title: Elderly out-of-hospital cardiac arrest has worse outcomes with a family bystander than a non-family bystander.
abstract: BACKGROUND
  A growing elderly population along with advances in equipment and approaches for pre-hospital resuscitation necessitates up-to-date information when developing policies to improve elderly out-of-hospital cardiac arrest (OHCA) outcomes. We examined the effects of bystander type (family or non-family) intervention on 1-month outcomes of witnessed elderly OHCA patients.
  
  
  METHODS
  Data from a total of 85,588 witnessed OHCA events in patients aged ≥65 years, which occurred from 2005 to 2008, were obtained from a nationwide population-based database. Patients were stratified into three age categories (65-74, 75-84, ≥85 years), and the effects of bystander type (family or non-family) on initial cardiac rhythm, rate of bystander cardiopulmonary resuscitation (CPR), and 1-month outcomes were assessed.
  
  
  RESULTS
  The overall survival rate was 6.9% (65-74 years: 9.8%, 75-84 years: 6.9%, ≥85 years: 4.6%). Initial VF/VT was recorded in 11.1% of cases with a family bystander and 12.9% of cases with a non-family bystander. The rate of bystander CPR was constant across the age categories in patients with a family bystander and increased with advancing age categories in patients with a non-family bystander. Patients having a non-family bystander were associated with significantly higher 1-month rates of survival (OR: 1.26; 95% CI: 1.19-1.33) and favorable neurological status (OR: 1.47; 95% CI: 1.34-1.60).
  
  
  CONCLUSIONS
  Elderly patient OHCA events witnessed by a family bystander were associated with worse 1-month outcomes than those witnessed by a non-family bystander. Healthcare providers should consider targeting potential family bystanders for CPR education to increase the rate and quality of bystander CPR.
authors.affiliation: Department of Public Health, Health Management and Policy, Nara Medical University School of Medicine, 840 Shijo-cho, Kashihara, Nara, 634-8521, Japan. makahane@naramed-u.ac.jp.
authors.forename: Manabu
authors.initials: M
authors.lastname: Akahane
authors.forename: Seizan
authors.initials: S
authors.lastname: Tanabe
authors.forename: Soichi
authors.initials: S
authors.lastname: Koike
authors.forename: Toshio
authors.initials: T
authors.lastname: Ogawa
authors.forename: Hiromasa
authors.initials: H
authors.lastname: Horiguchi
authors.forename: Hideo
authors.initials: H
authors.lastname: Yasunaga
authors.forename: Tomoaki
authors.initials: T
authors.lastname: Imamura