End of life IssuesHeart DiseaseProcedures

ON-SITE CPR IMPROVES SURVIVAL

CPR stands for Cardiopulmonary Resuscitation. It is the physical process of attempting to restore a person’s heart and lung activity in an emergency; a life-threatening situation where the heart has stopped and breathing has ceased. This discussion is not about the steps taken to accomplish a successful resuscitation but rather to report on the rate of success of this procedure. The goal is to determine what percentage of patients undergoing CPR actually survive to be discharged from the hospital, the percentage who are discharged without neurologic problems, and whether it’s better to do CPR at the scene of the cardiac arrest or immediately transport the patient to the ER.

During a cardiac arrest a patient essentially dies, or certainly is on his way to dying. CPR attempts to reverse that situation. In an assessment of nearly 44,000 patients the following facts were noted:

86% of cardiac arrests occurred in a “private location”—home, hospital, etc.

37% occurred in women—men ignore warning signs

49% were witnessed by bystanders or emergency personnel—help was imminent

22% had rhythms that could be shocked back to normal

26% were transported to ER immediately, then given CPR

Of the 44K patients, 27,705 had similar circumstances. The success rates for CPR done on site were compared to the results of immediate transport, and the following conclusions reached.

Survival to Hospital Discharge:

On-site CPR—8.5% survived to hospital discharge

Immediate transport—4.0% survived to hospital discharge

Twice as many survived with on-site CPR

Survival Without Neurologic Deficit (Damage):

On-site CPR—7.1% had no neurological deficit

Immediate transport—2.9% had no neurologic deficit

Two-and-a-half times better outcome with on-site CPR

I think these authors were desperate to find something to write about. How often do you see EMT’s just stick someone in an ambulance and head for the ER without attempting to stabilize them by CPR first? Rarely! In this study, it was said to be done 26% of the time. Really?

Sudden cardiac arrest is a low-success-rate scenario to begin with. Those that are witnessed have an advantage of getting help more rapidly, but those that are not have poor outcomes. It only takes four minutes of anoxia (no oxygen to the brain) to begin causing brain damage. Longer episodes are devastating. Of the entire 44K group of patients, 12.6% of those with on-site CPR survived to hospital discharge while only 3.8% of immediate transport patients survived.

CPR is a desperate measure performed in a desperate situation. It makes obvious sense that it should always be performed before a patient is whisked off to the ER. Yes, successful resuscitations occur in a small minority of cardiac arrests, but at least, an effort was made to sustain life, stabilize the patient, and give the individual a chance to live on. That’s what should be done, and thankfully is done.

Reference: Grunau B, Kime N, et al. Association of Intra-arrest Transport vs. Continued On-scene Resuscitation with Survival to Hospital Discharge Among Patients with Out-of-Hospital Cardiac Arrest. JAMA 2020 Sep 15;324(11):1058-1067.

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