Bystander and first responder intervention has increased the survival of patients who experience out-of-hospital cardiac arrest, according to two studies in the July 21 issue of JAMA.
In the first study, researchers examined association between bystander intervention and changes in neurologically intact survival among patients with OHCA in Japan. They used data from the nationwide OHCA registry, started in January 2005, which includes patients with OHCA transported to the hospital by emergency medical services and recorded patients’ characteristics, prehospital interventions and outcomes.
Interventions included defibrillation using public-access automated external defibrillators and chest compression.
Researchers studied 167,912 patients with bystander-witnessed OHCA between January 2005 and December 2012. Researchers found the number of visits during this period increased, and rate of bystander chest compression/bystander-only defibrillation combined with EMS defibrillation increased.
Results showed an increase in the number of bystander-witnessed OHCAs of presumed cardiac origin from 17,882 to 23,797; and an increase in neurologically intact survival from 587 cases to 1,710 cases. Rates of bystander chest compression increased from 38.6% to 50.9%; bystander-only defibrillation increased from 0.1% to 2.3%; bystander defibrillation combined with EMS defibrillation increased from 0.1% to 1.4%; and EMS-only defibrillation decreased from 26.6% to 23.5%.
In addition, the likelihood of neurologically intact survival improved from 3.3% to 8.2%, but remained low.
Increase in neurologically intact survival was associated with bystander defibrillation and chest compressions.
Researchers say an increase in chest compressions should be promoted.
“In Japan, it is used in just 50% of patients and is increasing slowly,” researchers wrote. “Simplifying the basic life support procedure by omitting mouth-to-mouth breathing may have reduced hesitancy and increased its use.”
Researchers concluded facilitating chest compression has an economic advantage over deployment of expensive public-access AEDs. They added that fire departments provide training to more than 1,400,000 citizens every year to increase the prevalence of skills in basic resuscitation procedures, including chest compression and AED use.
“This effort should be further strengthened,” they said.
Meanwhile, a three-year study conducted in the U.S. found the combination of bystander CPR and first-responder defibrillation increased from 14% to 23% from 2010 to 2013, and survival with favorable neurological outcome increased from 7% to 10%, associated with bystander-initiated CPR.
Bystander and first-responder interventions were associated with higher survival to hospital discharge, the study showed.
Researchers looked at 4,961 patients with out-of-hospital cardiac arrest for whom resuscitation was attempted and who were identified through the Cardiac Arrest Registry to Enhance Survival.
First responders included police, firefighters, rescue squad or lifesaving crew trained to perform basic life support until EMS arrival. Statewide initiatives, including training the general public and professional first responders, have been in place to improve interventions, the study stated.
“Our study presents novel findings indicating that improvements in bystander and first-responder CPR and defibrillation are both associated with increased survival,” the authors wrote. “Our findings suggest the possibility of improving outcomes by strengthening first-responder programs, in addition to increasing the number of bystanders who could then provide CPR, including those assisted by emergency dispatchers, and by improving EMS systems.”
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