al., 2017). This problem can be addressed, and people can be motivated to take action through educational programmes designed to educate about CPR and increase public awareness of the significance of bystander CPR (Navarro-Patn et al., 2017).
Another obstacle to bystander CPR is the fear of harming someone or facing legal ramifications. Some people hesitate to start CPR because they are worried about hurting the sufferer or worsening their condition (Kim et al., 2021). These anxieties can be reduced with clear instructions on the simplicity and safety of bystander CPR, as well as legal protections for those engaging in good faith. The possibility of disease transfer during CPR is another subject of widespread misunderstanding. People could be concerned about catching diseases like HIV or hepatitis from the sufferer (Case et al., 2018). However, there is very little chance of disease transfer during bystander CPR, and the advantages of performing quick life-saving measures outweigh any possible hazards (Wnent et al., 2021). Social obstacles and the bystander effect can contribute to a person's reluctance to intervene during an emergency. Sometimes, people could think that someone else will be in charge or help them, which might result in a diffusion of responsibility (Nord, 2017). These obstacles can be overcome through community-based programmes that cultivate a civic-minded mindset and urge people to act quickly in need.
1.1.3 Surviving Cardiac Arrest
A life-threatening emergency, such as a heart attack, cardiac arrest, stroke, or foreign body airway obstruction, must be treated immediately. The Chain of Survival illustrates the crucial steps that must be taken. A series of interventions must be performed in order to survive cardiac arrest. Because a chain is only as strong as its weakest link, the likelihood of survival can only be increased by optimising the timing of all of these treatments (Nolan et al., 2006). According to the chain of survival idea, these interventions must be optimised. Early access to the emergency response system, early advanced care provided by emergency medical services and hospital personnel, early defibrillation to treat cardiac arrest brought on by ventricular fibrillation, and early cardiopulmonary resuscitation to support circulation to the heart and brain until normal heart activity is restored are the links in this Chain of Survival (Zoll, 2023).
Around 90% of OHCA patients in the US pass away before being released from the index hospital stay. The survival percentage for patients admitted to the hospital following OHCA is between 50% and 60% (Amacher et al., 2022). Survival differences varied from 26.4% to 44.3% in the Utstein subgroup (classified as bystander-witnessed OHCA with an initial shockable rhythm). Survival disparities in all-rhythm patients were seen throughout the five states, ranging from 8.0% to 16.1%. In EMS organisations that treated more than 20 OHCAs annually, survival did rise. The survival rate for patients with all rhythms increased in this latter group from 2.7% to 26.5% and from 10.0% to 57.0% in the Utstein group. Curiously, overall cohort survival did not improve over time (Berger, 2017). It has been demonstrated that the chain of survival increases the likelihood that cardiac arrest sufferers will survive. It has been proven that post-cardiac arrest care significantly impacts OHCA survivors' chances of surviving (Lai et al., 2018).
1.1.4 Significance of Timely CPR
CPR (cardiopulmonary resuscitation) performed on time can mean the difference between life and death. A certified individual might not be accessible to perform CPR at emergency locations. Gupta (2014, Gupta et al.). In order to deliver high-quality CPR, it is crucial to recognise cardiac arrest quickly, begin chest compressions, use the proper depth and rate of compressions, and give enough time for the chest to recoil (Iqbal et al., 2021). According to the American Heart Association, "Survival is closely correlated with the interval between the start of abrupt cardiac arrest and defibrillation. A victim's chances of survival decrease by 7 to 10 per cent for each minute before defibrillation if bystanders are not performing CPR (Leeb, 2016).
