Characterising trends in the initiation, timing, and completion of recommended summary plan for emergency care and treatment (ReSPECT) plans: Retrospective analysis of routine data from a large UK hospital trust.

AIM: To assess patient socio-demographic and disease characteristics associated with the initiation, timing, and completion of emergency care and treatment planning in a large UK-based hospital trust. METHODS: Secondary retrospective analysis of data across 32 months extracted from digitally stored Recommended Summary Plan for Emergency Care and Treatment (ReSPECT) plans within the electronic health record system of an acute hospital trust in England, UK. RESULTS: Data analysed from ReSPECT plans (n = 23,729), indicate an increase in the proportion of admissions having a plan created from 4.2% in January 2019 to 6.9% in August 2021 (mean = 8.1%). Forms were completed a median of 41 days before death (a median of 58 days for patients with capacity, and 21 days for patients without capacity). Do not attempt cardiopulmonary resuscitation was more likely to be recorded for patients lacking capacity, with increasing age (notably for patients aged over 74 years), being female and the presence of multiple disease groups. 'Do not attempt cardiopulmonary resuscitation' was less likely to be recorded for patients having ethnicity recorded as Asian or Asian British and Black or Black British compared to White. Having a preferred place of death recorded as 'hospital' led to a five-fold increase in the likelihood of dying in hospital. CONCLUSION: Variation in the initiation, timing, and completion of ReSPECT plans was identified by applying an evaluation framework. Digital storage of ReSPECT plan data presents opportunities for assessing trends and completion of the ReSPECT planning process and benchmarking across sites. Further research is required to monitor and understand any inequity in the implementation of the ReSPECT process in routine care.

Tendencias actuales en la enseñanza de la reanimación cardiopulmonar básica / Current trends in the teaching of basic cardiopulmonary resuscitation / Current trends in the teaching of basic cardiopulmonary resuscitation

Introducción: La enseñanza de la reanimación cardiopulmonar se basa en el estudio de conceptos, teorías y prácticas que son evaluados con el objetivo de medir el nivel de retención de los individuos. Objetivo: Caracterizar el impacto de las tendencias actuales en la enseñanza de la reanimación cardiopulmonar básica. Métodos: Se realizó una revisión bibliográfica de artículos científicos pertenecientes a las bases de datos Medline, PubMed, SciELO Regional y SciELO Cuba. Se utilizaron descriptores en español e inglés y se revisaron 29 citas. Resultados: Las tendencias actuales implican la aplicación de las nuevas tecnologías, la autopreparación y el poco desarrollo de entornos presenciales. Se consideran las escuelas como lugares clave para las nuevas formas de enseñanza. Los simuladores permiten la formación bajo situaciones clínicas reales. El autoaprendizaje garantiza la consolidación de las habilidades prácticas trasmitidas por el instructor y asimiladas por el estudiante. Conclusiones: La reanimación cardiopulmonar garantiza una mejor calidad de vida de la población en general. Con el avance tecnológico se ha abierto una nueva etapa en la formación de habilidades, donde ha primado la autonomía; aunque existen notables desventajas. Entonces se necesita un asesoramiento con instructor, que ofrezca los conocimientos teóricos y prácticos básicos compaginados con un nivel de autonomía del aprendizaje. Este proceso debe seguirse y controlarse. A la vez que la formación no se detiene ahí, la formación sistemática en cualquier lugar permite la reafirmación de lo aprendido. De este modo, los avances tecnológicos desempeñarán su mejor beneficio(AU)

Introduction: The teaching of cardiopulmonary resuscitation is based on the study of concepts, theories and practices evaluated with the aim of measuring the retention level of individuals. Objective: To characterize the impact of current trends in the teaching of cardiopulmonary resuscitation. Methods: A bibliographic review of scientific articles from Medline, PubMed, SciELO Regional and SciELO Cuba databases was carried out. Descriptors in Spanish and English were used, as well as 29 citations were reviewed. Results: Current trends involve the application of new technologies, self-training and little development of face-to-face settings. Schools are considered as key places for new forms of teaching. Simulators allow training under real clinical situations. Self-learning guarantees the consolidation of practical skills transmitted by the instructor and assimilated by the student. Conclusions: Cardiopulmonary resuscitation guarantees better quality of life for the general population. Technological progress has opened a new stage in the training of skills, in which autonomy has prevailed; however, there are significant disadvantages. Therefore, there is a need for instructor-led counseling, offering basic theoretical and practical knowledge combined with a level of learning autonomy. This process must be monitored and controlled. While training does not stop at such point, systematic training at any location allows reaffirmation of what has been learned. In this way, technological advances will permit to take the best advantage(AU)

A walk through the progression of resuscitation medicine.

