{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T21:17:16Z","timestamp":1791667036949,"version":"4.3.4"},"reference-count":32,"publisher":"American Medical Association (AMA)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"Importance<\/jats:title>The lack of evidence-based implementation strategies is a major contributor to increasing mortality due to out-of-hospital cardiac arrest (OHCA) in developing countries with limited resources.<\/jats:p><\/jats:sec>Objective<\/jats:title>To evaluate whether the implementation of legislation is associated with increased bystander cardiopulmonary resuscitation (CPR) and automated external defibrillator (AED) use and improved clinical outcomes for patients experiencing OHCA and to provide policy implications for low-income and middle-income settings.<\/jats:p><\/jats:sec>Design, Setting, and Participants<\/jats:title>This observational cohort study analyzed a prospective city registry of patients with bystander-witnessed OHCA between January 1, 2010, and December 31, 2022. The Emergency Medical Aid Act was implemented in Shenzhen, China, on October 1, 2018. An interrupted time-series analysis was used to assess changes in outcomes before and after the law. Data analysis was performed from May to October 2023.<\/jats:p><\/jats:sec>Exposure<\/jats:title>The Emergency Medical Aid Act stipulated the use of AEDs and CPR training for the public and provided clear legal guidance for OHCA rescuing.<\/jats:p><\/jats:sec>Main Outcomes and Measures<\/jats:title>The primary outcomes were rates of bystander-initiated CPR and use of AEDs. Secondary outcomes were rates of prehospital return of spontaneous circulation (ROSC), survival to arrival at the hospital, and survival at discharge.<\/jats:p><\/jats:sec>Results<\/jats:title>A total of 13\u202f751 patients with OHCA (median [IQR] age, 59 [43-76] years; 10\u202f011 men [72.83%]) were included, with 7858 OHCAs occurring during the prelegislation period (January 1, 2010, to September 30, 2018) and 5893 OHCAs occurring during the postlegislation period (October 1, 2018, to December 31, 2022). The rates of bystander-initiated CPR (320 patients [4.10%] vs 1103 patients [18.73%]) and AED use (214 patients [4.12%] vs 182 patients [5.29%]) increased significantly after legislation implementation vs rates before the legislation. Rates of prehospital ROSC (72 patients [0.92%] vs 425 patients [7.21%]), survival to arrival at the hospital (68 patients [0.87%] vs 321 patients [5.45%]), and survival at discharge (44 patients [0.56%] vs 165 patients [2.80%]) were significantly increased during the postlegislation period. Interrupted time-series models demonstrated a significant slope change in the rates of all outcomes.<\/jats:p><\/jats:sec>Conclusions and Relevance<\/jats:title>These findings suggest that implementation of the Emergency Medical Aid Act in China was associated with increased rates of CPR and public AED use and improved survival of patients with OHCA. The use of a systemwide approach to enact resuscitation initiatives and provide legal support may reduce the burden of OHCA in low-income and middle-income settings.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2024.7909","type":"journal-article","created":{"date-parts":[[2024,4,26]],"date-time":"2024-04-26T15:31:54Z","timestamp":1714145514000},"page":"e247909","source":"Crossref","is-referenced-by-count":51,"title":["Survival After Out-of-Hospital Cardiac Arrest Before and After Legislation for Bystander CPR"],"prefix":"10.1001","volume":"7","author":[{"given":"Siwen","family":"Li","sequence":"first","affiliation":[{"name":"Shenzhen Center for Prehospital Care, Futian District, Shenzhen, China"},{"name":"Department of Global Health, School of Public Health, Peking University, Beijing, China"},{"name":"Institute for Global Health and Development, Peking University, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chongzhen","family":"Qin","sequence":"additional","affiliation":[{"name":"Shenzhen Center for Prehospital Care, Futian District, Shenzhen, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hongjuan","family":"Zhang","sequence":"additional","affiliation":[{"name":"Shenzhen Center for Prehospital Care, Futian District, Shenzhen, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mailikezhati","family":"Maimaitiming","sequence":"additional","affiliation":[{"name":"Department of Global Health, School of Public Health, Peking University, Beijing, China"},{"name":"Institute for Global Health and Development, Peking University, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Junyi","family":"Shi","sequence":"additional","affiliation":[{"name":"Department