Promotion of hands-only CPR could increase usage, improve outcomes in cardiac arrest
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National CPR and AED Awareness Week, initiated by the American Heart Association, the American Red Cross and the National Safety Council and designated by Congress in 2007, is held June 1 to 7 of each year.
Its purpose is to highlight how lives can be saved if more Americans learn how to perform CPR and use automated external defibrillators.
According to the AHA, nearly 383,000 out-of-hospital cardiac arrests occur in the U.S. annually, 88% of which occur at home, more than 90% of which are fatal, and many of which occur in people with no known CVD or CV risk factors. While use of CPR and AEDs more than doubles the chance of survival, only 32% of patients with out-of-hospital cardiac arrest receive bystander CPR.
As part of this year’s observance, the AHA is promoting the use of hands-only CPR. Healio spoke with Cardiology Today Editorial Board Member Matthew W. Martinez, MD, director of Atlantic Health System Sports Cardiology at Morristown Medical Center in New Jersey, about why bystander CPR and AED use is so important, what the barriers are to adoption and how promotion of hands-only CPR could increase the usage of bystander CPR and improve outcomes.
Healio: What are the consequences if no bystander CPR or AED use occurs during an out-of-hospital cardiac arrest?
Martinez: We know that out-of-hospital cardiac arrest is somewhat common. According to the AHA, more than 350,000 Americans had out-of-hospital cardiac arrest in 2017. Unfortunately, 90% of those incidents are fatal. However, if bystander CPR occurs, the survival rate is two to three times higher than if it does not.
Healio: Why are people hesitant to respond to a cardiac emergency?
Martinez: We do not know the absolute answer to this, but we think there are two major drivers. Some of it has to do with the uncomfortable part of rescue breathing. There is a hesitancy to perform that, and the COVID-19 pandemic did not make it any better. Mouth-to-mouth resuscitation has its own set of anxiety that goes with it. You probably do not know this person or whether they have an infectious disease such as COVID-19.
No. 2, most people, if you ask them, feel like they are not trained well enough, and they are uncomfortable doing not just mouth-to-mouth resuscitation, but the entire process. In an emergency, most of us revert to our level of training. We spring into action with whatever we are comfortable with. The simplicity of hands-only CPR has been promoted in recent years and was first formally recommended by the AHA in 2008. For that long, we have been saying, don’t worry about the mouth-to-mouth if it is uncomfortable. There can be confusion about how many breaths, what to do if there is more than one responder, when to stop and other factors. It was a lot to take in for an event that is unusual for most people.
It is faster and easier to do hands-only CPR. It is a little less exhausting and a whole lot less intimidating for people to initiate, find the breastbone, grab their palm, lock their fingers and start chest compressions 1 to 2 in. deep.
Healio: In what other ways does use of bystander CPR and AEDs improve outcomes?
Martinez: Early CPR is very critical to improve outcomes at hospital discharge. By itself, it does not bring people back to life, but it allows circulation and oxygen to get to the brain and the other vital organs while we are waiting for help to arrive. You still have to call 911 and find a defibrillator. Rather than watching the clock waiting for help to arrive, this simple lifesaving intervention can be started. I believe there are four reasons why hands-only CPR has helped improve outcomes compared with traditional CPR: It’s faster, it’s easier, it’s less exhausting and it’s less intimidating for people to get started with it.
Healio: What prompted the messaging about hands-only CPR to occur, and how has it improved outcomes?
Martinez: The primary reason was to get more people involved by simplifying the way CPR was delivered. The Journal of the American College of Cardiology in May published a paper by Victoria L. Vetter, MD, MPH, MSHP, professor of pediatrics at the Perelman School of Medicine at the University of Pennsylvania, and colleagues that analyzed statewide mandates for training in CPR. The researchers found that people who were trained in CPR had faster response times and those patients had better outcomes. That is a surrogate to show that if we can get more people trained, and we can improve the training, then the outcomes will be better. We can’t say if traditional CPR would have been less effective than hands-only CPR, but if people are less likely to perform traditional CPR, then there is no utility in even learning it. I love the phrase, “We need to make education that is useful and used.” If it is too complicated, people will shy away and avoid doing it. But if we can simplify it and make training more widely available, the outcomes are showing that we can have improvement in survival.
Healio: Who can be a first responder?
Martinez: We are doing an initiative with the AHA about trying to take away the mystique of CPR. The message is, it’s easier than you think, it does not take long to learn and it does not take a full-day course to get familiar with how to start hands-only CPR, call 911 and find a defibrillator. If you spend a little bit of time learning about this, from an online module from the AHA or through your local health system, you will find that you can do it. It is simpler than it has ever been, and the defibrillator does all the work for you. You have to turn it on and then it tells you what to do. So I believe anyone can be a first responder; whether you are a teacher, a student, an athlete, a coach, a referee or anyone else, the opportunity is there. And we are working to make the training more available.
Healio: What will it take to get more people trained in proper use of CPR and AEDs?
Martinez: It’s going to have to be a mandate that everyone has to learn this in high school. Younger people are going to be more apt to try things and to be comfortable with learning a skillset that may feel uncomfortable, whereas an adult may shy away and say they can’t do it. The future is in training middle school, high school and college students, because then there will be a wave of pressure to move forward.
Healio: Is there anything else you’d like to mention?
Martinez: The key message is that CPR and AEDs are a critical part of how we can all improve the health and safety of our communities. The best way to do that is by being trained and educated in these procedures. There are easy resources at your fingertips; you just have to ask or look.
References:
- American Heart Association. CPR statistics. cprblog.heart.org/cpr-statistics/#:~:text=Effective%20bystander%20CPR%20provided%20immediately,arrest%20outside%20the%20hospital%20survive. Accessed June 3, 2022.
- Vetter VL, et al. J Am Coll Cardiol. 2022;doi:10.1016/j.jacc.2022.03.359.
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