April 01, 2019
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Out-of-hospital cardiac arrest survival rates doubled with bystander CPR

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Bystander-performed CPR for out-of-hospital cardiac arrest incidents before the arrival of emergency personnel doubled the survival rate compared with no CPR, according to findings published in Circulation.

In addition, both standard CPR, which includes rescue breaths and chest compressions, and compression-only CPR were associated with better survival rates than no CPR, although standard CPR was slightly more effective than compression-only CPR.

Gabriel Riva, MD, and colleagues sought to describe changes in the rate and type of CPR performed before the arrival of emergency medical services (EMS) during three consecutive guideline periods in correlation to 30-day survival.

“This is important since CPR performed by bystanders before emergency services arrival is one of the most important factors for surviving an out-of-hospital cardiac arrest,” Riva, a PhD student at Karolinska Institutet in Sweden, said in a press release. “Thus, increasing CPR rates by simplifying the CPR algorithm for bystanders can increase overall survival.”

The researchers analyzed data of all reported bystander-witnessed out-of-hospital cardiac arrests from a Swedish register for CPR between 2000 and 2017. Patients (n = 30,445) were categorized as receivers of no CPR, standard CPR or compression-only CPR before EMS arrival.

Riva and colleagues established guideline periods from 2000 to 2005, 2006 to 2010 and 2011 to 2017 for comparisons over time.

The primary outcome was 30-day survival.

Patients receiving CPR before EMS arrival increased in each of the three time periods (2000-2005, 40.8%; 2006-2010, 58.8%; 2011-2017, 68.2%), Riva and colleagues reported.

Standard CPR was higher in the 2006 to 2010 time period (44.8%) compared with 2000 to 2005 (35.4%) and 2011 to 2017 (38.1%).

Chest compression-only CPR increased over time (earliest period, 5.4%; middle period, 14%; latest period, 30.1%), the researchers wrote.

Bystander-performed CPR for out-of-hospital cardiac arrest incidents before the arrival of emergency personnel doubled the survival rate compared with no CPR, according to findings published in Circulation.
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Thirty-day survival was lower in the no-CPR group during the three time periods (3.9% to 6% to 7.1%) compared with the standard CPR (9.4% to 12.5% to 16.2%) and chest compression-only groups (8% to 11.5% to 14.3%), Riva and colleagues wrote.

The 30-day survival adjusted OR for all time periods combined was higher in for standard CPR (aOR = 2.6; 95% CI, 2.4-2.9) and chest compression-only CPR (aOR = 2; 95% CI, 1.8-2.3) in comparison with the no CPR group, the researchers wrote.

Standard CPR was linked to better 30-day survival than chest compression-only CPR (aOR = 1.2; 95% CI, 1.1-1.4), Riva and colleagues wrote.

There was twofold higher rate of CPR before EMS arrival and a concomitant sixfold higher rate of a chest compression-only CPR over time, the researchers wrote.

“Bystanders have an important role in out-of-hospital cardiac arrest,” Riva said in the press release. “Their actions can be lifesaving.” – by Earl Holland Jr.

Disclosures: The authors report no relevant financial disclosures.