A multifaceted intervention to increase bystander CPR rates after out-of-hospital cardiac arrest in France: a stepped-wedge, cluster-randomised, controlled trial

Bystander cardiopulmonary resuscitation (CPR) is a key determinant of survival after out-of-hospital cardiac arrest (OHCA), but rates remain suboptimal worldwide.

By Debaty, Ribes, Ray +19The Lancet. Public healthNov 1, 2026

Score█████░░░░░5.4

Key numbers

95% CI 1.09-2.19

VerdictA leading story on any desk.

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Abstract

Background Bystander cardiopulmonary resuscitation (CPR) is a key determinant of survival after out-of-hospital cardiac arrest (OHCA), but rates remain suboptimal worldwide. We evaluated whether a multifaceted intervention targeting emergency dispatch systems and community response could increase bystander-initiated CPR before emergency medical service (EMS) arrival. Methods We conducted a stepped-wedge, cluster-randomised trial in 15 French EMS agencies. The intervention combined dispatcher training for early recognition of cardiac arrest and telephone-assisted CPR, activation of trained volunteers through a geolocation smartphone application, and structured audit and feedback provided to EMS agencies. Consecutive adults (≥18 years) with non-traumatic OHCA were included. Randomisation was stratified by tercile of OHCA volume managed by each EMS in 2015. The intervention was implemented during a 1-month transition period before the intervention period at each EMS centre. A dedicated protocol guided dispatchers to identify cardiac arrest from unresponsiveness and abnormal breathing, then gave scripted compression-only instructions and activated volunteers, targeting recognition within 60 s of call pick-up and first compression within a further 60 s. The primary outcome was bystander-initiated CPR before EMS arrival. The trial was prospectively registered on ClinicalTrials.gov (NCT03633370) and is completed. Findings Of the 15 EMS agencies initially randomised, two withdrew before recruitment began and were replaced, and one enrolled no patients. Therefore, between Aug 27, 2018, and Feb 20, 2022, 14 EMS agencies recruited a total of 2160 patients. The intention-to-treat analysis included 1684 patients (686 control, 998 intervention) enrolled across the 12 originally randomised EMS agencies. The mean age for all patients included in the intention-to-treat analysis was 67 years (SD 15), and 1205 (71·6%) were male. Bystander-initiated CPR before EMS arrival occurred in 421 (61·4%) patients in the control group and 708 (70·9%) patients in the intervention group (adjusted odds ratio [OR] 1·54 [95% CI 1·09-2·19]; p=0·017). Estimates were consistent across six prespecified sensitivity analyses (OR range, 1·38-1·55), remaining significant in four, but not after adjustment for cluster-specific secular trends (1·38 [0·98-1·94]) or baseline characteristics (1·39 [0·97-1·98]). No intervention-related adverse events were reported. Interpretation A multifaceted intervention was associated with increased bystander-initiated CPR after OHCA, although the estimate was sensitive to the modelling of secular trends, and it did not translate into improved clinical outcomes. These findings support further investigation of coordinated community-based strategies to strengthen the early links in the chain of survival at a population level. Funding Direction Générale de l'Offre de Soins.

Guillaume Debaty, Simon Ribes, Patrick Ray, Tahar Chouihed, Nicolas Desseigne, Pascal Usseglio, Patrice Serre, Catherine Pradeau, Vincent Bounes, Thierry Roupioz, Anne-Sophie Lucas, Didier Giolito, Claude Zamour, Christophe Boyer, Hervé Hubert, Dominique Savary, Karim Tazarourte, Yonathan Freund, Samuel I Watson, Karla Hemming, Lionel Lamhaut, José Labarère

The editor's rubric

Heuristic review

Leverage2 / 5: Reusable within one subfield (a technique, dataset, or protocol a few groups will adopt).; 10% of this desk’s rubric
Magnitude3 / 5: Large gain: roughly 2x, or a clear new state of the art on a hard, unsaturated problem.; 20% of this desk’s rubric
Evidence5 / 5: Definitive: phase 3 randomized evidence on hard endpoints, multi-lab replication, or community verification at scale.; 32% of this desk’s rubric
Novelty3 / 5: A genuinely new approach to an open problem.; 8% of this desk’s rubric
Trajectory2 / 5: Some room to improve with obvious engineering.; 5% of this desk’s rubric
Stakes3 / 5: Meaningful benefit to many people within a few years.; 25% of this desk’s rubric

Dimension	Level	Weight	What that level means
Leverage	██░░░2/5	10%	Reusable within one subfield (a technique, dataset, or protocol a few groups will adopt).
Magnitude	███░░3/5	20%	Large gain: roughly 2x, or a clear new state of the art on a hard, unsaturated problem.
Evidence	█████5/5	32%	Definitive: phase 3 randomized evidence on hard endpoints, multi-lab replication, or community verification at scale.
Novelty	███░░3/5	8%	A genuinely new approach to an open problem.
Trajectory	██░░░2/5	5%	Some room to improve with obvious engineering.
Stakes	███░░3/5	25%	Meaningful benefit to many people within a few years.

Editor’s rationale

Heuristic triage from title and abstract text only, not a reading of the paper. Cues found: gains (efficacy); novelty (open problem); design (randomized, placebo-controlled, registered); verification (confidence interval, p-value); stakes (global scale, mortality).

How the score was computed

rank-2026-10-18

Score█████░░░░░5.4

Score = 10 × (80% × adjusted merit / 10 + 10% × attention + 10% × freshness)

Desks place stronger verdicts first, then use this score to order work within the same verdict.

Merit: 7.0 / 10; Weighted rubric, evidence-gated.
Adjusted merit: 5.4 / 10; Shrunk toward the desk prior by editor confidence (48%).
Attention: 4%; Citations, upvotes, points, mentions.
Freshness: 98%; Half-life decay since publication.

Citations1 (reference 20, via semantic-scholar, Nov 1, 2026, 06:17 UTC)

The record

Reviewed by heuristic-v10 on Nov 1, 2026, 06:17 UTC. Paper type: clinical.
Categories: Multicenter Study, Randomized Controlled Trial, Journal Article, Humans, Cardiopulmonary Resuscitation, Cluster Analysis, Adult, Aged, Middle Aged, Emergency Medical Services
TOP, No.1 in the Front page edition of November 1, 2026.
TOP, No.1 in the Medicine edition of November 1, 2026.