# 5728
Over the years I’ve written often about the importance of learning CPR, and on occasion, of my own experiences as a paramedic and as an American Red Cross and American Heart Association CPR instructor.
The first four or five minutes of any cardiac arrest are the most critical. And resuscitation efforts that are started after that time period are less likely to produce a good outcome.
Quite simply, since EMS response times are often longer than 5 minutes - when someone suffers cardiac arrest outside of the hospital – the patient’s ultimate survival hinges greatly on whether bystander CPR is started before help arrives.
Last week the CDC’s MMWR released a surveillance summary that illustrates this point with data gleaned over the past 5 years from 911 Call Centers, EMS services, and Hospitals on OHCA’s (Out Of Hospital Cardiac Arrests).
Out-of-Hospital Cardiac Arrest Surveillance --- Cardiac Arrest Registry to Enhance Survival (CARES), United States, October 1, 2005--December 31, 2010
Surveillance Summaries
July 29, 2011 / 60(SS08);1-19Bryan McNally, MD, Rachel Robb, MMSc,Monica Mehta, MPH,Kimberly Vellano, MPH,Amy L. Valderrama, PhD, Paula W. Yoon, ScD, Comilla Sasson, MD, Allison Crouch, MPH, Amanda Bray Perez, BS, Robert Merritt, MA, Arthur Kellermann, MD
Abstract
Problem/Condition: Each year, approximately 300,000 persons in the United States experience an out-of-hospital cardiac arrest (OHCA); approximately 92% of persons who experience an OHCA event die. An OHCA is defined as cessation of cardiac mechanical activity that occurs outside of the hospital setting and is confirmed by the absence of signs of circulation. Whereas an OHCA can occur from noncardiac causes (i.e., trauma, drowning, overdose, asphyxia, electrocution, primary respiratory arrests, and other noncardiac etiologies), the majority (70%--85%) of such events have a cardiac cause.
The majority of persons who experience an OHCA event, irrespective of etiology, do not receive bystander-assisted cardiopulmonary resuscitation (CPR) or other timely interventions that are known to improve the likelihood of survival to hospital discharge (e.g., defibrillation). Because nearly half of cardiac arrest events are witnessed, efforts to increase survival rates should focus on timely and effective delivery of interventions by bystanders and emergency medical services (EMS) personnel. This is the first report to provide summary data from an OHCA surveillance registry in the United States.
The entire report is detail rich and worth reading, but briefly:
In 2004 the CDC, in collaboration with the Emergency Department at the Emory University School of Medicine, began a pilot program called the Cardiac Arrest Registry to Enhance Survival (CARES).
This registry – which has since expanded to include 46 EMS agencies in 36 communities in 20 states – evaluates patients who received resuscitative efforts, including CPR or defibrillation, outside of the hospital following a coronary related cardiac arrest.
In evaluating 31,689 OCHA events, the registry found that the mean patient age was 64, 61.1% were male, and nearly half (47.3%) were witnessed by a bystander or EMS personnel. Two thirds occurred at a home or residence, 13.5% in a nursing home or assisted living facility, and roughly 20% in public locations.
Just over 20% were pronounced dead at the scene by EMS personnel, while 26.3% survived to be admitted to the hospital.
Overall, the survival rate to hospital discharge was 9.6%.
Although 36.7% of these cardiac arrests were witnessed by bystanders, less than half (43.8%) of those received bystander CPR, and only 3.7% of those were treated with an AED prior to the arrival of EMS.
Among those who received bystander CPR or AED treatment, the survival rate to hospital discharge was 11.2% as opposed to just 7% for those who received no CPR.
A 60% improvement in the survival rate.
In conclusion, the authors write:
The data provided in this report indicate the need for prompt and effective resuscitation efforts. Provision of optimal care at the scene is essential to survival. If a pulse is not restored before EMS transport, additional efforts at the receiving hospital almost invariably fail (23).
Education of public officials and community members about the importance of increasing rates of bystander CPR far beyond the current 33.3% and promoting use of early defibrillation by lay and professional rescuers are critical to improving survival of OHCA events. CARES data can be used at the community level to target interventions (e.g., bystander CPR training and AED placement) and assess their effectiveness. CDC uses CARES data for cardiovascular surveillance efforts and makes data available to the public at http://apps.nccd.cdc.gov/NCVDSS_DTM. As statewide CARES registries become available, the data will be used for state-specific OHCA surveillance efforts.
With expansion to state-level surveillance, CARES will enable local and state public health departments and EMS agencies to better coordinate their efforts. Such coordination can improve the quality of EMS care and thus increase the proportion of persons who survive an OHCA event.
Luckily, today CPR is easier to do than ever.
Compression-only CPR is now the standard for laypeople, and so you don’t have to worry about doing mouth-to-mouth.
This from the American Heart Association.
- Sudden cardiac arrest is a leading cause of death in the U.S.
- Everyone should know how to perform CPR in an emergency.
- Immediate, effective CPR could more than double a victim's chance of survival.
- Push on the chest at a rate of at least 100 beats per minute.
- Push to the beat of "Stayin' Alive" and you could save a life.
- Click here for more information on Hands-Only CPR.
While it won’t take the place of an actual class, you can watch how it is done on in this brief instructional video from the American Heart Association.
A CPR class only takes a few hours, and it could end up helping you save the life of someone you love.
To find a local CPR course contact your local chapter of the American Red Cross, the American Heart Association, or (usually) your local fire department or EMS can steer you to a class.
For more on the recent changes to bystander CPR, you may wish to visit these recent blogs.
CPR As A Requirement For High School Graduation
