A retrospective before-and-after study evaluated pit-crew CPR training across 27 EMS agencies in 1,917 adults with non-traumatic out-of-hospital cardiac arrest. In interrupted time series analysis, survival to discharge with good neurological function increased gradually after implementation (adjusted odds ratio 1.20 per four-month interval; 95% confidence interval 1.01–1.44). Sustained return of spontaneous circulation increased at intervention onset (adjusted odds ratio 1.41; 95% confidence interval 1.1–1.81). Overall survival to hospital discharge showed no change before, at, or after implementation, distinguishing the neurological outcome association from the absence of an observed overall survival improvement.
The training initiative was associated with gradually improving neurologically intact survival, but not improved overall discharge survival. The observational design does not establish that training caused these changes.
Study limitation: The retrospective before-and-after design remains vulnerable to confounding and concurrent changes in resuscitation care despite statistical adjustment.
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