DALLAS, – Death from sudden cardiac arrest (SCA) can be significantly reduced if cardiopulmonary resuscitation (CPR) and defibrillation are administered before emergency medical services (EMS) arrive, according to an editorial in today’s Circulation: Journal of the American Heart Association.
A related study, also in today’s issue, indicates that cardiac arrest victims who received early CPR from dispatcher-assisted bystanders before EMS arrived had higher survival rates than those who did not.
In the United States, cardiac arrests suffered outside a hospital kill about 220,000 people a year.
In the editorial, Douglas P. Zipes, M.D., notes that studies on casinos and airplanes that have installed automated external defibrillators (AEDs) and trained people to use them show that people who suffer SCA there have a greater than 50 percent chance of being resuscitated and surviving to hospital discharge.
However, in most cities only 3 percent to 5 percent of those who have cardiac arrest at home survive until they are discharged from the hospital. People at home lose precious minutes before resuscitation either because they are alone or because they must await the arrival of EMS, he says. Those who have cardiac arrest on airplanes and in casinos have a better chance of being resuscitated by someone onsite with access to an AED.
“The most important point is that 75 percent of sudden deaths occur in the home, and we need to create an approach that can rapidly deliver CPR and defibrillation to the home. For every minute lost in the resuscitation process, the risk of death increases by 10 percent,” says Zipes, who is a distinguished professor of medicine and head of the division of cardiology at the Krannert Institute of Cardiology, Indiana University School of Medicine, Indianapolis. Zipes also is president of the American College of Cardiology.
Zipes suggests a new approach called Save A Victim Everywhere (SAVE). In the SAVE model, which has been used successfully by volunteer firemen and neighborhood crime watch groups, there would be teams of neighbors trained to administer CPR and deliver treatment with automated external defibrillators. Even those not trained in CPR can make a difference, an observational study in the same issue found. In the first investigation to evaluate whether dispatcher assistance was associated with improved survival in cardiac arrest, researchers found that the chances of survival among those who received dispatcher-assisted CPR approached that of persons who received bystander CPR without dispatcher assistance (from citizens previously trained in CPR).
Preliminary results of this study were recently presented at the American Heart Association’s Scientific Sessions 2001.
Using survival-to-hospital discharge data among a group of 7,265 people who experienced cardiac arrest, researchers found that dispatcher-assisted bystander CPR was associated with an approximately 45 percent improvement in survival to hospital discharge compared to those who received no CPR before EMS arrival. Lead author Thomas D. Rea, M.D., MPH, an epidemiologist at the Seattle-King County Department of Public Health and assistant professor of internal medicine at the University of Washington, says, “A relatively small portion of people who suffer cardiac arrest receive CPR by a citizen (layperson without medical training) prior to the arrival of emergency personnel. Efforts to increase the number of cardiac arrest victims who receive bystander CPR could improve overall survival.”
According to Rea, citizens who perform CPR traditionally have received formal prior instruction in CPR. In an effort to increase the proportion of cardiac arrest victims who receive bystander CPR, King County 911 dispatchers have been trained since 1983 to provide “on-the-spot” training to callers reporting a potential cardiac arrest.
Rea and his coauthors have been tracking those who received citizen CPR as a result of dispatcher “on-the-spot” instruction and evaluated cases of adult cardiac arrest occurring from 1983 to 2000 in King County. Forty-four percent of the individuals received no bystander CPR before EMS arrival, 26 percent received dispatcher-assisted CPR and 30 percent received bystander CPR without dispatcher assistance.
Overall survival was 15 percent. Compared to individuals who received no bystander CPR, survival was 45 percent greater among those who received dispatcher-assisted CPR and 69 percent greater for those who had bystander CPR without the aid of the dispatcher.
“Given the considerable health burden of cardiac arrest, these results have public health implications suggesting that dispatcher-assisted CPR could save hundreds or even thousands of lives each year in the United States,” says Rea.
Co-authors are Mickey S. Eisenberg, M.D., Ph.D.; Linda L. Culley and Linda Becker, M.A.
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