1.1.5 Times of Response
If it could be shown that the intervention had put the victim in a worse predicament than they would have been in if nothing had been done, then the only person who attempted resuscitation would be held legally responsible for their actions. This would be nearly impossible in the case of a cardiac arrest because death is unavoidable in such cases. Additionally, an AED will only administer shocks if it recognises a pattern indicative of a cardiac arrest (UK, 2018). There are two defences that healthcare workers can use in professional medical practice. Included among these are "implied consent" (the concept that if a person were conscious and able to make a decision, they would agree to the procedure) Moreover, "necessity" (the concept that the treatment is offered in the patient's best interests), the concept that a person would consent to the surgery if they were cognizant and capable of deciding it). If the rescuer has the necessary medical training, the implied consent defence may be more clear-cut, but the necessity defence might still be applicable if the rescuer behaves responsibly, given the circumstances. Without medical personnel, performing CPR and utilising an AED is reasonable (Keith, 2019). The Mental Capacity Act 2005116 and the Human Rights Act 1998115 in England and Wales provide the legal foundation for DNACPR decision-making, respectively (Perkins, 2016). Decision-making about using DNACPR (Do Not Attempt Cardiopulmonary Resuscitation) is crucial in medicine, especially when patients may have a restricted prognosis or have indicated preferences for end-of-life care (Fritz et al., 2014). In the case of cardiac or respiratory arrest, DNACPR decisions comprise talks and considerations regarding whether or not to undertake cardiopulmonary resuscitation (Coleman et al., 2020). The Mental Capacity Act of 2005 is founded on the idea that barring a mental capacity examination, every adult can make their own decisions (Perkins, 2016). Fundamental rights, including the right to life and the freedom from cruel or degrading treatment, are covered by the Human Rights Act of 1998, Section 115.
1.2 Research Rationale and Objectives
Resuscitation success rates and neurological outcomes are predicted to rise with early diagnosis and treatment of OHCA (Perkins, 2016; Keith, 2019). Therefore, bystander cardiopulmonary resuscitation (BCPR) is linked to improved neurologic outcomes and higher survival in individuals with OHCA. The rate of layperson-initiated CPR in OHCA situations increased from 36.5% in 2006 to 40.7% in 2016 as a result of the spread of information about BCPR (Lee et al., 2020). According to earlier research (Perkins, 2016; Keith, 2019; Sasson et al., 2013), bystander CPR can considerably enhance survival rates and improve outcomes for those who are experiencing OHCA. However, the strength of this influence may differ depending on the populations, environments, and historical periods. By combining information from several studies, a systematic review can assist in the consolidation of the available evidence and provide a thorough evaluation of the overall effect of bystander CPR on OHCA survival rates. A systematic review can also study the causes of variations in bystander CPR's effects and spot potential sources of heterogeneity. The results could be influenced by variables including bystander CPR proficiency, response time, and differences in EMS systems. Thereby, a thorough assessment of the literature sheds light on these variables and assist pinpoint potential obstacles and enablers to the adoption of bystander CPR.
The primary objectives are;
To assess the effect of bystander CPR on survival rates following OHCA.
To identify barriers and facilitators to bystander CPR implementation.
To analyze the quality of bystander CPR performance in OHCA cases.
To identify potential knowledge gaps and areas for future research.
1.3 Research Significance
In the fields of out-of-hospital cardiac arrest (OHCA) and bystander cardiopulmonary resuscitation (CPR), your research's main goals are extremely important. Each goal focuses on a crucial part of strengthening bystander CPR techniques and OHCA outcomes. Such as it is critical to determine how bystander CPR affects survival rates after OHCA. In OHCA situations, it has been demonstrated that bystander CPR greatly raises survival rates and lowers the possibility of long-term impairments. The development and execution of bystander CPR programs and policies will benefit greatly from knowledge of the precise effects of bystander CPR on survival rates.