Cardiac arrest (CA) is a sudden and devastating disease process resulting in more deaths in the United States than many cancers, metabolic diseases, and even car accidents. Despite such a heavy mortality burden, effective treatments have remained elusive. The past century has been productive in establishing the guidelines for resuscitation, known as cardiopulmonary resuscitation (CPR), as well as developing a scientific field whose aim is to elucidate the underlying mechanisms of CA and develop therapies to save lives. CPR has been successful in reinitiating the heart after arrest, enabling a survival rate of approximately 10% in out-of-hospital CA. Although current advanced resuscitation methods, including hypothermia and extracorporeal membrane oxygenation, have improved survival in some patients, they are unlikely to significantly improve the national survival rate any further without a paradigm shift. Such a change is possible with sustained efforts in the basic and clinical sciences of resuscitation and their implementation. This review seeks to discuss the current landscape in resuscitation medicine-how we got here and where we are going.

Association of a simple SACAF score with bystander witnessed sudden death due to ventricular tachyarrhythmias in a multicenter cohort.

Out-of-hospital cardiac arrest (OHCA) remains a major threat to public health worldwide. OHCA patients presenting initial shockable ventricular tachycardia/ventricular fibrillation (VT/VF) rhythm have a better survival rate. We sought to develop a simple SACAF score to discriminate VT/VF from non-VT/VF OHCAs based on the Taiwan multicenter hospital-based registry database. We analyzed the in- and pre-hospital data, including demographics, baseline comorbidities, response times, automated external defibrillator information, and the 12-lead ECG recording closest to the OHCA event in bystander-witnessed OHCA patients. Among the 461 study patients, male sex (OR 2.54, 95% CI = 1.32-4.88, P = 0.005), age ≤ 65 years (OR 2.78, 95% CI = 1.64-4.70, P < 0.001), cardiovascular diseases (OR 2.97, 95% CI = 1.73-5.11, P < 0.001), and atrial fibrillation (AF) (OR 2.36, 95% CI = 1.17-4.76, P = 0.017) were independent risk factors for VT/VF OHCA (n = 81) compared with non-VT/VF OHCA (n = 380). A composite SACAF score was developed (male Sex, Age ≤ 65 years, Cardiovascular diseases, and AF) and compared with the performance of a modified CHA2DS2-VASc score (Cardiovascular diseases, Hypertension, Age ≥ 75 years, Diabetes, previous Stroke, Vascular disease, Age 65-74 years, female Sex category). The area under the receiver operating characteristic curve (AUC) of the SACAF was 0.739 (95% CI = 0.681-0.797, P < 0.001), whereas the AUC of the modified CHA2DS2-VASc was 0.474 (95% CI = 0.408-0.541, P = 0.464). A SACAF score of ≥ 2 was useful in discriminating VT/VF from non-VT/VF OHCAs with a sensitivity of 0.75 and a specificity of 0.60. In conclusion, the simple SACAF score appears to be useful in discriminating VT/VF from non-VT/VF bystander-witnessed OHCAs and the findings may also shed light on future mechanistic evaluation.

Cardiopulmonary Resuscitation and Rescue Therapies.

The history of cardiopulmonary resuscitation and the Society of Critical Care Medicine have much in common, as many of the founders of the Society of Critical Care Medicine focused on understanding and improving outcomes from cardiac arrest. We review the history, the current, and future state of cardiopulmonary resuscitation.

Caseload and cardiopulmonary arrest management by an out-of-hospital emergency service during the COVID-19 pandemic. / Actividad y asistencia a la parada cardiorrespiratoria en un servicio extrahospitalario de emergencias durante la pandemia COVID-19.

