Cardiac arrests occurring at home, in patients over 80, in female patients, in non-medical events, and in urban settings were associated with a lower likelihood of bystanders performing chest compressions, while emergency service arrival within 15 minutes increased the probability of receiving chest compressions.
Only a minority of cardiac arrest events managed by lay bystanders received resuscitation maneuvers.
Cardiac arrests occurring at home were associated with a substantially lower likelihood of bystanders performing chest compressions.
Patients over 80 years old were associated with a markedly lower likelihood of receiving bystander chest compressions.
Female patients were less likely to receive bystander chest compressions compared to male patients.
Non-medical events were associated with a lower likelihood of bystanders performing chest compressions.
Urban settings were associated with a lower likelihood of bystanders performing chest compressions.
Emergency medical service arrival within 15 minutes was associated with an increased probability of the patient receiving chest compressions.
The authors recommend specific communication training for dispatch centers and targeted revision of BLS-D educational materials based on identified predictors.
This research analyzed over 12,000 out-of-hospital cardiac arrest cases in the Lombardy region of Italy over one year to understand why bystanders often skip performing CPR (cardiopulmonary resuscitation) when someone collapses. Of those cases where ordinary people (not medical professionals) were present, the study used statistical modeling to identify which situations made it more or less likely that a bystander would actually start chest compressions before emergency services arrived. The study found several factors that made bystanders less likely to perform CPR: the cardiac arrest happened at home, the patient was older than 80 years, the patient was female, the event occurred in an urban area, or the event was classified as non-medical. Conversely, when emergency services arrived within 15 minutes, bystanders were somewhat more likely to have performed chest compressions — possibly because dispatcher instructions prompted action. The gaps related to patient age and sex were highlighted as especially concerning, since survival from cardiac arrest is strongly linked to receiving immediate CPR regardless of who the patient is. This research suggests that training programs (BLS-D courses) and emergency dispatch protocols may need to be updated to specifically address these disparities. For example, dispatchers could be trained to recognize when a caller may be hesitant to perform CPR on an elderly person or a woman, and provide more targeted guidance. The findings point to the need for better communication strategies during the critical minutes before ambulances arrive, and the authors call for further research into how these conversations can be improved to save more lives.
Stirparo G, Ticozzi E, Merigo G, Magliocca A, Bodina A, Marconi G, et al.. (2026). When Bystanders Skip CPR: Insights from a Retrospective Study.. Medicina (Kaunas, Lithuania). https://doi.org/10.3390/medicina62081524