Chest Compression First in Cardiac Arrest Just as
Effective as Immediate Defibrillation
In cases of long emergency response time, chest
compressions first may be best approach
by Shantell M. Kirkendoll, University of
Michigan
Sept.
10, 2010 – Chest compressions before defibrillation in patients with
sudden cardiac arrest is equally successful as immediate treatment with
an electrical defibrillator, according to a new study by the University
of Michigan Health System.
Few people who suffer cardiac arrest outside of a
hospital survive. There’s an urgent need to find ways to save lives of
those whose heart has suddenly stopped beating.
U-M physicians, along with a team of international
experts, examined two promising rescue strategies: chest compressions
first vs. defibrillation first.
Their results, published online Thursday in BMC
Journal, show that both timing strategies are effective, yet chest
compressions before defibrillation may be best in events where emergency
response times are longer than five minutes.
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“Current evidence does not support the notion that
chest compressions first prior to defibrillation improves the outcome of
patients in out-of-hospital cardiac arrest; instead it appears that both
treatments are equivalent,” says lead study author Pascal Meier, M.D.,
an interventional cardiologist at the U-M Cardiovascular Center.
One-year survival rates were higher among those who
had chest compressions first. Data also suggests chest compressions may
benefit cardiac arrests with a prolonged response time.
The study pooled data from four randomized trials
that included a total of 1,503 patients. Researchers compared patient
survival rates after emergency medical service providers performed at
least 90 seconds of chest compressions before electrical defibrillation.
“The compressions-first approach appears to be as
good as the defibrillation-first approach, especially if there are
delays to EMS arriving on-scene,” says senior author Comilla Sasson,
M.D., an emergency medicine physician researcher at the University of
Colorado. “This has major policy implications.”
Sasson continues: “Our study shows that chest
compressions matter so even more emphasis should be placed on doing
high-quality chest compressions both by laypeople providing bystander
CPR and EMS providers.”
Sasson worked on the study while at the U-M where
she created a body of work focused on out-of-hospital cardiac arrest and
resuscitation, including demographic and racial differences in cardiac
arrest survival.
EMS providers assess approximately 300,000 people
with cardiac arrest in the United States each year. Only about 8 percent
of people who have sudden cardiac arrest outside of a hospital survive.
EMS providers assess approximately 300,000 people
with cardiac arrest in the United States each year. Only about 8 percent
of people who have sudden cardiac arrest outside of a hospital survive.
There’s an urgent need to find ways to save lives of those whose heart
has suddenly stopped beating.
When administered as soon as possible, chest
compressions in conjunction with cardiopulmonary resuscitation, and, in
some cases, rapid treatment with a defibrillator — a device that sends
an electric shock to the heart to try to restore its normal rhythm — can
be lifesaving.
When delivered by EMS professionals, CPR is a
combination of rescue breathing and chest compressions to keep
oxygen-rich blood circulating until an effective heartbeat is restored.
Bystanders are encouraged to immediately begin CPR
using only chest compressions until professional help arrives, according
to the American Heart Association. In the coming weeks, the AHA is
expected to launch its 2010 guidelines for CPR and emergency
cardiovascular care.
“Based on our study, current guidelines emphasizing
early defibrillation still are important,” Meier says. “However, since
the outcomes with the chest compression-first approach were not inferior
and might be even better in the long-term, and in case of longer
response times, this study may have an impact on future guidelines.”
Notes:
Authors: Pascal Meier, M.D., U-M Health System,
Paul Baker, Ph.D., SA Ambulance Service, Eastwood, South Australia,
Australia; Daniel Jost, M.D., Service Medical D’Urgence, Paris, France;
Ian Jacobs, Ph.D., Crawley Australia, Bettina Henzi, Department of
Clinical Research, University of Bern Medical School, Bern Switzerland;
Guido Knapp, Ph.D., Department of Statistics, TU Dortmund University,
Germany; and Comilla Sasson, M.D., M.S., formerly of the U-M Health
System.
Reference: “Chest compressions before
defibrillation for out of hospital cardiac arrest: A meta-analysis of
randomized controlled clinical trials,” BMC Journal.
Funding: The study was supported by a research
grant of the Swiss National Science Foundation.
University of Michigan Cardiovascular Center
www.umcvc.org
American Heart Association Resuscitation Guideline
updates
www.heartcheckmark.biz/presenter.jhtml?identifier=3035517
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