OBJECTIVES: To describe the effect of the coronavirus disease 2019 (COVID-19) pandemic on the initiation of cardiopulmonary resuscitation (CPR) in patients with out-of-hospital cardiopulmonary arrest. To compare the cardiopulmonary arrest caseload during the pandemic to the caseloads in other periods. MATERIAL AND METHODS: Observational, prospective study based on the registry of out-of-hospital cardiopulmonary arrest emergencies the SUMMA112 ambulance service responded to between March 1 and April 30, 2020, in the Spanish autonomous community of Madrid. The registry is a Utstein-style database. The period of March-April 2019 was the control period for direct comparison with the 2020 study period and with the January-February periods of 2019 and 2020. RESULTS: The responders undertook advanced CPR in 146 of the 313 cardiopulmonary arrest cases registered during March-April, 2020. Of the 87 patients with COVID-19-positive tests, 33 reached the hospital alive. Advanced CPR was not applied in 167 cases; the most frequent reason was prolonged circulatory collapse. Most cases (92.7%) occurred in the home. The emergency dispatchers received more calls in March and April of 2020, but they sent out a similar number of ambulances. CONCLUSION: Mortality was higher in cases of cardiopulmonary arrest during the COVID-19 pandemic. The percentage of cases with no application of advanced CPR rose; the main reason was the amount of time between collapse and first response. Even though the number of emergency calls increased significantly, the SUMMA112 service did not dispatch more ambulances.

OBJETIVO: Conocer las consecuencias de la pandemia COVID-19 en la atención a la parada cardiorrespiratoria (PCR) extrahospitalaria con relación al inicio de las maniobras de resucitación cardiopulmonar (RCP) y su supervivencia. Valorar el impacto de la pandemia por COVID-19 en la actividad asistencial de un servicio de urgencias y emergencias extrahospitalarias en comparación con otros periodos sin enfermedad. METODO: Estudio observacional prospectivo, basado en un registro continuo de PCR extrahospitalaria del SUMMA 112 de Madrid, durante el periodo del 1 de marzo al 30 de abril del 2020. Las variables se recogieron siguiendo las recomendaciones Utstein. Se utilizó el periodo de marzo-abril 2019 como control de comparación directa con el periodo de estudio y los periodos de enero-febrero de 2019 y de 2020 para conocer la variabilidad entre dichos años. RESULTADOS: De las 313 PCR atendidas en marzo-abril de 2020, en 146 casos se realizó RCP avanzada. De los 87 pacientes catalogados COVID positivo, llegaron vivos al hospital 33. No se aplicaron maniobras de RCP avanzada en 167 ocasiones, identificando como causa más frecuente el tiempo de colapso excesivo. El 92,7% de las PCR sucedieron en domicilio. Comparado con otros periodos, hubo más llamadas al centro coordinador de urgencias en marzo-abril de 2020, si bien la movilización de recursos fue similar. CONCLUSIONES: Durante la pandemia de COVID-19 hubo más mortalidad en la PCR extrahospitalaria, aumentando el porcentaje de PCR sin RCP avanzada, estacando como principal causa el tiempo de colapso excesivo. Sin embargo, aunque se incrementó significativamente la demanda telefónica, este servicio de emergencias extrahospitalarias no tuvo aumento en la movilización de los recursos móviles asistenciales.

Out-of-Hospital Cardiac Arrest Response and Outcomes During the COVID-19 Pandemic.

OBJECTIVES: The purpose of this study was to evaluate the potential impact of the coronavirus disease-2019 (COVID-19) pandemic on out-of-hospital cardiac arrest (OHCA) responses and outcomes in 2 U.S. communities with relatively low infection rates. BACKGROUND: Studies in areas with high COVID-19 infection rates indicate that the pandemic has had direct and indirect effects on community responses to OHCA and negative impacts on survival. Data from areas with lower infection rates are lacking. METHODS: Cases of OHCA in Multnomah County, Oregon, and Ventura County, California, with attempted resuscitation by emergency medical services (EMS) from March 1 to May 31, 2020, and from March 1 to May 31, 2019, were evaluated. RESULTS: In a comparison of 231 OHCA in 2019 to 278 in 2020, the proportion of cases receiving bystander cardiopulmonary resuscitation (CPR) was lower in 2020 (61% to 51%, respectively; p = 0.02), and bystander use of automated external defibrillators (AEDs) declined (5% to 1%, respectively; p = 0.02). EMS response time increased (6.6 ± 2.0 min to 7.6 ± 3.0 min, respectively; p < 0.001), and fewer OHCA cases survived to hospital discharge (14.7% to 7.9%, respectively; p = 0.02). Incidence rates did not change significantly (p > 0.07), and coronavirus infection rates were low (Multnomah County, 143/100,000; Ventura County, 127/100,000 as of May 31) compared to rates of ∼1,600 to 3,000/100,000 in the New York City region at that time. CONCLUSIONS: The community response to OHCA was altered from March to May 2020, with less bystander CPR, delays in EMS response time, and reduced survival from OHCA. These results highlight the pandemic's indirect negative impact on OHCA, even in communities with relatively low incidence of COVID-19 infection, and point to potential opportunities for countering the impact.

