Out-of-Hospital Cardiac Arrest: Recent Advances in Resuscitation and Effects on Outcome
The following are 10 points to remember from this review of cardiopulmonary resuscitation (CPR):
1. Bystander CPR is performed in only approximately one-third of cases of out-of-hospital cardiac arrest (OHCA).
2. Compared to no bystander CPR, bystander CPR for patients with OHCA is associated with anywhere from a 24% to >9-fold improvement in survival to hospital discharge, depending on the study.
3. Chest compressions should be ≥5 cm in depth and should have a rate of at least 100/minute.
4. A compression/ventilation ratio of 30:2 is recommended because it minimizes interruptions in chest compressions and avoids hyperventilation.
5. Interruptions in chest compressions are an independent predictor of adverse outcomes after OHCA.
6. Although compression-only CPR is easier to teach, more acceptable to bystanders, and reduces interruptions in chest compressions, a meta-analysis showed no differences in outcomes between bystander-initiated standard CPR versus compression-only CPR.
7. Bystanders who are untrained or unwilling to perform mouth-to-mouth ventilation should do compression-only CPR.
8. As of yet, there is no evidence of improved outcomes with the use of mechanical chest compression devices.
9. Vasopressin results in better outcomes than epinephrine only in the subgroup of patients with asystole who receive the drug within 20 minutes of collapsing.
10. Outcomes are significantly improved by therapeutic hypothermia in patients who are comatose after OHCA.
Keywords: Vasopressins, Cardiopulmonary Resuscitation, Pressure, Gastrointestinal Tract, Heart Massage, Coma, Hyperventilation, Out-of-Hospital Cardiac Arrest, Death, Hypothermia, Epinephrine, Respiration, Thorax
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