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A statewide Arizona program that officially endorsed chest-compression-only CPR significantly increased rates of bystander CPR and of patient survival in cases of cardiac arrest, according to a new report in the Oct. 6 issue of JAMA.
“Encouraging a technique that is easier to perform and more acceptable to the public may have helped increase the CPR rate independent of the public education efforts,” said Dr. Bentley J. Bobrow of the Arizona Department of Health Services, Phoenix, and his associates.
Nationally, bystander CPR of any kind is performed in less than 30% of cases. It is thought that bystanders refrain from providing conventional CPR for a variety of reasons, including fear of causing harm, fear of contracting infectious disease, the complexity of the psychomotor task, panic, and reluctance to make mouth-to-mouth contact, they noted.
Beginning in 2005, the investigators conducted a 5-year prospective, observational cohort study to evaluate the effects of implementing the state program, which advocated compression-only CPR through many types of training and information dissemination. “We estimate that at least 30,000 people have been directly trained in the [compression-only] technique and that more than 500,000 were exposed to at least one media forum,” Dr. Bobrow and his colleagues said (JAMA 2010;304:1447-54).
Emergency medical services personnel who responded to calls for out-of-hospital cardiac arrests recorded whether bystanders performed resuscitative measures and which techniques they used. The researchers then assessed outcomes for 4,415 cases that occurred during the next 5 years.
In 2,900 of those cases, there was no bystander CPR. Lay bystanders performed conventional CPR in 666 cases (15%) and compression-only CPR in 849 cases (19%). The overall survival rate was 7%.
After the program was implemented, the rate of lay bystanders performing any type of CPR rose significantly, from 28% at the beginning of the study to 40% at the end of the study period.
The proportion of bystander compression-only CPR attempts rose dramatically, from approximately 20% in 2005 to 76% at the end of 2009, the investigators said.
Survival increased concomitantly, from 3.7% at baseline to 9.8% at the end of the study. Both types of bystander CPR were associated with improved survival, compared with no bystander CPR.
In the subgroup of 1,017 patients with the best prognoses – those whose cardiac arrest was witnessed by a lay bystander and who had a shockable rhythm when the EMS arrived – survival was 17.6% with no CPR and 17.7% with conventional CPR, compared with 33.7% with compression-only CPR.
In addition, survivors attained good neurologic outcomes in 62 of 814 cases with bystander compression-only CPR (7.6%), compared with 34 of 651 cases with bystander conventional CPR (5.2%). That difference was small but significant, Dr. Bobrow and his associates said.
Disclosures: Dr. Cone reported no financial conflicts.
This important observational study is the first to show a survival benefit with compression-only CPR, said Dr. David C. Cone.
Over time, both the proportion of patients who received bystander CPR and the proportion who received compression-only CPR increased significantly. But “more importantly, the overall likelihood of survival to hospital discharge was higher among those receiving compression-only CPR than those receiving standard CPR (13.3% vs 7.8%, respectively),” he said.
“Even though the survival benefit was modest, this finding is important when considering that the survival rate from out-of-hospital cardiac arrest has remained dismally low despite decades of study,” Dr. Cone noted.
He added that improved survival without any loss in neurologic outcomes “must be considered an overall gain,” even though some may have hoped instead for better neurologic outcomes than are achieved with conventional CPR.
David C. Cone, M.D., is in the department of emergency medicine at Yale University, New Haven, Conn. He reported no financial disclosures. These comments are taken from his editorial that accompanied Dr. Bowbrow’s report (JAMA 2010;304:1493-5).
This important observational study is the first to show a survival benefit with compression-only CPR, said Dr. David C. Cone.
Over time, both the proportion of patients who received bystander CPR and the proportion who received compression-only CPR increased significantly. But “more importantly, the overall likelihood of survival to hospital discharge was higher among those receiving compression-only CPR than those receiving standard CPR (13.3% vs 7.8%, respectively),” he said.
“Even though the survival benefit was modest, this finding is important when considering that the survival rate from out-of-hospital cardiac arrest has remained dismally low despite decades of study,” Dr. Cone noted.
He added that improved survival without any loss in neurologic outcomes “must be considered an overall gain,” even though some may have hoped instead for better neurologic outcomes than are achieved with conventional CPR.
David C. Cone, M.D., is in the department of emergency medicine at Yale University, New Haven, Conn. He reported no financial disclosures. These comments are taken from his editorial that accompanied Dr. Bowbrow’s report (JAMA 2010;304:1493-5).
This important observational study is the first to show a survival benefit with compression-only CPR, said Dr. David C. Cone.
Over time, both the proportion of patients who received bystander CPR and the proportion who received compression-only CPR increased significantly. But “more importantly, the overall likelihood of survival to hospital discharge was higher among those receiving compression-only CPR than those receiving standard CPR (13.3% vs 7.8%, respectively),” he said.
“Even though the survival benefit was modest, this finding is important when considering that the survival rate from out-of-hospital cardiac arrest has remained dismally low despite decades of study,” Dr. Cone noted.
He added that improved survival without any loss in neurologic outcomes “must be considered an overall gain,” even though some may have hoped instead for better neurologic outcomes than are achieved with conventional CPR.