Emerging Trends and Hot Topics in Cardiopulmonary Resuscitation Research: A Bibliometric Analysis from 2010 to 2019.

BACKGROUND Cardiopulmonary resuscitation (CPR) is a topic of great scientific and clinical interest that has received much attention in the past decade. Our study aimed to predict the trends in CPR research activities and evaluate hot topics via bibliometric means, quantitatively and qualitatively. MATERIAL AND METHODS All data were collected from a search of the Web of Science Core Collection on May 12, 2020. Retrieved information was investigated with bibliometric analysis by CiteSpace and VOSviewer software and the Online Analysis Platform of Literature Metrology to analyze and predict the trends and hotspots in this field. RESULTS Our search returned a total of 9563 articles and reviews on CPR published from 2010 through 2019. The number of original research studies on CPR has been increasing annually. The journal Resuscitation published the greatest number of manuscripts involved CPR, and the leading country and institution with regard to contributions on CPR were the United States and the University of Pennsylvania. Keyword co-occurrence/co-citation-cluster analysis showed that the most popular terms associated with CPR occurred in the manner of cluster labels, such as therapeutic hypothermia and treatment recommendation, among others. In addition, palliative care, sepsis, extracorporeal membrane oxygenation, and brain injury were identified as new foci through burst detection analysis. CONCLUSIONS Our study showed that the scientific research focus on CPR is switching from traditional therapeutic treatments to a public health practice, with in-depth understanding and development of CPR-related techniques expanding over the past decade. These results demonstrate trends in the CPR research and detected the possible neo-foci for ensuing research.

Randomized Pilot Clinical Trial of Early Coronary Angiography Versus No Early Coronary Angiography After Cardiac Arrest Without ST-Segment Elevation: The PEARL Study.

BACKGROUND: The benefit of emergency coronary angiography after resuscitation from out-of-hospital cardiac arrest is uncertain for patients without ST-segment elevation. The aim of this randomized trial was to evaluate the efficacy and safety of early coronary angiography and to determine the prevalence of acute coronary occlusion in resuscitated patients with out-of-hospital cardiac arrest without ST-segment elevation. METHODS: Adult (>18 years) comatose survivors without ST-segment elevation after resuscitation from out-of-hospital cardiac arrest were prospectively randomized in a 1:1 fashion under exception to informed consent regulations to early coronary angiography versus no early coronary angiography in this multicenter study. Early angiography was defined as ≤120 minutes from arrival at the percutaneous coronary intervention-capable facility. The primary end point was a composite of efficacy and safety measures, including efficacy measures of survival to discharge, favorable neurologic status at discharge (Cerebral Performance Category score ≤2), echocardiographic measures of left ventricular ejection fraction >50%, and a normal regional wall motion score of 16 within 24 hours of admission. Adverse events included rearrest, pulmonary edema on chest x-ray, acute renal dysfunction, bleeding requiring transfusion or intervention, hypotension (systolic arterial pressure ≤90 mm Hg), and pneumonia. Secondary end points included the incidence of culprit vessels with acute occlusion. RESULTS: The study was terminated prematurely before enrolling the target number of patients. A total of 99 patients were enrolled from 2015 to 2018, including 75 with initially shockable rhythms. Forty-nine patients were randomized to early coronary angiography. The primary end point of efficacy and safety was not different between the 2 groups (55.1% versus 46.0%; P=0.64). Early coronary angiography was not associated with any significant increase in survival (55.1% versus 48.0%; P=0.55) or adverse events (26.5% versus 26.0%; P=1.00). Early coronary angiography revealed a culprit vessel in 47%, with a total of 14% of patients undergoing early coronary angiography having an acutely occluded culprit coronary artery. CONCLUSIONS: This underpowered study, when considered together with previous clinical trials, does not support early coronary angiography for comatose survivors of cardiac arrest without ST elevation. Whether early detection of occluded potential culprit arteries leads to interventions that improve outcomes requires additional study. REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT02387398.

Annie, Annie! Are You Okay?: Faces Behind the Resusci Anne Cardiopulmonary Resuscitation Simulator.

