Article Text

Original research
Comorbidity and bystander cardiopulmonary resuscitation in out-of-hospital cardiac arrest
  1. Geir Hirlekar1,2,
  2. Martin Jonsson3,
  3. Thomas Karlsson4,
  4. Maria Bäck1,5,
  5. Araz Rawshani1,
  6. Jacob Hollenberg3,
  7. Per Albertsson1,2,
  8. Johan Herlitz6
  1. 1 Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, Goteborg, Sweden
  2. 2 Department of Cardiology, Sahlgrenska University Hospital, Goteborg, Sweden
  3. 3 Department of Medicine, Center for Resuscitation Science, Karolinska Institutet, Stockholm, Sweden
  4. 4 Biostatistics, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, Gothenburg, Sweden
  5. 5 Department of Occupational Therapy and Physiotherapy, Sahlgrenska University Hospital, Gothenburg, Sweden
  6. 6 Center for Pre-Hospital Research, University of Borås, Borås, Sweden
  1. Correspondence to Geir Hirlekar, Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, Goteborg 413 90, Sweden; geir.hirlekar{at}


​Objective Cardiopulmonary resuscitation (CPR) performed before the arrival of emergency medical services (EMS) is associated with increased survival after out-of-hospital cardiac arrest (OHCA). The aim of this study was to determine whether patients who receive bystander CPR have a different comorbidity compared with patients who do not, and to determine the association between bystander CPR and 30-day survival when adjusting for such a possible difference.

​Methods Patients with witnessed OHCA in the Swedish Registry for Cardiopulmonary Resuscitation between 2011 and 2015 were included, and merged with the National Patient Registry. The Charlson Comorbidity Index (CCI) was used to measure comorbidity. Multiple logistic regression was used to examine the effect of CCI on the association between bystander CPR and outcome.

​Results In total, 11 955 patients with OHCA were included, 71% of whom received bystander CPR. Patients who received bystander CPR had somewhat lower comorbidity (CCI) than those who did not (mean±SD: 2.2±2.3 vs 2.5±2.4; p<0.0001). However, this difference in comorbidity had no influence on the association between bystander CPR and 30-day survival in a multivariable model including other possible confounders (OR 2.34 (95% CI 2.01 to 2.74) without adjustment for CCI and OR 2.32 (95% CI 1.98 to 2.71) with adjustment for CCI).

​Conclusion Patients who undergo CPR before the arrival of EMS have a somewhat lower degree of comorbidity than those who do not. Taking this difference into account, bystander CPR is still associated with a marked increase in 30-day survival after OHCA.

  • out-of-hospital cardiac arrest
  • comorbidity
  • bystander cardiopulmonary resuscitation
  • Charlson comorbidity index
  • survival

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  • Contributors Each author has contributed significantly to the submitted work, in terms of design of study, data acquisition, analysis or interpretation, drafting the article or revising it and final approval of the manuscript.

  • Funding The study was supported by the Swedish state under the ALF agreement (ALFGBG 716901).

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon reasonable request.

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