Similarly, it is crucial to pinpoint the facilitators and obstacles to bystander CPR implementation. Interventions can be created to remove barriers and improve bystander response rates by identifying the elements that inhibit or facilitate bystander CPR. This information will be useful in creating policy efforts, community-based training programs, and targeted educational campaigns to boost bystander CPR rates. Likewise, with the results obtained the researchers can pinpoint areas for improvement and offer evidence-based suggestions and recommendations for bystander CPR training programs by looking at variables including chest compression depth, pace, and ventilation adequacy. Thus, in order to develop OHCA management, it is crucial to identify potential knowledge gaps and opportunities for future study. This goal assists researchers in concentrating on particular areas that need further research, such as improving CPR procedures, investigating novel technology or therapies, or comprehending the long-term effects and quality of life for OHCA survivors.
1.4 Research Structure
The research is categorized into different chapters ranging from chapter one introduction to chapter five conclusion and recommendation. The second chapter is of literature review, the third is methodology whereas the fourth chapter is where the analysis/review is presented.
Chapter 2 Literature Review2.1. IntroductionA cardiac arrest that happens outside of a hospital, most often in the community, is a medical emergency that must be treated immediately. Prompt intervention is necessary to increase survival rates and decrease the risk of permanent brain impairment due to OHCA, both of which have a major influence on public health (Dezfulian et al., 2021). Before medical aid comes, bystander cardiopulmonary resuscitation (CPR) is vital in saving the lives of those who have had an OHCA. This literature review aims to assess the outcomes of bystander CPR in OHCA, with a concentration on CPR performance quality and the identification of research gaps.
Every minute that goes by without treatment decreases a patient's likelihood of survival from OHCA by 7-10% (Cave et al., 2019). Bystander CPR is essential because it keeps key organs, especially the brain, supplied with blood and oxygen until professional medical treatment arrives. International groups including the American Heart Association (AHA) and the European Resuscitation Council (ERC) have acknowledged the value of bystander CPR in increasing survival rates and improving outcomes. To promote bystander CPR and assure its correct execution, several groups have published guidelines and recommendations (Yasin et al., 2023). While bystander CPR's importance has been proven, it's important to note that the quality of CPR performed by non-medical persons is a significant component that may impact patient outcomes. Several research have looked at whether or not bystanders to OHCA occurrences comply to CPR standards and whether or not they are competent in doing CPR (Merchant et al., 2020). Research shows that bystander CPR is not always of high quality, which might affect survival and long-term neurological results.
A lack of knowledge and skills, fear or anxiety, unwillingness to give rescue breaths, and worries about inflicting injury to the patient have all been highlighted in these studies as contributing reasons to inadequate CPR performance. Educational programs and training activities geared on enhancing bystander CPR skills and confidence are crucial for overcoming these obstacles (Scott, 2020). While OHCA has made great strides in our understanding of bystander CPR, we still have many questions that need answering. The long-term outcomes of OHCA survivors who received bystander CPR should be evaluated, and future research should focus on identifying specific techniques to increase the quality of bystander CPR, addressing obstacles to bystander intervention, and doing so. Improving bystander response rates and enhancing patient outcomes would also benefit from research into the most effective training techniques and treatments for certain demographics, including as children and the elderly.
2.2. CPR Performance Quality of BystanderThe quality of bystander CPR performance during OHCA is a major factor impacting the efficacy of bystander CPR. Several studies have looked at bystander CPR competence and whether or not CPR recommendations were followed during OHCA incidents. Consistent with other studies, this one concludes that regular CPR training programs are essential for enhancing the quality of bystander CPR (Tse et al., 2023). These studies show that many onlookers do not have the training to do effective CPR. Incorrect compression depth is a frequently cited knowledge gap. Onlookers often fall short of the 2-inch (5-centimeter) minimum suggested for chest compression. If not enough blood is pumped to the heart and other essential organs, CPR may not be as successful as it may be.
