The Psychological Impact of Attending Out-of-Hospital Cardiac Arrest in Volunteer Lay Responders: A Mixed-Methods Systematic Review.

Abstract

OBJECTIVES: The objective of this study was to explore and describe the incidence of psychological impact, including post-traumatic stress-type symptoms, in volunteer lay responders following involvement with out-of-hospital cardiac arrest, and to identify factors influencing these outcomes. METHODS: A convergent integrated mixed-methods systematic review was conducted (PROSPERO registration: CRD42023467307). APA PsycInfo, CINAHL (EBSCO), PubMed (Medline), and Web of Science were searched for studies published between January 2003 and October 2025. The Joanna Briggs Institute methodological approach guided study selection, quality appraisal, data extraction, and synthesis. RESULTS: Twelve studies involving 80,742 participants from seven countries were included. Five key areas were identified: risk and prevalence of psychological impact; lay responder characteristics; situational dynamics; social connectedness and a sense of community; and emotions experienced while awaiting activation. Most studies reported low levels of severe psychological impact and individual characteristics, situational factors, and community support influenced psychological outcomes. CONCLUSIONS: Severe psychological effects following out-of-hospital cardiac arrest were uncommon; however, lay responders may experience mild-to-moderate distress influenced by demographics, situational exposure, and social support. This review highlights modifiable factors-targeted training, clear role expectations, and structured post-event support-that can mitigate psychological burden. Strengthening these areas is critical for protecting lay responders, enhancing the resilience of volunteer programs, and sustaining the Chain of Survival. Source: Paul du Toit et al. Prehospital emergency care (2026). https://doi.org/10.1080/10903127.2026.2640607. Reproduced under CC BY-NC-ND 4.0: https://creativecommons.org/licenses/by-nc-nd/4.0/. Abstract wording unchanged; section-heading formatting adapted.