Recognition and Immediate Management of Cardiac Arrest: The Role of First Aid and CPR Challenges-An Updated Review

Background: Out-of-hospital cardiac arrest (OHCA) remains a major public health challenge. Survival depends on timely recognition, cardiopulmonary resuscitation (CPR), defibrillation, emergency response, and coordinated post-arrest care. Outcomes vary across populations and healthcare systems. Aim: This review examines evidence on OHCA epidemiology, recognition, prehospital management, individualized resuscitation, in-hospital treatment, and long-term recovery. Methods: Published evidence on cardiac arrest registries, sex-related disparities, dispatcher-assisted CPR, first-responder networks, public education, resuscitation strategies, and post-arrest management was synthesized. System-level barriers and emerging approaches to strengthen the chain of survival were also considered. Results: Registry data demonstrates variation in OHCA incidence, bystander CPR, AED use, and survival between regions. Dispatcher-assisted CPR, trained community responders, accessible AEDs, and public education can strengthen early links in the chain of survival. Women may receive bystander intervention less often, highlighting social and recognition barriers. For refractory ventricular fibrillation, vector-change and double-sequential external defibrillation show potential benefits, although further evidence is needed. In hospitals, temperature control and coronary assessment should reflect clinical presentation. Survivors with non-ischemic causes may require targeted evaluation, including cardiac imaging and genetic assessment. Fatigue, cognitive impairment, and psychological symptoms remain important determinants of functional recovery and quality of life. Conclusion: Improving OHCA outcomes requires an integrated approach linking community action, emergency medical services, individualized resuscitation, evidence-based hospital care, and rehabilitation. Standardized registries, equitable access, and continued research are essential. The review also identifies priorities for equitable implementation and future research.