of Global Health, School of Public Health, Peking University, Beijing, China"},{"name":"Institute for Global Health and Development, Peking University, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"YiKai","family":"Feng","sequence":"additional","affiliation":[{"name":"Department of Global Health, School of Public Health, Peking University, Beijing, China"},{"name":"Institute for Global Health and Development, Peking University, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kepei","family":"Huang","sequence":"additional","affiliation":[{"name":"Department of Global Health, School of Public Health, Peking University, Beijing, China"},{"name":"Institute for Global Health and Development, Peking University, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yanxin","family":"Bi","sequence":"additional","affiliation":[{"name":"Department of Global Health, School of Public Health, Peking University, Beijing, China"},{"name":"Institute for Global Health and Development, Peking University, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Minmin","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Global Health, School of Public Health, Peking University, Beijing, China"},{"name":"Institute for Global Health and Development, Peking University, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qiang","family":"Zhou","sequence":"additional","affiliation":[{"name":"Shenzhen Center for Prehospital Care, Futian District, Shenzhen, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yinzi","family":"Jin","sequence":"additional","affiliation":[{"name":"Department of Global Health, School of Public Health, Peking University, Beijing, China"},{"name":"Institute for Global Health and Development, Peking University, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhi-Jie","family":"Zheng","sequence":"additional","affiliation":[{"name":"Department of Global Health, School of Public Health, Peking University, Beijing, China"},{"name":"Institute for Global Health and Development, Peking University, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","published-online":{"date-parts":[[2024,4,26]]},"reference":[{"issue":"9","key":"zoi240294r1","doi-asserted-by":"publisher","first-page":"e139","DOI":"10.1161\/CIR.0000000000000757","article-title":"Heart disease and stroke statistics-2020 update: a report from the American Heart Association.","volume":"141","author":"Virani","year":"2020","journal-title":"Circulation"},{"issue":"12","key":"zoi240294r2","doi-asserted-by":"publisher","first-page":"e923","DOI":"10.1016\/S2468-2667(23)00173-1","article-title":"Incidence, process of care, and outcomes of out-of-hospital cardiac arrest in China: a prospective study of the BASIC-OHCA registry.","volume":"8","author":"Zheng","year":"2023","journal-title":"Lancet Public Health"},{"issue":"2","key":"zoi240294r3","doi-asserted-by":"publisher","first-page":"133","DOI":"10.1001\/jamapediatrics.2016.3643","article-title":"Association of bystander cardiopulmonary resuscitation with overall and neurologically favorable survival after pediatric out-of-hospital cardiac arrest in the United States: a report from the cardiac arrest registry to enhance survival surveillance registry.","volume":"171","author":"Naim","year":"2017","journal-title":"JAMA Pediatr"},{"issue":"7","key":"zoi240294r4","doi-asserted-by":"publisher","first-page":"637","DOI":"10.1056\/NEJMoa040566","article-title":"Public-access defibrillation and survival after out-of-hospital cardiac arrest.","volume":"351","author":"Hallstrom","year":"2004","journal-title":"N Engl J Med"},{"issue":"1","key":"zoi240294r5","doi-asserted-by":"publisher","first-page":"915","DOI":"10.1186\/s12889-020-09072-y","article-title":"The impact of cardiopulmonary resuscitation (CPR) training on schoolchildren and their CPR knowledge, attitudes toward CPR, and willingness to help others and to perform CPR: mixed methods research design.","volume":"20","author":"Pivac","year":"2020","journal-title":"BMC Public Health"},{"key":"zoi240294r6","doi-asserted-by":"publisher","first-page":"140","DOI":"10.1016\/j.ijcard.2019.07.061","article-title":"Public-access automated external defibrillator pad application and favorable neurological outcome after out-of-hospital cardiac arrest in public locations: a prospective population-based propensity score-matched study.","volume":"299","author":"Kishimori","year":"2020","journal-title":"Int J Cardiol"},{"issue":"5","key":"zoi240294r7","doi-asserted-by":"publisher","first-page":"488","DOI":"10.1056\/NEJMc1803218","article-title":"Mobile automated external defibrillator