A multi-faceted intervention strategy for treating adults with out-of-hospital cardiac arrest that involved enhanced community and EMS education and training did not result in a greater percentage of patients surviving to hospital discharge with a favorable neurologic outcome vs. usual care, based on findings from RACE-CARS presented at AHA 2026 and simultaneously published in NEJM.

Researchers analyzed data from approximately 20,000 patients across 60 counties in North Carolina who experienced out-of-hospital cardiac arrest over a five-year period. Roughly half of patients were in communities that received free educational interventions, including community CPR and AED training and improved instruction for EMS responders, including 911 telecommunicators, on how to recognize cardiac arrest and communicate CPR guidance to bystanders. The other half of patients were in communities that did not receive additional training.

Overall, the percentage of patients who survived and left the hospital with favorable brain function was similar across both groups (9% in the community/EMS intervention group and 9.4% in the non-intervention group).

Researchers noted, however, that slightly more bystanders performed CPR in communities that received the educational intervention (44.8%) compared with communities that did not (42.3%). During the last year of the study, people who experienced out-of-hospital cardiac arrest in communities that were part of the program had 33% higher odds of receiving CPR from a bystander than those in communities that were not.

“The increase in bystander CPR toward the end of the study shows there was some effect and suggests that a sustained community outreach may be needed to show an improvement in survival,” said Christopher B. Granger, MD, FACC. “We have established an efficient, high-quality clinical trial network to continue this work.”

In presenting the findings, Carolina Malta Hansen, MD, PhD, called RACE-CARS an ambitious effort to improve cardiac arrest outcomes across entire communities, including rural areas where emergency care often relies on volunteer-first responders.

“Changing how an entire community responds to cardiac arrest takes time, and our findings show just how challenging that can be,” she said. “In the meantime, the message to the public remains simple: learn CPR, recognize the signs of cardiac arrest, call 9-1-1 immediately and follow the dispatcher’s instructions. Everyone has the potential to save a life.”

Clinical Topics: Arrhythmias and Clinical EP, SCD/Ventricular Arrhythmias

Keywords: AHA Annual Scientific Sessions, AHA26, Out-of-Hospital Cardiac Arrest, Emergency Responders, Emergency Medical Services, Brain