BYSTANDER-LEVEL GAPS IN EMERGENCY CARDIAC CARE IN NIGERIA: EVIDENCE FROM A NARRATIVE REVIEW

Out-of-hospital cardiac arrest (OHCA) is a leading cause of preventable death, with survival dependent on rapid recognition, activation of emergency medical services, and bystander cardiopulmonary resuscitation (CPR). In Nigeria, deficiencies in prehospital emergency care increase reliance on lay responders, yet the bystander-response gap remains poorly characterized. This review synthesized available evidence on bystander response in Nigeria and identified barriers and evidence-based strategies to strengthen community response to time-critical emergencies.

We conducted a targeted narrative review of peer-reviewed literature published between 2005 and 2026, including Nigerian and sub-Saharan African studies on OHCA and prehospital emergency care, alongside comparator registries (Danish Cardiac Arrest Registry and the US CARES Annual Report). Findings were synthesized within the Chain of Survival framework and interpreted alongside WHO emergency care guidance. RESULTS: Evidence demonstrated major deficiencies across the first three links of the Chain of Survival. Survival to hospital discharge following OHCA in a Nigerian tertiary cohort was 1.8%, while only 15.6% of public-place cardiac arrests received bystander CPR. Fewer than 2% of road traffic injury victims in Lagos received formal prehospital care. Key barriers included limited Basic Life Support training, inadequate public awareness, weak emergency medical services, and lack of legal protection for bystanders.

Strengthening community preparedness through Basic Life Support training, improved emergency medical services, and supportive legislation offers a feasible strategy to improve bystander response and survival from time-critical emergencies.