response system during road races.","volume":"379","author":"Kinoshi","year":"2018","journal-title":"N Engl J Med"},{"issue":"3","key":"zoi240294r8","doi-asserted-by":"publisher","first-page":"238","DOI":"10.1016\/j.jacc.2021.11.011","article-title":"Evolution of incidence, management, and outcomes over time in sports-related sudden cardiac arrest.","volume":"79","author":"Karam","year":"2022","journal-title":"J Am Coll Cardiol"},{"issue":"22","key":"zoi240294r9","doi-asserted-by":"publisher","first-page":"2159","DOI":"10.1161\/CIRCULATIONAHA.115.018175","article-title":"Regional variation in out-of-hospital cardiac arrest survival in the United States.","volume":"133","author":"Girotra","year":"2016","journal-title":"Circulation"},{"key":"zoi240294r10","doi-asserted-by":"publisher","first-page":"99","DOI":"10.1016\/j.resuscitation.2020.03.017","article-title":"Risk and ROSC: legal implications of bystander CPR.","volume":"151","author":"Murphy","year":"2020","journal-title":"Resuscitation"},{"issue":"9","key":"zoi240294r11","doi-asserted-by":"publisher","first-page":"1260","DOI":"10.1161\/CIRCULATIONAHA.106.172289","article-title":"Community lay rescuer automated external defibrillation programs: key state legislative components and implementation strategies: a summary of a decade of experience for healthcare providers, policymakers, legislators, employers, and community leaders from the American Heart Association Emergency Cardiovascular Care Committee, Council on Clinical Cardiology, and Office of State Advocacy.","volume":"113","author":"Aufderheide","year":"2006","journal-title":"Circulation"},{"issue":"17","key":"zoi240294r12","doi-asserted-by":"publisher","first-page":"2119","DOI":"10.1093\/eurheartj\/ehr178","article-title":"Consensus document regarding cardiovascular safety at sports arenas: position stand from the European Association of Cardiovascular Prevention and Rehabilitation (EACPR), section of Sports Cardiology.","volume":"32","author":"Borjesson","year":"2011","journal-title":"Eur Heart J"},{"issue":"11","key":"zoi240294r13","doi-asserted-by":"publisher","first-page":"994","DOI":"10.1056\/NEJMoa0906644","article-title":"Nationwide public-access defibrillation in Japan.","volume":"362","author":"Kitamura","year":"2010","journal-title":"N Engl J Med"},{"issue":"9","key":"zoi240294r14","doi-asserted-by":"publisher","first-page":"e1444","DOI":"10.1016\/S2214-109X(23)00302-9","article-title":"Cardiopulmonary resuscitation in low-resource settings: a statement by the International Liaison Committee on Resuscitation, supported by the AFEM, EUSEM, IFEM, and IFRC.","volume":"11","author":"Schnaubelt","year":"2023","journal-title":"Lancet Glob Health"},{"issue":"8","key":"zoi240294r15","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCOUTCOMES.118.004710","article-title":"Gender disparities among adult recipients of bystander cardiopulmonary resuscitation in the public.","volume":"11","author":"Blewer","year":"2018","journal-title":"Circ Cardiovasc Qual Outcomes"},{"issue":"3","key":"zoi240294r16","doi-asserted-by":"publisher","first-page":"309","DOI":"10.1093\/eurheartj\/ehy687","article-title":"Bystander cardiopulmonary resuscitation and long-term outcomes in out-of-hospital cardiac arrest according to location of arrest.","volume":"40","author":"Sondergaard","year":"2019","journal-title":"Eur Heart J"},{"issue":"21","key":"zoi240294r17","doi-asserted-by":"publisher","first-page":"2140","DOI":"10.1016\/j.jacc.2022.03.359","article-title":"Impact of state laws: CPR education in high schools.","volume":"79","author":"Vetter","year":"2022","journal-title":"J Am Coll Cardiol"},{"key":"zoi240294r18","doi-asserted-by":"publisher","first-page":"9","DOI":"10.1016\/j.resuscitation.2019.04.037","article-title":"Association of state-level CPR training initiatives with layperson CPR knowledge in the United States.","volume":"140","author":"Alexander","year":"2019","journal-title":"Resuscitation"},{"issue":"7","key":"zoi240294r19","doi-asserted-by":"publisher","first-page":"889","DOI":"10.1016\/j.resuscitation.2013.01.009","article-title":"Influence of nationwide policy on citizens\u2019 awareness and willingness to perform bystander cardiopulmonary resuscitation.","volume":"84","author":"Lee","year":"2013","journal-title":"Resuscitation"},{"issue":"2","key":"zoi240294r20","doi-asserted-by":"publisher","first-page":"572","DOI":"10.1016\/j.jfma.2018.07.018","article-title":"Public knowledge, attitudes and willingness regarding bystander cardiopulmonary resuscitation: a nationwide survey in Taiwan.","volume":"118","author":"Pei-Chuan Huang","year":"2019","journal-title":"J