b'CARES 2022 Annual ReportIn summary, we found that Black and Hispanic patients have lower rates of bystander CPR than White patients with OHCA. Compared with White patients, Black and Hispanic patients had 17% lower odds of receiving bystander CPR for arrests at home and 24% lower odds of bystander CPR for arrests in public. These differences were present across all types of neighborhoods, including majority Black/Hispanic communities and low-income communities. Our findings suggest that multifaceted public health interventions that go beyond CPR training may be needed to reduce racial/ethnic differences in bystander CPR. Several factors could explain lower bystander CPR rates among Black/Hispanic patients at home. CPR training is less commonly conducted in Black and Hispanic communities, and dispatcher-assisted bystander CPR may not be as available. These differences between neighborhoods may be due to unequal investments in CPR training and community infrastructure in these neighborhoods. Additional barriers such as cost of CPR training, a different language from dispatchers, immigration status concerns, and/or untrustworthy institutions (e.g., police) could contribute to lower bystander CPR rates within neighborhoods for Black/Hispanic patients with OHCAs at home. Racial/ethnic differences in bystander CPR in public locations raise additional concerns about implicit and explicit biases in layperson response. In contrast to a home location, bystanders may not know the victim in public. Implicit bias may deter bystander response for a Black or Hispanic vs. a White cardiac arrest victim. If present, this was not confined to predominantly White communities, as we found racial/ethnic differences in bystander CPR rates in Black/Hispanic and low-income communities. Additionally, explicit bias may contribute to differences in bystander CPR for public arrests, especially at recreational facilities and public transportation centers (e.g., airports and bus terminals), where bystanders were likely strangers.Our study therefore suggests that multifaceted public health interventions will be needed to reduce racial/ethnic differences in bystander CPR as issues of explicit and implicit bias may influence whether a Black/Hispanic vs. White patient with OHCA receive potentially life-saving CPR from a layperson bystander.Eligibility of OHCA patients for extracorporeal cardiopulmonary resuscitation in the United States: A geographic information system modelBy Adam L. Gottula, MD, Fellow Physician, Emergency Medicine and Anesthesia Critical Care, Michigan MedicineCindy H. Hsu, MD, PhD, Assistant Professor, Emergency Medicine and Surgery, Michigan MedicineJustin L. Benoit, MD, MS, Associate Professor, Emergency Medicine, University of Cincinnati College of Medicine Despite many recent advances, the survival rate for out-of-hospital cardiac arrest (OHCA) patients in the United States (U.S.) remains low. OHCA treated by emergency medical services (EMS) in the U.S. has a neurologically intact survival to hospital discharge rate of 7.2% with substantial regional variation. The low survival rate of OHCA prompted development of advanced therapies including extracorporeal cardiopulmonary resuscitation (ECPR). In some studies, ECPR has been shown to improve outcomes up to 55% in select patients suffering refractory OHCA. However, ECPR has only demonstrated improved outcomes in select patients, is technically challenging, and only available at select healthcare facilities, thereby limiting its accessibility and feasibility. A strength of the Cardiac Arrest Registry to Enhance Survival (CARES) registry is that it includes clinical characteristics often used to determine ECPR eligibility and the location of the OHCA. We constructed a novel Geographic Information System (GIS) model to estimate the location and number of ECPR candidates in the U.S. using the CARES registry. We additionally determined the time dependent rates of prehospital return of spontaneous circulation (ROSC) in this select population using the Resuscitation Outcomes Consortium Prehospital Resuscitation using an IMpedance valve and Early versus Delayed Analysis (ROC-PRIMED) database.Our team evaluated 588,203 patients for ECPR eligibility from the CARES registry from 20132020. Patients were considered clinically eligible for ECPR if they met the following prehospital criteria: (1) age 65 years old; (2) initial rhythm of ventricular fibrillation (VF) or pulseless ventricular tachycardia (VT); (3) witnessed cardiac arrest; (4) received bystander CPR; (5) a presumed cardiac etiology of arrest; and (6) no ROSC upon arrival to the hospital. In addition to clinical criteria, we applied a GIS model to the CARES registry to model ECPR eligibility based on transportation time to predetermined healthcare centers with the ability to perform ECPR (ECMO-ready centers; with 78.7% of these hospitals reporting adult ECPR). This allowed us to utilize the CARES registry to determine the total volume of OHCA patients that fulfilled ECPR eligibility criteria and met prespecified transportation times to predefined centers. Patients otherwise clinically eligible for ECPR may achieve ROSC prior to hospital arrival, as several cardiac arrest variables for ECPR eligibility are also associated with higher likelihood of prehospital ROSC. We used the ROC-PRIMED database to model the time-dependent rates of prehospital ROSC and applied the model to patients determined to be ECPR eligible from the CARES registry. 24'