Compression rate has also been shown to be inadequate in studies. 100120 compressions per minute is the minimum acceptable compression rate (Loza et al., 2022). Compressions should be done at a tempo that is neither too slow nor too quick, yet many observers do neither. Successful resuscitation is hindered by insufficient blood flow, which may be caused by an insufficient compression rate. Full chest recoil is also an essential part of doing CPR. Many spectators, according to studies, don't give the chest enough time to completely recoil between compressions. If the chest doesn't fully recoil, it might cut off blood flow and make CPR less efficient (Ventura et al., 2021). Poor bystander CPR performance has been shown to adversely affect patient outcomes. In order to increase the likelihood of successful resuscitation and decrease the danger of brain damage, doing CPR is essential. Suboptimal results, such as lower survival rates and more morbidity, may result from subpar CPR.
Efforts to enhance the quality of bystander CPR have been studied as a potential solution to these problems. Dispatcher-assisted cardiopulmonary resuscitation (CPR) is one such strategy in which trained dispatchers guide and support bystanders in real time over the phone. The dispatcher instructs the bystander on how to do CPR, including the appropriate compression depth, pace, and technique (Olasyeengen et al., 2020). It has been found that dispatcher-assisted CPR improves bystander CPR performance and leads to improved patient outcomes. CPR feedback devices are another kind of intervention. Bystanders may get immediate information on compression depth, rate, and other CPR parameters from these devices (Chen et al., 2019). Bystanders may benefit from feedback devices during CPR by adjusting their technique as needed and ensuring high-quality compressions. The use of CPR feedback devices has been linked to better CPR performance and increased survival rates.
In addition, bystander CPR quality may be greatly enhanced by ongoing education and training initiatives. Bystander CPR skills and understanding have been improved by short, regular refresher courses and community-wide CPR training efforts. Bystanders' self-assurance in their capacity to administer CPR in an emergency is bolstered by the knowledge they learn from these training programs. Patient outcomes after OHCA are strongly influenced by the quality of bystander CPR (Cournoyer et al., 2023). Consistent research has shown that continued CPR training programs are necessary to fill up knowledge gaps and improve the quality of CPR performed by bystanders. CPR performance may be improved by interventions including dispatcher-assisted CPR and the use of feedback devices (Chen et al., 2019). To ensure that bystanders are able to provide high-quality CPR, ongoing education and training activities are essential. Patients suffering from OHCA in the community have a better chance of surviving if bystander CPR is of a higher quality.
2.3. Barriers and Solutions for Bystander CPR ImplementationThere are several obstacles that might slow down the broad use of bystander CPR. Lack of public education and awareness regarding bystander CPR is a key obstacle (Becker et al., 2019). Many people may not know how to administer CPR properly or why it is so crucial to act quickly. To combat this, public education and outreach efforts might be launched to make more people aware of the importance of bystander CPR in saving lives.
According to Aldridge et al. (2022), Bystander CPR is hampered not just by physical barriers, but also by psychological ones, such as fear. People may hesitate to do CPR for fear of doing more damage than good. Potential bystanders may feel less anxious and more prepared to react to an OHCA incident if they have access to psychological support and stress management training. Individuals may be reluctant to do CPR due to legal considerations. Bystanders may be reluctant to start CPR out of concern that they may be sued if they make a mistake (Chen et al., 2019). Concerns like these may be allayed and bystander participation in life-saving efforts encouraged via the implementation of Good Samaritan laws that protect those who administer CPR in good faith.
Another obstacle to bystander CPR is the reluctance to conduct mouth-to-mouth breathing, especially out of fear of spreading disease. Hands-only CPR, which emphasizes just chest compressions, may alleviate this hesitation and make CPR easier for bystanders to do. People may feel more at ease doing CPR without using mouth-to-mouth ventilation if the urgency of beginning chest compressions immediately is emphasized (Yasin et al., 2023). Access to training programs must be boosted to enhance bystander CPR implementation. Increasing people's comfort and competence in doing CPR may be accomplished via the provision of accessible and inexpensive training options, such as community-based classes, online modules, and workplace training. One way to enhance bystander reaction is to increase the availability of automated external defibrillators (AEDs) and increase their visibility in public spaces so that they may be used quickly if needed.