Formos Med Assoc"},{"issue":"2","key":"zoi240294r21","doi-asserted-by":"publisher","first-page":"80","DOI":"10.15441\/ceem.16.160","article-title":"Association between public cardiopulmonary resuscitation education and the willingness to perform bystander cardiopulmonary resuscitation: a metropolitan citywide survey.","volume":"4","author":"Son","year":"2017","journal-title":"Clin Exp Emerg Med"},{"key":"zoi240294r23","doi-asserted-by":"publisher","first-page":"112","DOI":"10.1016\/j.resuscitation.2021.01.040","article-title":"Use and coverage of automated external defibrillators according to location in out-of-hospital cardiac arrest.","volume":"162","author":"Sarkisian","year":"2021","journal-title":"Resuscitation"},{"issue":"5","key":"zoi240294r24","doi-asserted-by":"publisher","first-page":"507","DOI":"10.1001\/jamacardio.2017.0008","article-title":"Bystander defibrillation for out-of-hospital cardiac arrest in public vs residential locations.","volume":"2","author":"Hansen","year":"2017","journal-title":"JAMA Cardiol"},{"key":"zoi240294r25","doi-asserted-by":"publisher","DOI":"10.1016\/j.resuscitation.2023.110044","article-title":"Out-of-hospital cardiac arrest outcomes when law enforcement arrives before emergency medical services.","volume":"194","author":"Lupton","year":"2024","journal-title":"Resuscitation"},{"issue":"1","key":"zoi240294r26","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.115.002892","article-title":"Implementation of pit crew approach and cardiopulmonary resuscitation metrics for out-of-hospital cardiac arrest improves patient survival and neurological outcome.","volume":"5","author":"Hopkins","year":"2016","journal-title":"J Am Heart Assoc"},{"issue":"3","key":"zoi240294r27","doi-asserted-by":"publisher","first-page":"398","DOI":"10.1093\/europace\/euv218","article-title":"Better management of out-of-hospital cardiac arrest increases survival rate and improves neurological outcome in the Swiss Canton Ticino.","volume":"18","author":"Mauri","year":"2016","journal-title":"Europace"},{"key":"zoi240294r28","doi-asserted-by":"publisher","first-page":"48","DOI":"10.1016\/j.resuscitation.2015.03.017","article-title":"Cost-effectiveness of a national public access defibrillation programme.","volume":"91","author":"Moran","year":"2015","journal-title":"Resuscitation"},{"issue":"6","key":"zoi240294r29","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0233966","article-title":"The impact of a high-quality basic life support police-based first responder system on outcome after out-of-hospital cardiac arrest.","volume":"15","author":"Krammel","year":"2020","journal-title":"PLoS One"},{"issue":"12","key":"zoi240294r30","doi-asserted-by":"publisher","first-page":"795","DOI":"10.7326\/M15-2234","article-title":"Early coverage, access, utilization, and health effects associated with the Affordable Care Act Medicaid expansions: a quasi-experimental study.","volume":"164","author":"Wherry","year":"2016","journal-title":"Ann Intern Med"},{"issue":"6","key":"zoi240294r31","doi-asserted-by":"publisher","first-page":"738","DOI":"10.1016\/j.annemergmed.2021.04.039","article-title":"Policed patients: how the presence of law enforcement in the emergency department impacts medical care.","volume":"78","author":"Harada","year":"2021","journal-title":"Ann Emerg Med"},{"issue":"5","key":"zoi240294r32","doi-asserted-by":"publisher","first-page":"367","DOI":"10.1161\/CIRCULATIONAHA.123.066659","article-title":"Associations between end-tidal carbon dioxide during pediatric cardiopulmonary resuscitation, CPR quality, and survival.","volume":"149","author":"Morgan","year":"2024","journal-title":"Circulation"},{"key":"zoi240294r22","unstructured":"World Health Organization. A system-wide approach to analysing efficiency across health programmes. February 24, 2017. Accessed October 31, 2023. https:\/\/www.who.int\/publications\/i\/item\/9789241511964"}],"container-title":["JAMA Network Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/articlepdf\/2818105\/li_2024_oi_240294_1713460247.59409.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,4,26]],"date-time":"2024-04-26T15:31:58Z","timestamp":1714145518000},"score":1,"resource":{"primary":{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/fullarticle\/2818105"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,4,26]]},"references-count":32,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2024,4,1]]}},"URL":"https:\/\/doi.org\/10.1001\/jamanetworkopen.2024.7909","relation":{},"ISSN":["2574-3805"],"issn-type":[{"value":"2574-3805","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,4,26]]}}}