Hands-Only CPR Increases Bystander Participation and Survival After Cardiac Arrest

MedicalResearch.com Interview with:

Hands only CPR AHA image

Hands only CPR
AHA image

Gabriel Riva, Graduate Student
Department of Medicine, Solna (MedS),
Karolinka Institute

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: During the last decade there has been a gradual adoption of compression-only CPR, as an option to conventional CPR with chest compressions and rescue breaths, in international CPR guidelines. The simplified technique is recommended for bystanders who are untrained and in “telephone assisted CPR”. One of the reasons was the assumption that more people would actually do CPR with the simplified technique.  We could in this nationwide study running over 3 guideline periods demonstrate a 6-fold higher proportion of patients receiving compression-only CPR and a concomitant almost doubled rate of CPR before emergency medical services arrival over time. This very large increase in simplified CPR was surprising to us, especially considering there has never been any public campaigns promoting compression-only CPR in Sweden and training still include compressions and ventilations.  Continue reading

Why Are Women Less Likely To Receive Bystander CPR?

MedicalResearch.com Interview with:

Dr. Sarah Perman MD, M.S.C.E. Assistant professor of Emergency Medicine University of Colorado School of Medicine in Denver 

Dr. Perman

Dr. Sarah Perman MD, M.S.C.E.
Assistant professor of Emergency Medicine
University of Colorado School of Medicine
Denver 

MedicalResearch.com: What is the background for this study?

Response: Women who suffer an out-of-hospital cardiac arrest have been observed to receive less bystander cardiopulmonary resuscitation (B-CPR) than men, and the potential reasons were largely unknown. We asked 54 people online to explain – with no word limit – why women might be less likely to get CPR when they collapse in public.

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Children Can Save Lives By Learning CPR in School

MedicalResearch.com Interview with:
Young girl learning Hands-Only CPR at the American Heart Association Hands-Only CPR training kiosk at Cincinnati-Northern Kentucky International Airport. copyright American Heart Association 2017 Photos by Tommy Campbell Photography
Mimi Biswas M.D., MHSc
University of California Riverside School of Medicine and
Riverside Community Hospital 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: This started as  My son’s science project. He wanted to make a video game to teach CPR based on a science fair website. It grew to teaching the whole 6th grade using the AHA CPR training kit alone vs adding the video game or music, staying alive, to help with compression rate.  We found that a 12 year can easily learn the basic concepts of calling for help and starting hands only CPR and they can physically perform effective CPR at this age.

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Bystander CPR Not Only Improves Survival But Reduces Brain Damage

MedicalResearch.com Interview with:

Kristian Kragholm, MD, PhD Departments of Cardiology and Epidemiology/Biostatistics, Aalborg University Hospital, Aalborg, DK

Dr. Kragholm

Kristian Kragholm, MD, PhD
Departments of Cardiology and Epidemiology/Biostatistics,
Aalborg University Hospital,
Aalborg, DK

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: It is well known that early help from bystanders including cardiopulmonary resuscitation (CPR) before arrival of the emergency medical services can increase chances of 30-day survival by three to four times compared to situations where no bystander resuscitation was initiated.

The main and novel finding of our study is that bystander interventions, in addition to increasing survival, also lowers the risk of damage to the brain and nursing home admission in 30-day survivors during the first year following out-of-hospital cardiac arrest.

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Bystander CPR Associated With Improved Outcomes in Pediatric Cardiac Arrest

MedicalResearch.com Interview with:

Maryam Y. Naim, MD Pediatric Cardiac Intensive Care Physician The Cardiac Center The Children’s Hospital of Philadelphia Perelman School of Medicine The University of Pennsylvania, Philadelphia

Dr. Maryam Y. Naim

Maryam Y. Naim, MD
Pediatric Cardiac Intensive Care Physician
The Cardiac Center
The Children’s Hospital of Philadelphia
Perelman School of Medicine
The University of Pennsylvania, Philadelphia

MedicalResearch.com: What is the background for this study? 

Response: In adults bystander compression only CPR has similar outcomes to bystander conventional COR therefore the The American Heart Association recommends untrained lay rescuers perform compression only CPR in adults that have an out of hospital cardiac arrest. In children respiratory arrests are more common therefore conventional CPR with chest compressions and rescue breaths are recommended for out of hospital cardiac arrest.

