Cardiac Arrest Survival Rate Almost Triples After
Efforts to Increase Bystander CPR
There was an increase in the proportion of patients
receiving bystander CPR 21.1% to 44.9%
Oct. 1, 2013 - Ten years ago a study in Denmark
found very low frequency of bystander CPR (about 20%) and low 30-day
survival (under 6%) after out-of-hospital cardiac arrest. These alarming
low rates stimulated several national initiatives to strengthen
bystander resuscitation attempts and advanced care. A recent study finds
the results virtually tripled the survival rates.
Out-of-hospital cardiac arrest affects
approximately 300,000 individuals in North America annually. Despite
efforts to improve prognosis, survival remains low, with aggregated
survival-to-discharge rates less than 8 percent, according to
background on the study in the October 2 issue of JAMA.
In many cases, time from recognition of cardiac
arrest to the arrival of emergency medical services (EMS) is long,
leaving bystanders in a critical position to potentially influence
patient prognosis through intervention before EMS arrival. Only a
minority of cardiac arrests receive bystander CPR.
This is the first study to look at the changes in
resuscitation attempts by bystanders and improvements in survival in
Denmark after 10 years of efforts.
To examine this question, Mads Wissenberg, M.D., of
Copenhagen University Hospital Gentofte, Hellerup, Denmark, and
colleagues analyzed trends in pre-hospital factors directly related to
cardiac arrest as well as trends in survival during the past 10 years.
The study included 19,468 patients with
out-of-hospital cardiac arrest for whom resuscitation was attempted. The
median (midpoint) age of patients was 72 years; 67 percent were men.
Throughout the study period, there was an increase
in the proportion of patients receiving bystander CPR (21.1 percent to
44.9 percent). The increase in proportion of people defibrillated with
an automatic defibrillator by a bystander was small (1.1 percent to 2.2
The large temporal increase in rates of bystander
CPR observed in our study is most likely attributable to the overall
increasing level of attention to resuscitation by bystanders in Denmark,
including an increase in both mandatory and voluntary first aid
training, with an estimate of more than 15 percent of the Danish
population having taken CPR courses between 2008 and 2010.
During the study period, there was an increase in
the proportion of patients alive on arrival at the hospital (7.9 percent
to 21.8 percent), as well as an increase in 30-day (3.5 percent to 10.8
percent) and 1-year (2.9 percent to 10.2 percent) survival. Bystander
CPR was positively associated with 30-day survival.
Our nationwide study had 4 major findings: rates
of bystander CPR increased substantially; survival rates at 30 days and
l year more than tripled; the number of survivors per 100,000 persons
more than doubled; and rates of defibrillation by bystanders remained
low, the authors write.
Because of the co-occurrence of other initiatives
to improve outcome after cardiac arrest, a causal relationship between
bystander CPR and survival remains uncertain.
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