Chance of Surviving Out-of-Hospital Cardiac Arrest
Unimproved Since Seniors Were Kids
Reviving a pulse beat at the scene is best
chance of survival; dismal trend considering enormous spending on heart
research, new emergency care protocols, new drugs, devices such as
defibrillators
Dec.
3, 2009 - The chance of surviving an out-of-hospital cardiac arrest has
not improved since the 1950s, when most of today’s senior citizens were
still school kids, according to a report by the University of Michigan
Health System.
It's a dismal trend considering enormous spending on
heart research, new emergency care protocols, and the advent of new
drugs and devices such as defibrillators.
The analysis shows only 7.6 percent of victims
survive an out-of-hospital cardiac arrest, a number that has not changed
significantly in years.
Each year, 166,000 people experience cardiac arrest
– an event during which the heart stops beating – away from a hospital.
Physicians report in the current issue of
Circulation: Cardiovascular Quality and Outcomes that there are some
key factors that can make a difference in saving lives when cardiac
arrest happens at home, a hotel, restaurant or workplace.
"Our study shows that patients with a heart rhythm
that can be shocked, or who have bystander CPR or a pulse restored at
the scene have a much greater chance of survival," says lead author
Comilla Sasson, M.D., a Robert Wood Johnson Scholar and emergency
medicine physician at the U-M Health System.
Although half of cardiac arrests are witnessed by a
bystander, according to the study, only 32 percent, or about 1 in every
3 people, is receiving bystander CPR.
This is the first study that looks at the
associations between five clinical variables and overall survival from
an out-of-hospital cardiac arrest.
The American Heart Association 2005 Guidelines for
Cardiopulmonary Resuscitation and Emergency Cardiovascular Care were
released in November 2005.
The variables studied include: witnessed by
emergency medical services provider, bystander CPR, types of heart
rhythm - asystole (motionless) vs. ventricular fibrillation (rapid or
twitching) and return of spontaneous circulation.
Researchers evaluated data on 142,740 patients from
79 studies published internationally between January 1950 and August
2008.
Here's what researchers found:
● Of the more than 140,000 patients, only 23.8
percent survived to hospital admission, and 7.6 percent, or about 1 in
10 people, lived to be discharged from the hospital.
● Cardiac arrest victims who received CPR from a
bystander or an emergency medical services provider, and those who had a
shockable heart rhythm, referred to as ventricular fibrillation, were
more likely to survive.
● The strongest predictor of survival was a
return of spontaneous circulation, meaning a pulse was restored at the
scene. Among them, 15.5 percent (in low-performing EMS systems) to 33.6
percent (in high performing EMS systems) survived.
Survival to hospital discharge was more likely
among those:
● witnessed by a bystander (6.4% to 13.5%),
● witnessed by EMS (4.9% to 18.2%),
● who received bystander CPR (3.9% to 16.1%),
● were found in ventricular fibrillation/ventricular tachycardia
(14.8% to 23.0%), or
● achieved return of spontaneous circulation (15.5% to 33.6%).
"Increasing bystander CPR rates, increasing the
awareness and use of devices to shock the heart, and keeping paramedics
on scene until they restore a person's pulse needs to occur if we are
ever going to change our dismal survival rate," Sasson says.
‘For the first few minutes, it’s probably right
just to push on the chest. But at some point you probably need to add
oxygen, however you can’
Nov. 30, 2009 – A study released today adds to the
efforts to find a cardiopulmonary resuscitation method that is effective
and easy to use. The favored CPR method had been a combination of chest
compressions and blowing of air into the victim’s lungs. Recently,
however, the American Heart Association has been reviewing chest
compressions alone as an acceptable alternative. This new report says,
however, that the victim is going to need some oxygen during this
process to survive.
Read more...
Places like Seattle, which has the highest rates of
cardiac arrest survival in the country, are doing these three basic
things exceptionally well, says the U-M physician. "We can learn a lot
from that emergency response system," she says.
The lack of progress in survival across the U.S.
and abroad may be linked to an aging population, a lower number of
people who are found in a shockable rhythm, which is associated with the
highest chance of survival, and longer EMS drives due to the increasing
size of cities and traffic congestion, authors write.
While the overall rate of out-of-hospital cardiac
arrest survival has not improved, the field of cardiac and cerebral
resuscitation is rapidly evolving.
Most of the studies in the analysis were conducted
before the advent of therapeutic hypothermia, a body cooling treatment
that has shown to benefit resuscitated patients. U-M C.S. Mott
Children's Hospital is leading a clinical trial to evaluate therapeutic
hypothermia to prevent brain damage in children who have cardiac arrest.
Studies did not distinguish between patients
treated with traditional CPR and those cared for under new American
Heart Association guidelines for CPR which emphasizes chest compressions
over mouth-to-mouth resuscitation.
Others authors were Mary A.M. Rogers, Ph.D.,
University of Michigan Department of Internal Medicine; Jason Dahl,
M.D., University of Rochester, Rochester, N.Y. and Arthur L. Kellerman,
M.D., MPH, Emory University, Atlanta, Ga.
Funding for the study was from the Robert Wood
Johnson Foundation
ec.
3, 2009 - The chance of surviving an out-of-hospital cardiac arrest has
not improved since the 1950s, when most of today’s senior citizens were
still school kids, according to a report by the University of Michigan
Health System. 
