For those of who you believe that just doing CPR won’t help, read on. While having an AED is important, if the patient has a non-shockable rhythm, there is STILL a chance. This article is from the American Heart Association publication Circulation.
The latest major cardiopulmonary-resuscitation (CPR) study from Seattle shows that chest compressions can save the lives of people in cardiac arrest even if their arrhythmia does not respond to defibrillator shocks.
Dr Peter Kudenchuk (University of Washington, Seattle) and colleagues analyzed records of 3960 patients with nontraumatic out-of-hospital cardiac arrest resulting from nonshockable initial rhythms that were treated with CPR by emergency personnel prior to the patient reaching a hospital. “Why the study is important is that a huge emphasis has been placed on treating patients with shockable arrhythmias. That’s why these public-access defibrillators and rapid shock [methods] have evolved and been promoted and rightly so, but shockable rhythms account for only a small proportion of cardiac arrests.”
Nonshockable cardiac arrest, including asystole and so-called pulseless electrical activity, represent about 75% of sudden cardiac-arrest cases, but this is the first study to rigorously evaluate whether CPR could improve survival in this group, he said. Results of the study are published online April 2, 2012 in the AHA Publication Circulation. All of the patients in the study were determined to have a nonshockable arrhythmia after the responders tried to defibrillate their hearts. “These patients do very poorly, because the only real therapies we have to throw at them are CPR and drugs and trying to find something reversible that may have caused the rhythm,” Kudenchuk stated.
All of the patients in this study were in King County, WA from 2000 to 2010, so the study was able to compare outcomes of patients in King County before and after the release of the 2005 American Heart Association CPR guidelines that encourage uninterrupted chest compressions. The 2010 guidelines also emphasize chest compressions. Kudenchuk explained that the current CPR guidelines “provide a stronger emphasis on ongoing minimally interrupted CPR and to reduce the time that a patient is in cardiac arrest and the hands are not actively pumping the chest. In simply deploying those guidelines—there is nothing magical about it—you can almost double survival from a non-survivable disease, and that is nonshockable cardiac arrest.” The patient demographics and general resuscitation characteristics were similar between the 1774 patients treated before the release of the 2005 guidelines and the 2186 people treated later. After adjustment for potential confounders, the post-2005-guidelines patients had a 50% better chance of regaining spontaneous circulation than the earlier patients, a 56% better chance of a favorable neurological outcome, and a 85% better chance of living one year. “Although survival in this group is smaller than in those who have a shockable rhythm, in part because we don’t have good treatments for them, you can have a meaningful impact by simply applying what we know, and that’s doing good CPR,” Kudenchuk stated.
Kudenchuk serves as volunteer contributor to the International Liaison Committee on Resuscitation and the American Heart Association for development of resuscitation guidelines and receives financial support from the National Heart, Lung, and Blood Institute in his roles as a coinvestigator in the Resuscitation Outcomes Consortium. Although these organizations may have intellectual interest in the findings of this study, no funding was received nor support sought from these sources for this study. Unrestricted support from the Laerdal Foundation also contributed to the compilation and analysis of these data.
