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Bystander CPR linked to better outcomes after cardiac arrest
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Patients with out-of-hospital cardiac arrest had better outcomes with bystander CPR and defibrillation than with no resuscitation, according to a study in The New England Journal of Medicine.
“The present study, which shows associations between early resuscitative efforts by bystanders and a lower 1-year risk of anoxic brain damage or nursing home admission, further supports the view that bystander interventions can improve functional outcomes and underscores the need to implement or improve strategies that help bystanders initiate CPR and strategies that facilitate public access to automated external defibrillators,” Kristian Kragholm, MD, PhD, a clinical assistant at Aalborg University Hospital and Aarhus University in Denmark, and colleagues wrote.
Cardiac arrest survival
Researchers reviewed data from 2,855 patients who survived 30 days after out-of-hospital cardiac arrest in Denmark from 2001 to 2012. Patients received resuscitation from a bystander or emergency medical services (EMS) or no resuscitation during cardiac arrest. One-year outcomes included nursing home admission or anoxic brain damage, death from any cause and a composite endpoint of all three outcomes.
At 1 year, 276 patients (9.7%) died; 71.4% due to a CV-related cause. Diagnosis of anoxic brain damage or admission to a nursing home occurred in 300 patients (10.5%) at follow-up.
Bystander CPR on patients whose cardiac arrest was not witnessed by EMS increased from 66.7% to 80.6% (P < .001). Rate of bystander defibrillation rose from 2.1% to 16.8% (P < .001). Patients admitted to a nursing home or diagnosed with brain damage decreased from 10% to 7.6% (P < .001). Researchers also noted a decrease in all-cause mortality, from 18% to 7.9% (P = .002).
Resuscitation by EMS
EMS-witnessed cardiac arrest contributed to lower absolute 1-year risk for nursing home admission or anoxic brain damage (3.7%; 95% CI, 2.5-4.9). Patients who received bystander defibrillation had the lowest absolute 1-year risk for death (2%; 95% CI, 0-4.2). The highest risk for brain damage or nursing home admission (18.6%; 95% CI, 16-22.2) and all-cause death (15.5%; 95% CI, 12.5-18.6) was seen in the group with no bystander resuscitation.
“EMS-witnessed cardiac arrests are probably managed with higher-quality CPR and more rapid and effective use of defibrillators than are cardiac arrests with bystander intervention, which may explain why the patients with EMS-witnessed cardiac arrest had the lowest risk of brain damage or nursing home admission,” Kragholm and colleagues wrote.
Adjusted analyses showed that bystander CPR were associated with a lower risk for nursing home admission or anoxic brain damage compared with no bystander resuscitation (HR = 0.62; 95% CI, 0.47-0.82). This was also seen in risk for death (HR = 0.7; 95% CI, 0.5-0.99) and the composite endpoint (HR = 0.67; 95% CI, 0.53-0.84).
Adjusted risks for all outcomes were even lower in those who received bystander defibrillation vs. those who received no resuscitation, according to the researchers.
“Altogether, the changes in functional outcomes that were observed after these [nationwide] initiatives were implemented suggest that systematic national efforts to improve cardiac-arrest management may result in improvements not only in survival, but also in functionally intact survival,” Kragholm and colleagues wrote. – by Darlene Dobkowski
Disclosure: Kragholm reports receiving lecture fees from Novartis Healthcare. Please see the full study for a list of the other researchers’ relevant financial disclosures.
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