Incidence and factors associated with bystander cardiopulmonary resuscitation in out-of-hospital cardiac arrest in an Italian region

Introduction: Out-of-hospital cardiac arrest (OHCA) is a major cause of mortality, and early bystander cardiopulmonary resuscitation (CPR) is critical for survival. This study assessed OHCA incidence and factors associated with bystander-initiated CPR in the Piedmont region of Northern Italy. Methods: A retrospective cross-sectional analysis was conducted using 2022 administrative data from an Emergency Medical Dispatch Centre serving 851,538 residents. All confirmed OHCA cases were included. Demographic, clinical, and contextual variables were extracted. Descriptive statistics summarized case characteristics, and comparisons between events with and without bystander CPR were performed using chi-square or Fisher's exact tests. Results: Among 905 confirmed cases, the incidence was 106 per 100,000 inhabitants. Most patients were male (57%), with a mean age of 76 years, and arrests occurred predominantly at home (87%). Bystander CPR was documented in 644 cases, occurring in 39.9%, mainly independently. CPR was more frequent in rural areas (p=0.002) and public settings (p<0.001). Return of spontaneous circulation occurred in 6.4% and was strongly associated with bystander intervention (p<0.001). Conclusions: Fewer than half of eligible patients received bystander CPR, highlighting gaps in community readiness. Strengthening public training and dispatcher-assisted CPR may improve outcomes.