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Popular TV Shows Depict Overly Optimistic CPR Success

Jaclyn Portanova, Ph.D School of Gerontology University of Southern California DavisMedicalResearch.com Interview with:
Jaclyn Portanova, Ph.D student
School of Gerontology
University of Southern California Davis

Medical Research: What is the background for this study?
Response: Over the past two decades, we have made a lot of progress in educating the public about the need to engage in advance care planning and make health care decisions, such as whether or not to receive CPR in a medical crisis. The media plays a major role in shaping the way people think about life-saving measures such as cardiopulmonary resuscitation (CPR). In fact, a study published in 1996 showed that popular medical shows portrayed CPR as having a much higher rate of success than actual rates. We sought to determine if popular media has improved in the accuracy of their depiction of CPR survival rates.

Medical Research: What are the main findings?

Response: Nearly 70% of TV show patients who received CPR survived the initial incident. This success rate is twice as high as actual rates. Even more striking, survival rate to hospital discharge following receipt of CPR was four times higher in popular medical television shows than actual rates. Advance care planning discussions between physicians and patients were rarely portrayed, but when they did occur patient preferences were honored.

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Bystander CPR Programs Can Save Lives After Cardiac Arrest

Carolina Malta Hansen, M.D Duke Clinical Research InstituteMedicalResearch.com Interview with:
Carolina Malta Hansen, M.D
Duke Clinical Research Institute

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.

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Bystander CPR Saves Lives – Mobile App May Help Save More

Jacob Hollenberg M.D., Ph.D. Assistant Professor, Cardiologist Head of Research, Centre for Resuscitation Science Karolinska Institutet, Stockholm, SwedenMedicalResearch.com Interview with:
Jacob Hollenberg M.D., Ph.D.
Assistant Professor, Cardiologist
Head of Research, Centre for Resuscitation Science
Karolinska Institutet, Stockholm, Sweden

Editor’s note: Dr. Hollenberg and colleagues published two articles in the NEJM this week discussing CPR performed by bystanders in out-of-hospital cardiac arrests.

MedicalResearch: What is the background for the first study?

Dr. Hollenberg: There are 10,000 cases of cardiac arrest annually in Sweden. Cardiopulmonary Resuscitation (CPR) has been taught to almost a third of Sweden’s population of 9.7 million. In recent years the value of bystander CPR has been debated, largely due to a lack of a randomized trial demonstrating that bystander CPR is lifesaving.

In this study, which included all cases of emergency medical services (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, our primary aim was to assess whether CPR initiated before the arrival of EMS was associated with an increase in the 30-day survival rate.

MedicalResearch: What were the main findings?

Dr. Hollenberg: Early CPR prior to arrival of an ambulance more than doubled the chance of survival. (30-day survival rate was 10.5% among patients who underwent CPR before EMS arrival, as compared with 4.0% among those who did not (P<0.001).)

This association held up in all subgroups regardless of sex, age, cause of cardiac arrest, place of arrest, EKG findings or time period (year analyzed).

MedicalResearch: How did the patients who survived cardiac arrest do from a disability standpoint?

Dr. Hollenberg: We had cerebral performance scores from 474 patients who survived for 30 days after cardiac arrest. (higher scores indicate greater disability).

At the time of discharge from the hospital, 81% of these patients had a score of category of 1. Less than 2% had category scores of 4 or 5.

MedicalResearch: What should patients and providers take away from this report?

Dr. Hollenberg:

  • For patients with an out-of-hospital cardiac arrest, CPR performed by bystanders before the arrival of emergency medical personnel, saves lives. This has been validated by both the size of this study and the consistency of the results over three decades.
  • CPR education needs to continue and to increase. In Sweden about one-third of the population has been taught CPR.       Legislation has recently been passed that mandates CPR be taught to all teenagers in school which should allow an entire generation to become familiar with this lifesaving technique.
  • The willingness of the public to become involved also needs to increase. We need new ways of educating lay people to recognize cardiac arrest and to motivate them to perform it. The knowledge that bystander CPR saves lives may enhance that motivation.

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Bystander CPR Allows Many Cardiac Arrest Patients To Return To Work

Kristian Kragholm, MD, PhD-student Cardiovascular Research Center, Department of Anesthesiology, Aalborg University HospitalMedicalResearch.com Interview with:
Kristian Kragholm, MD, PhD-student
Cardiovascular Research Center,
Department of Anesthesiology,
Aalborg University Hospital

Medical Research: What is the background for this study?