We investigated the history of Resusci Anne, the well-known cardiopulmonary resuscitation (CPR) simulation trainer. The creation of Resusci Anne began with Peter J. Safar, an accomplished anesthesiologist who experimented with resuscitation of respiration and cardiac function. He collaborated with Asmund S. Laerdal, whose early experimentation with soft plastics allowed him to create a human simulator that could be used to teach the skills of resuscitation to both medical care practitioners and individuals of all walks of life. A special face was chosen for the simulation mannequin, one based on a mysterious death mask of a beautiful woman from the late 19th century. The success of Resusci Anne led to the widespread acceptance of CPR and simulation use in medical training.

International Liaison Committee on Resuscitation: COVID-19 consensus on science, treatment recommendations and task force insights.

Consensus on Science and Treatment recommendations aim to balance the benefits of early resuscitation with the potential for harm to care providers during the COVID-19 pandemic. Chest compressions and cardiopulmonary resuscitation have the potential to generate aerosols. During the current COVID-19 pandemic lay rescuers should consider compressions and public-access defibrillation. Lay rescuers who are willing, trained and able to do so, should consider providing rescue breaths to infants and children in addition to chest compressions. Healthcare professionals should use personal protective equipment for aerosol generating procedures during resuscitation and may consider defibrillation before donning personal protective equipment for aerosol generating procedures.

Temporal Trends in the Incidence, Characteristics, and Outcomes of Hanging-Related Out-of-Hospital Cardiac Arrest.

Aim: The aim of this study was to describe temporal trends in the incidence, characteristics, and outcomes of hanging-related out-of-hospital cardiac arrest (OHCA). Method: A retrospective study of all hanging-related OHCA in Victoria, Australia, between 2000 and 2017 was conducted. Trends in incidence, characteristics, and outcomes were assessed using linear regression and a non-parametric test for trend, as appropriate. Predictors of survival to hospital discharge were identified using multivariable logistic regression. Results: Between 2000 and 2017, emergency medical services (EMS)-attended 3,891 cases of hanging-related OHCA, of which 876 cases (23%) received an attempted resuscitation. The overall incidence rate of EMS-attended cases was 3.8 cases per 100,000 person-years increasing from 2.3 cases per 100,000 person-years in 2000 to 4.7 cases in 2017 (p for trend <0.001). Incidence rates increased approximately two-fold in young adults (18-44 years) and three-fold in middle aged adults (45-64 years). Despite improvement in the rate of bystander cardiopulmonary resuscitation (from 49% in 2000-2005 to 75% in 2012-2017), the survival to hospital discharge rate remained unchanged (3% overall). Among adult survivors with 12-month follow-up (n = 10), five patients responded to telephone interviews. Of those, three (60%) reported severe functional disability. Five patients responded to telephone interviews, of which 3 patients reported severe functional disability. An initial shockable rhythm (OR 23.17, 95% CI: 5.75, 93.36) or pulseless electrical activity (OR 13.14, 95% CI: 4.79, 36.03) were associated with survival. Conclusion: The incidence of hanging-related OHCA doubled over the 18 year period with no change to survival rates. New preventative strategies are needed to reduce the community burden of these events.

Benefits of adding a physician-staffed ambulance to bystander-witnessed out-of-hospital cardiac arrest: a community-based, observational study in Niigata, Japan.

OBJECTIVE: This study aimed to assess the benefits of adding a physician-staffed ambulance to bystander-witnessed out-of-hospital cardiac arrest using a community-based registry. DESIGN: Population-based, retrospective cohort study. SETTING: An urban city with approximately 800 000 residents. PARTICIPANTS: Patients aged ≥18 years with bystander-witnessed out-of-hospital cardiac arrests of medical aetiology in Niigata City, Japan, between January 2012 and December 2016, according to the Utstein style. PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome was 1-month survival with a favourable neurological outcome, defined as a cerebral performance category score of 1 or 2. We used logistic regression analysis to assess the association between favourable neurological outcome and prehospital physician involvement. RESULTS: During the study period, a total of 4172 cardiac arrests were registered; of these, 892 patients with out-of-hospital cardiac arrest were eligible for this analysis, among whom 135 (15.1%) had prehospital physician involvement and 757 (84.9%) did not have prehospital physician involvement. The percentage of favourable neurological outcomes was 20.7% (28 of 135) in those with physician involvement and 10.4% (79 of 757) in those without physician involvement (p=0.001). Using multivariable logistic regression, prehospital physician involvement had an OR for a favourable neurological outcome of 3.44 (95% CI 1.64 to 7.23). CONCLUSIONS: Among adults with out-of-hospital cardiac arrest, adding a physician-staffed ambulance was associated with significantly greater favourable neurological outcomes than standard emergency medical services.

