A comprehensive programme of community CPR and defibrillator training, dispatcher coaching and first responder education did not improve survival after out-of-hospital cardiac arrest, according to the RACE-CARS trial presented at the American Heart Association Scientific Sessions on November 8 and published the same day in the New England Journal of Medicine. Survival to hospital discharge with favourable neurologic function was 9.0 percent in counties assigned to the intervention and 9.4 percent in counties continuing usual care.
The trial randomised 60 North Carolina counties, home to about 8.5 million people, starting in 2021. Roughly 20,000 adults who suffered an out-of-hospital cardiac arrest over five years were analysed, 11,615 of them in intervention counties and 10,844 in control counties by STAT’s count of the presentation. The intervention trained 911 dispatchers to recognise cardiac arrest faster and talk bystanders through CPR, alongside community-wide CPR and AED education and added training for emergency responders.
The process measures moved only slightly. Bystander CPR was performed in 44.8 percent of arrests in intervention communities against 42.3 percent in control communities over the full study period. In the final year, however, patients in intervention counties had 33 percent higher odds of receiving bystander CPR, an exploratory finding the investigators read as evidence that the training component works but takes years to register.
Lead author Carolina Malta Hansen pointed to Denmark as the contrast case. There, the share of the population trained in CPR climbed from about 20 percent in the early 2000s to about 80 percent, bystander defibrillation runs at 11 percent against 2 percent in the United States, and survival is about 16 percent against about 10 percent. The North Carolina programme trained almost 5 percent of the population, the point at which a difference in CPR delivery began to appear.
The result is a dosing finding as much as a negative one. A five year intervention across whole counties, the largest randomised test of its kind, did not reach the population penetration that the Danish experience suggests is required. For public health funders, the implication is that short, campaign-style training drives are unlikely to move survival, and that the returns sit in sustained, near-universal training of the kind built into schools and licensing over decades.