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 Cardiac arrest often proves fatal when it happens outside a hospital
because bystanders don’t know how to start chest compressions or use
an external defibrillator to keep the patient’s blood flowing to
vital organs until emergency responders reach the scene.
“Every minute counts; therefore, effective and prompt bystander CPR
is critical and (is) the first link after activating EMS by calling
911,” said lead study author Dr. Christopher Fordyce of Vancouver
General Hospital and the University of British Columbia in Canada.
For the study, researchers examined survival odds in North Carolina
after a statewide program was initiated in 2010 to train community
members, patients with heart disease and their families to do chest
compressions. Among other things, the program also trained school
staff to use automated external defibrillators (AEDs) and taught
emergency medical dispatchers how to instruct bystanders in
cardiopulmonary resuscitation (CPR)
Over five years, the proportion of patients receiving bystander CPR
climbed from 28 percent to 41 percent for home-based cardiac arrests
and from 61 percent to 72 percent for those that happened in public.
The proportion of patients receiving defibrillation at home also
increased from 42 percent to 51 percent.
At the same time, the proportion of people who had a cardiac arrest
at home and lived long enough to leave the hospital rose from 5.7
percent to 8.1 percent, while survival odds for a cardiac arrest in
public increased from 10.8 percent to 16.2 percent.
The North Carolina project was funded by $2.5 million over five
years from the Medtronic Foundation, Fordyce said by email.
“I would say that at $500,000 a year this is fairly cost-effective
for a statewide initiative that improved care processes and saved
lives,” Fordyce said.
Cardiac arrest involves the abrupt loss of heart function, breathing
and consciousness. Unlike a heart attack, which happens when blood
flow to a portion of the heart is blocked, cardiac arrest occurs
when the heart’s electrical system malfunctions, often due to
irregular heart rhythms. Cardiac arrest may occur with no warning
and is often fatal.
When patients had a cardiac arrest at home, survival odds were 55
percent higher if they received CPR from a bystander and
defibrillation from EMS than if they didn’t receive CPR before
medical help arrived, researchers report in JAMA Cardiology.
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In public, cardiac arrest survival odds were more than quadrupled
when patients had both CPR and defibrillation administered by a
bystander than when they waited for EMS to arrive, the study also
found.
The study included data on 5,602 people who had a cardiac arrest at
home and another 2,667 who had a cardiac arrest in public in 16
North Carolina counties over five years. Combined, these counties
have about 3.3 million residents and included both urban and rural
areas.
It wasn’t a controlled experiment designed to prove that the
training program directly saved lives.
Survival odds improved, but remained low, based on how many people
lived long enough to leave the hospital, and the study also lacked
longer-term survival data, the authors note.
Even so, the results suggest that efforts to get more bystanders
involved can make a difference, said Dr. Graham Nichol, co-author of
an accompanying editorial and director of the University of
Washington-Harborview Center for Prehospital Emergency Care in
Seattle.
“In many communities, survival after out-of-hospital cardiac arrest
has been static for decades,” Nichol told Reuters Health by email.
“This work showed that implementing a bundle of education strategies
improved outcomes; the sum appeared greater than the parts.”
Earlier bystander intervention can also help preserve brain function
in patients who survive, said Dr. Lenworth Jacobs, a researcher at
the University of Connecticut and director of the Trauma Institute
at Hartford Hospital.
“This is an issue of seconds and minutes,” Jacobs, who wasn’t
involved in the study, said by email. “Three or four minutes can
make a dramatic difference in the functional outcome and survival of
these patients.”
SOURCES: http://bit.ly/2yj29PR and http://bit.ly/2z2y7gN JAMA
Cardiology, online October 4, 2017.
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