Medical Research: What is the background for this study? What are the main findings?
Dr. Hansen: Approximately 300,000 persons in the United States suffer an out-of-hospital cardiac arrest every year and under 10% survive. Cardiopulmonary resuscitation (CPR) and defibrillation within the first few minutes of cardiac arrest can increase the chance of survival from under 10% to over 50%. In 2010, the HeartRescue program in North Carolina initiated statewide multifaceted interventions to improve care and outcomes for cardiac arrest patients in North Carolina. The project included public training programs in defibrillators and compression-only CPR at schools, hospitals and major events such as the N.C. State Fair, plus additional instruction for EMS and other emergency workers on optimal care for patients in cardiac arrest.
We found that following these four years of initiatives to improve care and outcomes for cardiac arrest patients, the proportion of patients who received bystander CPR and first responder defibrillation increased by more than 25% to approximately 50%, the combination of bystander CPR and first responder defibrillation increased from 14% to 23%. Survival with favorable neurologic outcome increased from 7% to 10% and this increase was only observed among patients who received bystander CPR. Finally, we found that compared to patients who received CPR and defibrillation by emergency medical services (EMS), patients who received bystander and/or first responder CPR, defibrillation, or both, were more likely to survive. The combination of bystander CPR and bystander defibrillation was associated with the best survival rates but remained low during the study period with no increase over time.
Medical Research: What should clinicians and patients take away from your report?
Dr. Hansen: Early intervention is paramount to increase the chance of surviving a cardiac arrest and people (trained and untrained) should not hesitate to immediately start CPR and use an automated external defibrillator (AED), if they suspect a cardiac arrest. Ordinary people should know that their intervention is decisive to increase the chance of survival and can’t do any harm. Also, our results suggest that strengthening first responder programs in addition to encouraging bystander CPR is likely to improve survival. Finally, this program shows that state and national programs to improve care of cardiac arrest, with a focus on the community and emergency medical response, can save more lives.
Medical Research: What recommendations do you have for future research as a result of this study?
Dr. Hansen: Future research should study how we can increase bystander AED use, which is still very low and did not increase during the study period. Future studies should also examined whether the observed improvements have been consistent across gender, race and socioeconomic status or whether certain groups are in disadvantage and need targeted efforts.
Carolina Malta Hansen, M. (2015). Bystander CPR Programs Can Save Lives After Cardiac Arrest