Use of Mechanical Cardiopulmonary Resuscitation Devices for Out-of-Hospital Cardiac Arrest, 2010-2016.

Importance: Out-of-hospital cardiac arrest is a common scenario facing prehospital emergency medical services (EMS) professionals and nearly always involves either manual or mechanical cardiopulmonary resuscitation (CPR). Mechanical CPR devices are expensive and prior clinical trials have not provided evidence of benefit for patients when compared with manual CPR. Objectives: To investigate the use of mechanical CPR in the prehospital setting and determine whether patient demographic characteristics or geographical location is associated with its use. Design, Setting, and Participants: A retrospective cross-sectional study was performed using the 2010 through 2016 National Emergency Medical Services Information System data. Participants included all patients identified by EMS professionals as having out-of-hospital cardiac arrest. Main Outcomes and Measures: Use of CPR, categorized as manual or mechanical. Results: From 2010 to 2016, 892 022 patients (38.6% female, 60.4% male, missing for 1%; mean [SD] age, 61.1 [20.5] years) with out-of-hospital cardiac arrest were identified by EMS professionals. Overall, manual CPR was used for 618 171 patients (69.3%) and mechanical CPR was used for 45 493 patients (5.1%). The risk-standardized rate of mechanical CPR use, accounting for patient demographic and geographical characteristics, rose from 1.9% in 2010 to 8.0% in 2016 (P < .001). In multivariable analyses, use of mechanical CPR devices was increasingly likely over time among patients identified with out-of-hospital cardiac arrest treated by EMS professionals, increasing from an adjusted odds ratio of 1.58 (95% CI, 1.42-1.77; P < .001) when comparing 2011 with 2010, to an adjusted odds ratio of 11.32 (95% CI, 10.22-12.54; P < .001) when comparing 2016 with 2010. In addition, several other patient demographic and geographical characteristics were associated with a higher likelihood of receiving mechanical CPR, including being 65 years or older, being male, being Hispanic, as well as receiving treatment in the Northeast Census Region, in a suburban location, or in a zip code with a median annual income greater than $20 000. Conclusions and Relevance: Mechanical CPR device use increased more than 4-fold among patients with out-of-hospital cardiac arrest treated by EMS professionals. Given the high costs of mechanical CPR devices, better evidence is needed to determine whether these devices improve clinically meaningful outcomes for patients treated for out-of-hospital cardiac arrest by prehospital EMS professionals to justify the significant increase in their use.

Public perception towards bystander cardiopulmonary resuscitation.

OBJECTIVE: Bystander cardiopulmonary resuscitation (CPR) after out-of-hospital cardiac arrest (OHCA) improves survival and neurological outcomes. Nonetheless, many OHCA patients do not receive bystander CPR during a witnessed arrest. Our aim was to identify potential barriers to bystander CPR. METHODS: Participants at CPR training events conducted in the USA between February and May 2018 answered a 14-question survey prior to training. Respondents were asked about their overall comfort level performing CPR, and about potential concerns specific to performing CPR on a middle-aged female, a geriatric male, and male and female adolescent patients. Open-ended responses were analysed qualitatively by categorising responses into themes. RESULTS: Of the 677 participants, 582 (86.0%) completed the survey, with 509 (88.1%) between 18 and 29 years of age, 341 (58.6%) without prior CPR training and 556 (96.0%) without prior CPR experience. Across all four scenarios of patients in cardiac arrest, less than 65% of respondents reported that they would be 'Extremely Likely' (20.6%-29.1%) or 'Moderately Likely' (26.9%-34.8%) to initiate CPR. The leading concerns were 'causing injury to patient' for geriatric (n=193, 63.1%), female (n=51, 20.5%) and adolescent (n=148, 50.9%) patients. Lack of appropriate skills was the second leading concern when the victim was a geriatric (n=41, 13.4%) or adolescent (n=68, 23.4%) patient, whereas for female patients, 35 (14.1%) were concerned about exposing the patient or the patient's breasts interfering with performance of CPR and 15 (6.0%) were concerned about being accused of sexual assault. Significant differences were observed in race, ethnicity and age regarding the likelihood of starting to perform CPR on female and adolescent patients. CONCLUSIONS: Participants at CPR training events have multiple concerns and fears related to performing bystander CPR. Causing additional harm and lack of skills were among the leading reservations reported. These findings should be considered for improved CPR training and public education.