FirstCPR: A pragmatic community organisation-based cluster randomised trial to increase community training and preparedness to respond to out-of-hospital cardiac arrest

Background: Bystander cardiopulmonary resuscitation (CPR) and defibrillation improve out-of-hospital cardiac arrest survival. However, basic life support (BLS) skills are low. Aim: The FirstCPR cluster randomised controlled trial aimed to test the effectiveness of a community organisation-targeted BLS education and training approach. Methods: Clusters (community organisations with 50+ members) were randomly allocated to intervention (12-month period of opportunities to access BLS education and training) or control (no intervention). Outcomes were assessed via surveys at 12 months and pre-specified analysis involved hierarchical mixed-models. Results: Of 165 randomised clusters (82 intervention), 58% were sports and 42% were social/faith-based. Most of the intervention clusters (74/82) participated in at least one intervention activity (15 in all activities). Factors such as the COVID-19 pandemic and organisation support impacted intervention uptake. Overall 924 members, across 93 clusters (407 from 57 intervention clusters; 517 from 36 control clusters), completed surveys. At 12-months, intervention organisation surveyed members reported higher rates of: being trained and willing to perform CPR on a stranger (primary outcome: 63.8% vs 46.9 %; Adjusted Odds Ratio (AOR) 2.22, 95% confidence interval (CI):1.50–3.30), confidence to use an automated external defibrillator (AED) (48.4% vs 26.4%; AOR:3.23, 95%CI:2.22–4.71) and willingness to use AEDs on a stranger (73.9% vs 62.9%; AOR:1.84, 95%CI:1.22–2.80). Conclusions: The results should be interpreted cautiously as the survey response rates were very low. However, survey respondents showed desired outcomes and key learnings for future research were gained.