A study titled “to investigate the survival of patients with out-of-hospital cardiac arrest using compression-only CPR (COCPR) compared with conventional CPR” has been published in the recent issue of JAMA.
In 2005, an evaluation of out-of-hospital cardiac arrest in Arizona revealed dismal outcomes, so a statewide program aimed at improving survival was established.
These efforts included changes in the approach to the care provided by both bystanders and emergency medical services (EMS) personnel and were based on the increasing evidence in favor of minimizing interruptions in chest compressions during CPR.
This led to alterations in the resuscitative care provided by EMS personnel, termed minimally interrupted cardiac resuscitation (MICR). Simultaneously, a statewide, multifaceted effort to encourage bystanders to use compression-only CPR (COCPR) because this approach is easier to teach, learn, remember, and perform than conventional CPR was established.
It is a 5-year prospective observational cohort study of survival in patients at least 18 years old with out-of-hospital cardiac arrest between January 1, 2005, and December 31, 2009, in Arizona. The relationship between layperson bystander CPR and survival to hospital discharge was evaluated using multivariable logistic regression.
Main Outcome Measure was Survival to hospital discharge.
Results
A total of 4415 met all inclusion criteria for analysis, including 2900 who received no bystander CPR, 666 who received conventional CPR, and 849 who received COCPR.
Rates of survival to hospital discharge were 5.2% (95% confidence interval [CI], 4.4%-6.0%) for the no bystander CPR group, 7.8% (95% CI, 5.8%-9.8%) for conventional CPR, and 13.3% (95% CI, 11.0%-15.6%) for COCPR.
The adjusted odds ratio (AOR) for survival for conventional CPR vs no CPR was 0.99 (95% CI, 0.69-1.43), for COCPR vs no CPR, 1.59 (95% CI, 1.18-2.13), and for COCPR vs conventional CPR, 1.60 (95% CI, 1.08-2.35).
From 2005 to 2009, lay rescuer CPR increased from 28.2% (95% CI, 24.6%-31.8%) to 39.9% (95% CI, 36.8%-42.9%; P < .001); the proportion of CPR that was COCPR increased from 19.6% (95% CI, 13.6%-25.7%) to 75.9% (95% CI, 71.7%-80.1%; P < .001).
Overall survival increased from 3.7% (95% CI, 2.2%-5.2%) to 9.8% (95% CI, 8.0%-11.6%; P < .001).
Neurologic status for 4310 of 4515 cases of out-of-hospital cardiac arrest (217/315 survivors) of whom 4.2% (95% CI, 3.6%-4.8%) had a good neurologic status (CPC score of 1 or 2).
Proportion of individuals with good neurologic status differed significantly based on the type of CPR provided: no CPR, 86 of 2852, or 3.0% (95% CI, 2.4%-3.6%); conventional CPR, 34 of 651, or 5.2% (95% CI, 3.5%-6.9%); COCPR, 62 of 814, or 7.6% (95% CI, 5.8%-9.4%) (P < .001).
There are multiple reasons COCPR might have advantages over conventional CPR techniques.
1. These include the rapid deterioration of forward blood flow that occurs during even brief disruptions of chest compressions,
2. the long ramp-up time to return to adequate blood flow after resuming chest compressions,
3. the reduction of cardiac venous return with the use of positive pressure ventilation, the complexity of conventional CPR,
4. the significant time required to perform the breaths, the critical importance of cerebral and coronary circulation during arrest, the reduced time required for emergency medical dispatchers to instruct a bystander over the telephone how to perform COCPR, and the reluctance to perform mouth-to-mouth ventilation on strangers.
Conclusion Among patients with out-of-hospital cardiac arrest, layperson compression-only CPR was associated with increased survival compared with conventional CPR and no bystander CPR in this setting with public endorsement of chest compression–only CPR.
http://jama.ama-assn.org/cgi/content/full/304/13/1447
No comments:
Post a Comment