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Guideline changes for CPR led to higher neurologically-intact hospital discharge rates
Aufderheide TP. Heart Rhythm. 2010;7:1357–1362.
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American Heart Association guideline changes for CPR resulted in significantly higher neurologically-intact hospital discharge rates in patients with out-of-hospital cardiac arrest, suggested data from Heart Rhythm.
“In 2005, AHA recommended multiple ways to improve circulation during CPR. Little is known about the impact of this new approach on survival rates for patients with out-of-hospital cardiac arrest,” the researchers wrote.
They tested this hypothesis that the new changes — including a renewed emphasis on more hard and fast compressions, fewer ventilations and complete chest wall recoil – could improve outcome by analyzing conglomerate quality assurance data during prospective implementation of the 2005 AHA Guidelines in five emergency medical services (EMS) systems. The EMS personnel were all trained in the new aspects of the guidelines and the primary outcome was defined as survival to hospital discharge.
According to study results, demographics, rate of bystander CPR, and time from the 911 call for help to arrival of EMS personnel were similar between the intervention (n=1,605) and historical control (n=1,641) groups. Researchers recorded a survival to hospital discharge rate of 10.1% in the control group vs. 13.1% in the intervention group (P=.007).
Additional study data indicated that the survival to discharge in patients presenting with a rhythm of ventricular fibrillation/ventricular tachycardia was 20% in controls vs. 32.3% the intervention group (P<.001), while the intervention group also had an advantage in survival to discharge with a CPC classification or 1 or 2 (intervention, 59.6% vs. control, 33.3%; P=.038).
“These findings support the importance of implementing an optimized sequence of therapeutic interventions during the performance of CPR for patients in cardiac arrest,” the researchers concluded. – by Brian Ellis
While the results are in concert with an increasing body of data supporting benefit of the 2005 guidelines, which includes an emphasis on minimizing interruptions in chest compressions, [this study] is not a randomized trial and some advances in care after resuscitation, including implementation of hypothermia and revascularization, could explain the greater survival to hospital discharge.
– William G. Stevenson, MD
Cardiology Today Editorial Board
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