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Elderly out-of-hospital cardiac arrest has worse outcomes with a family bystander than a non-family bystander

Manabu Akahane1*, Seizan Tanabe2, Soichi Koike3, Toshio Ogawa1, Hiromasa Horiguchi4, Hideo Yasunaga4 and Tomoaki Imamura1

Author Affiliations

1 Department of Public Health, Health Management and Policy, Nara Medical University School of Medicine, 840 Shijo-cho, Kashihara, Nara, 634-8521, Japan

2 Foundation for Ambulance Service Development, Emergency Life-Saving Technique Academy of Tokyo, Tokyo, Japan

3 Department of Planning, Information and Management, The University of Tokyo Hospital, Tokyo, Japan

4 Department of Health Management and Policy, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan

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International Journal of Emergency Medicine 2012, 5:41  doi:10.1186/1865-1380-5-41

Published: 9 November 2012



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.


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.


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).


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.

Out-of-hospital cardiac arrest; Elderly; Bystander cardiopulmonary resuscitation; Bystander type; Survival rate