Statewide initiatives to improve bystander cardiopulmonary resuscitation (CPR) and first-responder defibrillation may be associated with improved survival and reduced brain injury in people with out-of-hospital cardiac arrest, according to research published March 23 which will be presented at ACC.16 in Chicago.

Christopher B. Fordyce, MD, and colleagues analyzed 8,269 cases of cardiac arrest between 2010 and 2014 collected from the North Carolina Cardiac Arrest Registry to Enhance Survival. The statewide program, part of the HeartRescue Project, trained family members and bystanders to recognize the signs of sudden cardiac arrest, quickly call emergency responders, and use CPR or automated external defibrillators (AEDs). The study is the first to separately track the effects of such interventions on cardiac arrests in public places and private homes.

Results showed that the proportion of patients receiving bystander CPR increased at home from 28.3 percent to 41.3 percent (p<0.0001) and in public locations from 61.0 percent to 70.6 percent (p=0.007), while first-responder defibrillation increased at home from 42.2 percent to 50.8 percent (p=0.01) but stayed mostly the same in public locations (33.1 percent to 37.8 percent; p=0.16). There was not a statistically significant increase in non-EMS first-responder AED use in public places, which the authors attribute to timely defibrillation by EMS. The rate at which cardiac arrest patients survived until their discharge from the hospital rose from 10.8 to 16.8 percent for public cardiac arrests and from 5.7 to 8.1 percent for cardiac arrests in the home. The rate at which patients only suffered minor losses in brain function or regained it fully increased from 4.9 to 6.1 percent at home and from 9.5 to 14.7 percent in public.

The authors explain that these results are encouraging, but due to the low absolute survival rates, there is still room for improvement. They suggest that future research in this area include interventions such as deploying AEDs into more private homes when cardiac arrests occur and using mobile technology to notify nearby citizens trained in CPR who can initiate care quickly.

“Survival is notoriously worse in private homes, where the majority of cardiac arrests occur,” says Fordyce. “Little is known about whether broader efforts to teach people to recognize cardiac arrest and act quickly also impact home cardiac arrests, where the bystander is typically a family member. What’s interesting about this study is it’s the first time a statewide intervention has improved both public and residential cardiac arrest outcomes,” he adds.

“There were three lessons from our study,” said James Jollis, MD, FACC, co-author of the study and immediate past president of ACC’s North Carolina Chapter. “First, patients who suffer out-of-hospital characteristics share the same demographics as our cardiology patients. As part of discharge discussions with patients, we should be sure that they and their families know how to recognize and respond to cardiac arrest: check, call and compress. Second, the best emergency systems have strong cardiology leadership and pre-specified plans for patients who survive cardiac arrest to hospital admission including who to urgently take to the catheterization laboratory. Thirdly, the cardiology community should support the widespread training of chest compression-only CPR to all employees of health systems, interested community groups, and high school students as part of a standard heart health curriculum.”   

Keywords: Brain, Brain Injuries, Cardiopulmonary Resuscitation, Death, Sudden, Cardiac, Defibrillators, Electric Countershock, Emergency Responders, North Carolina, Out-of-Hospital Cardiac Arrest, Registries, Rosa, Survival Rate, ACC Annual Scientific Session

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