Challenges to bystander CPR deployment in culturally and linguistically diverse areas include language and cultural limitations. It's important to make sure that people of all linguistic backgrounds have access to and can understand CPR training materials and instructors (Crawford and Gross, 2019). A bystander's reaction may be influenced by a variety of factors, some of which can be mitigated by including cultural sensitivity training. Bystander cardiopulmonary resuscitation (CPR) rates may be lower in underprivileged neighborhoods due to socioeconomic differences. To close this gap and equip people in underprivileged neighborhoods to react effectively to OHCA situations, targeted interventions like free or subsidized CPR training programs are needed.
According to Blewer et al. (2020), implementation of bystander CPR may be improved via the use of initiatives such as education, support, legal protection, simpler procedures, expanded accessibility, cultural sensitivity, and socioeconomic interventions to overcome these obstacles. More lives will be saved as a result of these initiatives, which will increase survival rates and improve patient outcomes after OHCA occurrences.
2.4.Areas for Future Research and Knowledge GapsWhile our understanding of the results of bystander CPR at OHCA has come a long way, there are still many unknowns that need to be explored. Filling in these blanks may aid in the creation of more efficient plans to increase bystander CPR rates and better patient outcomes.
Future studies should investigate whether factors help or hinder bystander CPR performance. Despite widespread education and training in CPR, many localities still have less-than-ideal bystander CPR rates. To increase the number of bystanders who provide CPR, we need a better understanding of the elements that impact their decision-making and responsiveness (Payot et al., 2021). Some people could be reluctant to begin CPR because of emotions like fear or a lack of confidence, or because they worry about hurting the patient. More research is needed to identify effective methods for overcoming these barriers, such as increased emphasis on training instructors, more community involvement, and clarification of common misconceptions concerning bystander CPR.
There is also a lack of research on the long-term effects of bystander CPR for OHCA survivors. Besides survival rates, factors like neurologic outcomes, quality of life, and functional recovery may provide light on the impact of bystander CPR (Low et al., 2023). Longitudinal studies with repeated measurements of outcomes may provide light on the value of survival and the benefits of early intervention. Cognitive performance, disability rates, and mental health should all be studied in order to better post-resuscitation therapy and support for OHCA survivors.
Research into the most effective methods of teaching bystanders CPR is also required. While traditional classroom teaching has been around for a while, modern technological advancements have made possible some very interesting alternatives. Comparing different CPR training approaches, such VR simulations, smartphone applications, and online courses, will help us understand which is most effective (Ricci et al., 2022). Further identifying the most effective means of assuring skill retention and confidence among the general population may be possible by studying the effects of refresher courses and continual training on bystander CPR performance.
Knowing the value of bystander CPR for certain populations is also essential. Particular challenges arise while treating OHCA in children due to the age range throughout which the condition often manifests and the physiological differences between children and adults. In the same way that the patient's age and other characteristics specific to the elderly may impact the efficacy of bystander CPR, research focusing on children may assist update guidelines for bystander CPR in pediatric cases (Wyckoff et al., 2022). Studying what motivates and deters elderly bystanders might help guide the development of CPR guidelines and educational programs tailored to their needs. Many questions remain unanswered despite the extensive research on the benefits of bystander CPR for OHCA patients. More research is needed to determine what variables promote or discourage bystander CPR, what happens to those who survive an OHCA, what kinds of training are most successful, and what percentage of the population knows how to do CPR (Doan et al., 2020). By filling up these knowledge gaps, we may be able to enhance the number of lives saved by bystander CPR in OHCA occurrences.
2.5. ConclusionBystander CPR's impact on patient outcomes and survival rates at OHCA can't be overstated. Performing bystander CPR may save lives by allowing people to take action before medical personnel arrive. However, the quality of CPR conducted by laypeople is a major problem and needs constant development. The gaps in understanding have been identified, and the quality of bystander CPR has been shown to be improved through continuous training programs, as shown by this research review. Several studies have shown that bystanders who attempt to do CPR make mistakes in compression depth, compression rate, and chest recoil. The success of CPR and the outcome for the patient are both affected by these variables.
