Survival and Neurologic Performance at 30 Days and Beyond Following Out-of-Hospital Cardiac Arrest Comparing Standard Cardiopulmonary Resuscitation Versus Chest Compression–Only Resuscitation by Bystanders: A Systematic Review and Meta-Analysis

Introduction Out-of-hospital cardiac arrest is a global health concern, in which bystanders' ability and willingness to perform cardiopulmonary resuscitation determine the survival and neurologic performance of patients. This study aimed to synthesize the available evidence that compares the effects of standard cardiopulmonary resuscitation with chest compression–only cardiopulmonary resuscitation provided by bystanders in terms of survival and neurologic performance at 1 month or later after out-of-hospital cardiac arrest. Methods This systematic review with meta-analysis adhered to recognized reporting guidelines. The search strategy was performed in the MEDLINE, Embase, Cochrane Library, and Web of Science databases from inception to February 2025. The DerSimonian and Laird method was used to calculate odds ratios with 95% CIs. Standard cardiopulmonary resuscitation was considered the intervention group, and compression–only cardiopulmonary resuscitation was considered the control group. The risk of bias was assessed using the Newcastle‒Ottawa quality assessment scale. Egger's test and funnel plot symmetry were used to assess publication bias. Results Six cohort studies were included. A comparison of standard cardiopulmonary resuscitation and compression–only cardiopulmonary resuscitation performed by bystanders revealed that standard cardiopulmonary resuscitation improved survival at and beyond 30 days after out-of-hospital cardiac arrest (odds ratio, 1.22; 95% CI, 1.00-1.43; I 2 = 90.9%; P ≤.05). However, no significant differences were found in terms of favorable neurologic performance (odds ratio, 1.22; 95% CI, 0.96-1.48; I 2 = 78.7%; P ≤.05). Discussion Compared with compression–only cardiopulmonary resuscitation, bystander-provided standard cardiopulmonary resuscitation may increase survival after out-of-hospital cardiac arrest, with a positive (albeit nonsignificant) trend toward better neurologic performance. However, there are not enough studies with randomized controlled designs and longer follow-up periods to establish robust recommendations.