Dr. Kragholm: During 2001-2010 in Denmark, survival to 30 days and 1 year more than doubled. Whether this substantial improvement in survival was accompanied by good functional recovery in survivors was not clear. Discharge neurological status or post-discharge follow-up assessments were not systematically recorded in Denmark but through nationwide registries employment outcomes were available. Therefore, we examined return to work as a marker of favorable neurological outcome in 30-day survivors of out-of-hospital cardiac arrest in a nationwide study in Denmark between 2001-2011.

Medical Research: What are the main findings?

Dr. Kragholm: More than 75% of all 30-day out-of-hospital survivors in Denmark during 2001-2011 who were employed prior to arrest returned to work

Not only did the majority of these survivors return to work, survivors also sustained work without any long-term sick absences for a median time of 3 years and maintained the same income after arrest as before arrest.

Finally, relative to survivors who did not receive bystander cardiopulmonary resuscitation (CPR), chances for return to work were increased by approximately 40% if bystanders had provided CPR in multivariable adjusted modeling. Continue reading

CPR Rate High In End Stage Dialysis Patients Despite Poor Outcomes

MedicalResearch.com Interview with:
Susan P. Y. Wong, M.D.
Acting Instructor & Senior Research Fellow
Division of Nephrology
University of Washington

Medical Research: What is the background for this study? What are the main findings?

Dr. Wong: There is a paucity of information on the use of cardiopulmonary resuscitation (CPR) and its outcomes among patients receiving maintenance dialysis. To address this knowledge gap, we performed a retrospective study to define contemporary trends in in-hospital CPR use and its outcomes among a nationally representative sample of 663,734 patients receiving maintenance dialysis between 2000 and 2011. We found that in-hospital CPR use among this cohort of patients was very high—nearly 20 times more common than that found in the general population. The rate of in-hospital CPR use has also been increasing among patients receiving maintenance dialysis despite evidence of poor long-term survival among these patients. Median survival after hospital discharge for members of this cohort was only 5 months, and this has not change substantially in the recent decade.

We also found that a large proportion  of dialysis patients who died in hospital settings had received CPR during their terminal hospitalization. This proportion has also been steadily increasing over time, and in 2011, 1 in 5 dialysis patients who died in hospital had received CPR during their terminal hospitalization.

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CHEST 2014: ECMO CPR May Improve Patient Recovery

MedicalResearch.com Interview with:
Graham Peigh, BA
Thomas Jefferson University

Medical Research: What are the main findings of the study?

Response: The main findings of our study show that extracorporeal cardiopulmonary resuscitation (E-CPR) can provide recovery when a patient is unresponsive to conventional CPR. In our sample of 24 patients, 13 survived ECMO, and 7 were successfully discharged from the hospital. Major meta analytic studies have shown that in-hospital CPR yields a discharge rate of under 20%, and our study presents results which demonstrate that E-CPR provides a method by which those survival figures can be increased. Importantly, our study also showed that vital organ function among ECMO survivors was maintained. All13 patients had improved or unchanged kidney and liver function, and 12/13 had improved or unchanged metabolic function. After using standard hypothermia protocols, all seven hospital survivors had full neurological recovery. This study differs from the majority of other studies on E-CPR because our institution does not have a dedicated E-CPR/Code team available to perform E-CPR 24/7. We believe that our results are thus generalizable to other academic institutions, which, like ours, have the capability to perform E-CPR, but are only able to do so during on-hours when physicians, perfusionists, and ECMO materials are available.

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Initiatives to Improve Cardiac Arrest Management

Mads Wissenberg, MD Department of Cardiology Gentofte Hospital, University of Copenhagen Niels Andersens Vej 65 2900 Hellerup, Denmark Post 635MedicalResearch.com Interview with:
Mads Wissenberg, MD
Department of Cardiology
Gentofte Hospital, University of Copenhagen
Niels Andersens Vej 65
2900 Hellerup, Denmark Post 635

MedicalResearch.com: What are the main findings of the study?

Answer: Our main findings from this nationwide study are that during a 10-year period where several national initiatives were taken to increase bystander CPR and improve advanced care, bystander CPR increased more than a two-fold from 21 % in 2001 to 45% in 2010. In the same period survival on arrival at the hospital increased more than a two-fold from 8% in 2001 to 22% in 2010, and 30-day survival more than a three-fold from 3.5% in 2001 to 11% in 2010.
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