David C. Cone, M.D., is in the department of emergency medicine at Yale University, New Haven, Conn. He reported no financial disclosures. These comments are taken from his editorial that accompanied Dr. Bowbrow’s report (JAMA 2010;304:1493-5).
A statewide Arizona program that officially endorsed chest-compression-only CPR significantly increased rates of bystander CPR and of patient survival in cases of cardiac arrest, according to a new report in the Oct. 6 issue of JAMA.
“Encouraging a technique that is easier to perform and more acceptable to the public may have helped increase the CPR rate independent of the public education efforts,” said Dr. Bentley J. Bobrow of the Arizona Department of Health Services, Phoenix, and his associates.
Nationally, bystander CPR of any kind is performed in less than 30% of cases. It is thought that bystanders refrain from providing conventional CPR for a variety of reasons, including fear of causing harm, fear of contracting infectious disease, the complexity of the psychomotor task, panic, and reluctance to make mouth-to-mouth contact, they noted.
Beginning in 2005, the investigators conducted a 5-year prospective, observational cohort study to evaluate the effects of implementing the state program, which advocated compression-only CPR through many types of training and information dissemination. “We estimate that at least 30,000 people have been directly trained in the [compression-only] technique and that more than 500,000 were exposed to at least one media forum,” Dr. Bobrow and his colleagues said (JAMA 2010;304:1447-54).
Emergency medical services personnel who responded to calls for out-of-hospital cardiac arrests recorded whether bystanders performed resuscitative measures and which techniques they used. The researchers then assessed outcomes for 4,415 cases that occurred during the next 5 years.
In 2,900 of those cases, there was no bystander CPR. Lay bystanders performed conventional CPR in 666 cases (15%) and compression-only CPR in 849 cases (19%). The overall survival rate was 7%.
After the program was implemented, the rate of lay bystanders performing any type of CPR rose significantly, from 28% at the beginning of the study to 40% at the end of the study period.
The proportion of bystander compression-only CPR attempts rose dramatically, from approximately 20% in 2005 to 76% at the end of 2009, the investigators said.
Survival increased concomitantly, from 3.7% at baseline to 9.8% at the end of the study. Both types of bystander CPR were associated with improved survival, compared with no bystander CPR.
In the subgroup of 1,017 patients with the best prognoses – those whose cardiac arrest was witnessed by a lay bystander and who had a shockable rhythm when the EMS arrived – survival was 17.6% with no CPR and 17.7% with conventional CPR, compared with 33.7% with compression-only CPR.
In addition, survivors attained good neurologic outcomes in 62 of 814 cases with bystander compression-only CPR (7.6%), compared with 34 of 651 cases with bystander conventional CPR (5.2%). That difference was small but significant, Dr. Bobrow and his associates said.
Disclosures: Dr. Cone reported no financial conflicts.
A statewide Arizona program that officially endorsed chest-compression-only CPR significantly increased rates of bystander CPR and of patient survival in cases of cardiac arrest, according to a new report in the Oct. 6 issue of JAMA.
“Encouraging a technique that is easier to perform and more acceptable to the public may have helped increase the CPR rate independent of the public education efforts,” said Dr. Bentley J. Bobrow of the Arizona Department of Health Services, Phoenix, and his associates.
Nationally, bystander CPR of any kind is performed in less than 30% of cases. It is thought that bystanders refrain from providing conventional CPR for a variety of reasons, including fear of causing harm, fear of contracting infectious disease, the complexity of the psychomotor task, panic, and reluctance to make mouth-to-mouth contact, they noted.
Beginning in 2005, the investigators conducted a 5-year prospective, observational cohort study to evaluate the effects of implementing the state program, which advocated compression-only CPR through many types of training and information dissemination. “We estimate that at least 30,000 people have been directly trained in the [compression-only] technique and that more than 500,000 were exposed to at least one media forum,” Dr. Bobrow and his colleagues said (JAMA 2010;304:1447-54).
Emergency medical services personnel who responded to calls for out-of-hospital cardiac arrests recorded whether bystanders performed resuscitative measures and which techniques they used. The researchers then assessed outcomes for 4,415 cases that occurred during the next 5 years.
In 2,900 of those cases, there was no bystander CPR. Lay bystanders performed conventional CPR in 666 cases (15%) and compression-only CPR in 849 cases (19%). The overall survival rate was 7%.
After the program was implemented, the rate of lay bystanders performing any type of CPR rose significantly, from 28% at the beginning of the study to 40% at the end of the study period.
The proportion of bystander compression-only CPR attempts rose dramatically, from approximately 20% in 2005 to 76% at the end of 2009, the investigators said.
Survival increased concomitantly, from 3.7% at baseline to 9.8% at the end of the study. Both types of bystander CPR were associated with improved survival, compared with no bystander CPR.
In the subgroup of 1,017 patients with the best prognoses – those whose cardiac arrest was witnessed by a lay bystander and who had a shockable rhythm when the EMS arrived – survival was 17.6% with no CPR and 17.7% with conventional CPR, compared with 33.7% with compression-only CPR.
In addition, survivors attained good neurologic outcomes in 62 of 814 cases with bystander compression-only CPR (7.6%), compared with 34 of 651 cases with bystander conventional CPR (5.2%). That difference was small but significant, Dr. Bobrow and his associates said.
Disclosures: Dr. Cone reported no financial conflicts.
FROM JAMA