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Compress the Chest: Better CPR Improves Survival from Out-of-Hospital Cardiac Arrest

Implementation of the 2005 AHA CPR guidelines that focus on uninterrupted chest compressions nearly doubled the odds of survival among patients with out-of-hospital cardiac arrest.

In 2005, the American Heart Association (AHA) released updated evidence-based guidelines for cardiopulmonary resuscitation and emergency cardiovascular care, but does adherence to the revised protocol improve outcomes? Investigators compared rates of survival from out-of-hospital cardiac arrest among 606 adult patients treated before and 1021 treated after implementation of the 2005 AHA guidelines in a single large emergency medical services system.

Review of a convenience sample of 69 electronic electrocardiogram recordings showed significant improvement in CPR quality after guideline implementation, including improvements in mean chest-compression rate, proportion of time that patients received chest compressions, and median preshock and postshock pause times for compressions. Unadjusted rates of survival to hospital discharge were significantly higher after implementation of the guidelines than before (9.4% vs. 6.1%). Among patients with witnessed arrest whose initial rhythm was ventricular fibrillation on EMS arrival, survival rates improved significantly from 24% (19 of 78) before implementation to 30% (34 of 112) after. Multivariate regression analysis that adjusted for initial rhythm, sex, arrest location, and witnessed arrest showed 1.8 greater odds of survival in the postintervention period.

Comment: The promising results of this large study suggest the AHA was on the right track with its renewed focus on basic CPR, including the importance of providing uninterrupted chest compressions.

— Kristi L. Koenig, MD, FACEP

Published in Journal Watch Emergency Medicine October 23, 2009

Citation(s):

Sayre MR et al. Impact of the 2005 American Heart Association cardiopulmonary resuscitation and emergency cardiovascular care guidelines on out-of-hospital cardiac arrest survival. Prehosp Emerg Care 2009 Oct-Dec; 13:469.

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Reader Remarks:

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• continuous CPR
  Bernard A Yablin, URMC-retired, 26 Oct 2009 12:04 PM EST
  To what extent should these recommendations apply to nursing home populations with already complex medical preoblems?
• Discharge Neurologic Status
  Harold M. Adelman, 26 Oct 2009 5:35 PM EST
  Did the patients given 2005 CPR guidlines CPR have better neurologic function than those given pre-2005 CPR?
• CPR and Emergency Medicine
  B A Tanagho, 26 Oct 2009 5:46 PM EST
  Maybe one should co relate the need of cpr to ICU admission barriers to decide which people should be allowed... [more]
• Chest Compression ONLY CPR
  Frank Rajan Kalappurackal, St Rita's Hospital, Changanacherry, 27 Oct 2009 2:04 PM EST
  Thia is indeed a revolutionary idea as important as discovering CPR irself. It saves not only time but also LIVES... [more]