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Out-of-hospital cardiac arrest survival rates stable but not improved after 30 years
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A patient who experiences out-of-hospital cardiac arrest may still be as likely to survive until hospital discharge as the patient would have been in the same circumstance in 1950, according to study results.
Researchers for the meta-analysis evaluated data on 142,740 patients experiencing cardiac arrest from 79 studies conducted from 1950 to 2008. The researchers evaluated five specific factors associated with survival after cardiac arrest, including arrest witnessed by a bystander; arrest witnessed by an emergency medical service provider; provision of CPR before EMS arrival; presenting cardiac rhythm; and patient response to pre-hospital emergency cardiac care with return of spontaneous circulation in the field.
According to the study results, the pooled survival rate to hospital admission was 23.8% (95% CI, 21.1-26.6) and was 7.6% (95% CI, 6.7-8.4) at hospital discharge. Survival to hospital discharge was more likely in patients whose cardiac arrest was witnessed by either a bystander (6.4% to 13.5%) or an EMS provider (4.9% to 18.2%); in those who received bystander CPR (3.9% to 16.1%); in those who presented with ventricular tachycardia or fibrillation (14.8% to 23%); and in those who had the return of spontaneous circulation (15.5% to 33.6%). The crude rate of survival to hospital discharge in patients with cardiac arrest witnessed by a bystander was 7.6% (7,214 survivors of 95,539 patients).
Also, 5,056 survivors (6.1% of 83,229 patients) whose cardiac arrests were witnessed by EMS personnel survived until hospital discharge, as did 5,094 (6.7%) of 75,388 patients who received CPR from a bystander. They also reported that 5,972 (7.2%) of 82,854 patients presenting with ventricular tachycardia or fibrillation survived until hospital discharge, as well as 1,162 (6.6%) of 17,697 patients who experienced spontaneous return of circulation in the field.
“Focused strategies designed to boost rates of bystander CPR, deliver earlier defibrillation and achieve return of spontaneous circulation before transport are likely to do more to improve aggregate rates of out-of-hospital cardiac arrest survival than interventions applied later in a patient’s treatment,” the researchers wrote. “Currently, 92% of individuals who experience out-of-hospital cardiac arrest each year do not survive to hospital discharge. This dismal statistic can be improved.”
For more information:
- Sasson C. Circulation: Cardiovascular Quality and Outcomes. 2009;doi:10.1161/CIRCOUTCOMES.109.889576.