Early CPR in Cardiac Arrest | Journal Scan

Jun 10, 2015
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Authors:
Hasselqvist-Ax I, Riva G, Herlitz J, et al.
Citation:
Early Cardiopulmonary Resuscitation in Out-of-Hospital Cardiac Arrest. N Engl J Med 2015;372:2307-2315.
Summary By:
Thomas C. Crawford, MD, FACC

Study Questions:

Does bystander cardiopulmonary resuscitation (CPR) prior to the arrival of emergency medical services (EMS) improve survival rate in out-of-hospital cardiac arrest victims?

Methods:

The authors analyzed all cases of EMS-treated and bystander-witnessed out-of-hospital cardiac arrests recorded in the Swedish Cardiac Arrest Registry from January 1, 1990, through December 31, 2011. Nonwitnessed cases and cases witnessed only by the EMS crew were excluded.

Results:

CPR was performed before the arrival of EMS in 51% of cases. The 30-day survival rate was 10.5% when CPR was performed before EMS arrival versus 4.0% when CPR was not performed before EMS arrival (p < 0.001). After propensity score adjustment, CPR before the arrival of EMS was associated with an increased 30-day survival rate (odds ratio, 2.15; 95% confidence interval, 1.88-2.45). The positive correlation between early CPR and survival rate remained stable over the course of the study period of 21 years.

Conclusions:

CPR performed before EMS arrival is associated with a 30-day survival rate after an out-of-hospital cardiac arrest that was more than twice as high as that associated with no CPR before EMS arrival.

Perspective:

Time and time again, studies have shown that outcomes in cases of cardiac arrest can be improved by decreasing the time to treatment. Whether bystander CPR improves survival has been questioned, given the lack of randomized data. The present study is important because it shows improved survival when bystander CPR is begun before the arrival of the EMS, and also because it demonstrates the feasibility of widespread CPR training. The main effect of CPR is probably increasing the window to successful defibrillation. A stunning 3 million people have undergone CPR training in Sweden, a country of less than 10 million, where more than 90% of out-of-hospital cardiac arrests are entered in the registry. Much can be learned from the impressive Swedish model.

Keywords: Arrhythmias, Cardiac, Cardiopulmonary Resuscitation, Electric Countershock, Emergency Medical Services, Geriatrics, Heart Arrest, Out-of-Hospital Cardiac Arrest, Primary Prevention, Propensity Score, Registries, Survival Rate, Time-to-Treatment


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