Research Explores Impacts of CPR on Patient Outcomes
New research presented on Aug. 30 during ESC Congress 2015 in London continues to prove that cardiopulmonary resuscitation (CPR) for out-of-hospital cardiac arrest can improve patient outcomes. However, there is still room for bystander education around CPR and use of automated external defibrillators (AEDs).
A Danish study of 2,387 adult cardiac arrest survivors linked bystander CPR to a 30 percent lower risk of nursing home admission and brain damage. During the first year after cardiac arrest, 7 percent of patients died, 11 percent were admitted to a nursing home or were diagnosed with brain damage, and 81 percent did not experience any of these events. In multivariable modelling, bystander CPR was the only factor significantly associated with lower risk of nursing home admission or brain damage with a hazard ratio of 0.67 (95 percent confidence interval 0.51-0.89, p=0.005).
"The current study shows that the benefits of bystander CPR seem to go beyond survival and also impact the physical and mental health of survivors," said Kristian Kragholm, MD, of the Cardiovascular Research Centre, Aalborg University Hospital, Denmark. "This novel and important finding demonstrates how vital it is that CPR is promptly initiated to increase not only chances of survival but also reduce brain damage and nursing home admission in survivors. Initiatives that improve bystander recognition of arrest and willingness to initiate CPR hold the potential to improve the chances of survival with intact function and enable survivors to carry on with their lives as before the arrest."
A second study found that refractory cardiac arrest patients brought to the hospital with ongoing CPR can survive with good brain function. The study looked at 4,000 Danish patients and investigated both the survival and functional status in patients with refractory cardiac arrest brought to the hospital with ongoing CPR and treated conservatively without the support of extracorporeal life systems.
Results showed that approximately 50 percent of the patients brought to the hospital with ongoing CPR were successfully resuscitated and were admitted to a hospital ward. In the other half, the resuscitation attempt was terminated in the emergency department after more than one hour of CPR on average. The rate of survival in patients with refractory cardiac arrest who received ongoing CPR was 20 percent compared to 42 percent in those who were resuscitated before arrival at the hospital (p<0.001). Sufficient function for carrying out independent daily activities was found in approximately nine out of 10 in both patient groups.
"Even though the survival rate in patients with refractory cardiac arrest is lower, the prognosis is not dismal and importantly the functional status at hospital discharge is similar to patients resuscitated before arrival at the hospital," said Helle Søholm, MD, of Copenhagen University Hospital Righospitalet, Denmark. "Our results indicate that maybe resuscitation attempts should be extended as the prognosis for patients with refractory cardiac arrest is not as poor as we previously thought. In general we recommend that cardiac arrest patients are given post-resuscitation care in dedicated cardiac arrest centers with highly specialized treatment options and experienced physicians.
Continuing the CPR theme, a study presented by Yoshikazu Goto, MD, associate professor and director of the Department of Emergency and Critical Care Medicine at Kanazawa University Hospital, Japan, suggests that emergency medical services (EMS) personnel or clinicians should continue CPR for at least 35 minutes in patients who suffer cardiac arrest outside the hospital. Results showed that 99.1 percent of all survivors and 99.2 percent of survivors with favourable neurological outcomes achieved return of spontaneous circulation within 35 minutes of EMS-initiated CPR. No patient with a CPR duration of ≥53 minutes survived one month after cardiac arrest.
Meanwhile, a Danish study suggests that while efforts to improve automated external defibrillator (AED) usage increase bystander defibrillation in public places, it does not increase use at home. The study included 25,287 patients who had a first-time out-of-hospital cardiac arrest between 2001 and 2012. Of these, 74 percent occurred at home and 26 percent occurred in a public location. Researchers observed the rate of defibrillation by bystanders increased from 1.4 percent in 2001 to 11.9 percent in 2012 in public locations; however, there was no increase in bystander defibrillation of cardiac arrest patients at home and rates remained low at about 1 percent over the 12-year span.
"Many factors are important for increasing survival even when the patient has been defibrillated by bystanders including bystander CPR, improved pre-hospital organisation and advanced care in hospitals," said Steen Hansen, a PhD student in the Department of Health, Science and Technology at Aalborg University in Denmark. "Continuing efforts are needed to improve bystander defibrillation and increase survival."
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