Bystanders participating in dispatcher-assisted CPR get real-time instructions and encouragement through phone to help them do CPR correctly. By providing real-time data on compression depth and pace, CPR feedback devices allow bystanders to fine-tune their technique for the best possible outcome. If put into practice, these actions may improve the quality of bystander CPR and boost the likelihood of a successful resuscitation. While our understanding of the results of bystander CPR has advanced, there are still gaps in our knowledge that must be filled. Factors that impact bystander choice and reaction may be identified by investigating the obstacles to and the supports for bystander CPR. In order to increase the number of bystanders who do CPR, it is important to identify the variables that contribute to low rates of bystander CPR.
There is a need for further study on the long-term impact of bystander CPR on OHCA survivors. Beyond mere survival numbers, assessing neurologic outcomes, quality of life, and functional recovery may provide a more complete picture of the impact of bystander CPR. This information might be utilized to refine post-resuscitation care and counseling for those who have experienced OHCA. It is critical to determine the most useful approach to teaching bystanders how to do CPR. By contrasting different training methods and evaluating the benefits of refresher courses and continual training, we may perhaps identify the most effective techniques to increase the public's CPR knowledge and skills. It is important that bystander CPR be modified for usage on a wide range of ages and sizes, from infants to the elderly. Research that focuses on these age groups will help develop guidelines, therapies, and training programs that are more suited to their needs.
Chapter 3 - Methods
The aim of this study is firstly to know whether the lay people are confident while performing bystander CPR and have access to the available automated external defibrillators. Secondly to know if the bystander CPR and use of AED will improve the survival rate of OHCA. My research question is PEO:
will bystander use of defibrillation and CPR improves the survival rates of out-of- hospital cardiac arrest?
Table SEQ Table * ARABIC 1
P Bystanders
E Use of defibrillation and CPR
O Survival rates of out-of-hospital cardiac arrest/ to increase awareness of importance and need for participation in OHCA until expert help arrives
This chapter explores the search methodology and strategy, key words used, incision and exclusion criteria implemented to retrieve eligible studies. The figure below presents the steps for the systematic review approach that is used in this research. Based on the figure, it can be concluded that a qualitative research approach is adopted, where secondary data from the data collection has been selected.
Figure SEQ Figure * ARABIC 1 Data selection and extraction process
3.1 Search Methodology:
A literature review is a comprehensive description or overview, (to include) assessment of previous research on a given topic. It shows what is already known and what needs to be studied regarding that particular topic. In the literature review, you should note the theories and earlier studies that have impacted your choice of research topic and methods (Ridley, 2008). A literature reviews is important because it enables authors to enhance their reading and learning abilities. Through reading as widely as possible, detailed information regarding certain topics is obtained and assimilated and it helps to identify any gaps which require further investigation or research. A robust literature review showcases the authors knowledge on particular topic (Jahan et al., 2016). According to Jahan et al (2016) a literature review provides important insight into a particular scholarly topic. It compiles published research on a topic, surveys different sources of research, and critically examines these sources. Alternatively, a systematic review is a high-level overview of primary research based on a focused question. Wright et al (2007) explain that a systematic review uses systematic and explicit methods to identify, select and critically appraise relevant primary research. It extracts and analyses data from the studies that are included in the review. Although dated, (15 years ago) this explanation of systematic reviews remains apt in todays academic field.
Other earlier authors Egger et al. (2001) explain that SRs help decrease bias by utilising explicit and transparent methods. This allows for reliable and comprehensive conclusions to be reached. This dissertation consists of a systematic review of the literature pertaining to the effect of bystander CPR on survival rates of OHCA. Following a systematic search strategy an integrative review of the literature will then be employed as it allows the combination of papers of varied methodologies (qualitative and quantitative) into a narrative or tabular form (Souza et al., 2010),
3.2 Search Strategy
A brief scoping review of research on OHCA and bystander CPR was conducted prior to the formulation of the search strategy. This was to identify common terminology used for this population. A systematic search strategy was then employed to identify relevant papers on the effects of bystander CPR at OHCA. The search was conducted using online databases from Mohammed Bin Rashid MBRU online library, and the online library of Ministry of health and prevention MOHAP Four main databases were searched for references between January 2012 to January 2022. This timeframe was selected to obtain the most up-to-date published papers in the area of interest. The used inclusion criteria is as such;
Table SEQ Table * ARABIC 2 Inclusion and exclusion criteria:
Inclusion Exclusion
Primary Literature reviews, systematic literature review, secondary research
Age above 8yrs old, all genders, all occupations Pediatric population below 8yrs old
Published between 2010-2020 All studies before 2010 or after 2020
Peer reviewed Non-peer reviewed
Published in English Studies not in English language
Studies the effect or bystander CPR Doesnt study the effect of bystander CPR
Full text available Article has no full text available
Abstract available No abstract available
Psych INFO
S.no Keywords Search Results
1# Bystander CPR 12
2# CPR 2393
3# Cardiopulmonary resuscitation 786
4# cardiac arrest 847
5# Resuscitation 2284
6# "Survival rate"AND "Cardiac arrest" 27
7# "Survival rate" AND "Bystander CPR" 2
8# Bystander effect AND CPR 8
9# Survival rate OR Cardiac Arrest OR Resuscitation 5591
10# 1# AND 4# 12
11# 2# AND 5# 555
12# 5# AND 6# 17
13# 5# AND 7 2
The search strategy was performed via systematic review based on guidelines presented by the "Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement (PRISMA) (Moher et al., 2009). Figure (1) below shows the selection of the articles.
Figure SEQ Figure * ARABIC 2 PRISMA Diagram
3.3 Databases accessed
The databases accessed include Psych INFO, Arab World Research Source, CINAHIL and Medline Complete as well as "Grey literature" such as nursing dissertations and conference proceedings (Paez, 2017). The main focus was given to the last two databases CINAHIL and Medline Complete as they had more primary research papers available
() define boolean operators as simple words (AND, OR, NOT or AND NOT) and they are used as conjunctions to combine or exclude keywords in a search. Their use leads to more focused and productive results. Use of Boolean operators save time and effort by eliminating inappropriate hits that must be scanned before discarding (Alliant Libraries, n.d.)
Provide an example of how you combined key words. Place in a table: Table 3: Key words and Boolean operators
For example
Database Key words NO. of papers
Psych INFO 1# Bystander CPR 12
2# CPR 2393
3# Cardiopulmonary resuscitation 786
4# cardiac arrest 847
5# Resuscitation 2284
6# "Survival rate"AND "Cardiac arrest" 27
7# "Survival rate" AND "Bystander CPR" 2
8# Bystander effect AND CPR 8
9# Survival rate OR Cardiac Arrest OR Resuscitation 5591
10# 1# AND 4# 12
11# 2# AND 5# 555
12# 5# AND 6# 17
13# 5# AND 7 2
Database Keywords NO. of papers
Arab World Research Source 1# Bystander CPR 11
2# CPR 279
3# Cardiac arrest 110
4# Out of hospital cardiac arrest AND Bystander CPR 8
5# Automated External Defibrillator 9
6# CPR AND automated external defibrillator 3
7# 3# AND 2# 27
8# 4# AND 5# 1 excluded on spot as its a literature review
Database Keywords NO. of papers
CINAHIL 1# Bystander CPR 1548
2# CPR 25284
3# Basic life support 3056
4# Cardiac arrest 36263
5# "Cardiopulmonary resuscitation" 19985
6# Bystander effect AND Cardiac arrest 9
7# Automated External Defibrillator 1442
8# AED 3813
9# Survival rate AND CPR 867
10# Survival rate AND Cardiac arrest 1428
11# 1# AND 3# 177
12# 4# AND 8# 1189
13# 9# AND 8# 137
14# 2# AND 3# 1361
Database Keywords NO. of pages
Medline Complete 1# CPR 43704
2# Bystander CPR 1883
3# " Automated External Defibrillator" 1765
4# AED 13984
5# "Cardiopulmonary resuscitation" 43081
6# "Cardiac arrest 96513
7# "Out of hospital cardiac arrest" 14729
8# Bystander effect AND Cardiac arrest 59
9# Survival rate AND Out of hospital cardiac arrest 2680
10# Survival rate AND Bystander CPR 621
11# 1# AND 7# AND 2# 1546
12# 2# AND 3# 319
13# 1# OR 5# 61993
14# 3# AND 6# AND 7# 900
PsycINFO database considered as one of the largest databases that contains peer reviewed literatures, it also contains a numerous number of citations and summaries of journals, books and dissertations in different medical fields.
MBRU online library gives an online access to the students; Ive done a basic research by using the previously mentioned keywords. Boolean searching and Boolean operators were implemented to give focused results in all databases.
Arab World Research Source database is an Arab and Middle Eastern platform where you can find studies, scholarly journals, magazines and many other sorts of researches and published papers. It includes more than 300 full test articles and about 200 scholarly journals.
I selected this database to look how is the effectiveness of bystander CPR in Arab countries and if the lay people are aware of it, whether its been taught to the children in schools, or whether the people are aware of the availability of AED in certain area and how to use it correctly.
Unfortunately very less numbers of studies were found compared with other databases; however one or two papers will be included in my final retrieved articles.
CINAHIL Cumulative Index to Nursing and Allied Health Literature covers a wide range of articles concerning nursing and allied health. Its great and comprehensive database to search topics related to health, biology, public health and more. It effectively helps users to follow (MeSH) Medical Subject headingsstructure to find more relevant studies and information.
Medline Complete is created by U.S national library of medicine, it concerns biomedical and health journals and used by majority of health care providers, its the largest associate of Medline index. The result of the primary search on this database revealed a numerous number of articles; however a final search needs to be done according to the inclusion and exclusion list.
3.4 Quality appraisal:
Hill and Spittleshouse define quality appraisal as a systematic assessment to evaluate the value, relevance and applicability of the research. There are a range of assessment tools that can be used for appraisal (give examples: Joanna Briggs, Critical Appraisal skills programme (CASP), but for the purposes of this review the CASP Tool (2020) will be used. CASP (2020) is clear, concise and helps to assess the articles critically and rigorously and it is widely utilised in health and social care (Falcon et al., 2006). The purpose of this tool is to help develop essential skills in understanding and disseminating research evidence into practice. The tool includes checklists for systematic reviews, randomised controlled trials, case-control, qualitative, diagnosis and cohort studies (CASP UK, 2020). The checklists ultimately describe three issues of the papers - validity, results and usefulness of the study.This study will include only a primary researches that answer the set research question, a CASP tool is implemented to study the strengths and weaknesses of the selected articles in order to assess the usefulness and validity of research findings (Courtney and McCutcheonm, 2010). It helps in critically appraising not only the qualitative studies, but also systematic reviews, randomized controlled trails, Cohort studies and more. CASP tool assess the validity of findings of research articles, CASP tool is set of 10 questions each question has a different methodological focus on. It enables the author to check the appropriateness of a research method and results. CASP tool is easy to use and was approved to use in qualitative evidence synthesis by Cochrane and the World Health Organization.
Chapter summary: This chapter discussed the methodology and search strategy used while undertaking this review. These aspects were outlined, explained and justified where appropriate and used tables to illustrate key points. The tool used to assist in critiquing the included articles (CASP) was also considered. The next chapter will report the findings of this review.
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