Public education of CPR, defibrillation improves survival rates for out-of-hospital cardiac arrests

Increasing educational public health initiatives across 16 North Carolina counties resulted in improved response to out-of-hospital cardiac arrest (OHCA) and better rates of survival, a study published in JAMA Cardiology reports.

Nearly 400,000 Americans fall subject to OHCA annually, lead author Christopher B. Fordyce, MD, MHS, MSc, and colleagues wrote in the study, and just 10 percent of those patients survive to hospital discharge. Although at-home cardiac arrests are more common—making up about 80 percent of all OCHAs—patients who experience cardiac arrest in their homes are four to five times less likely to survive than individuals who experience OHCA in public places.

“Although most OHCAs occur at home, historical outcomes have been significantly worse compared with public OHCAs,” Fordyce and co-authors wrote. “This finding has increased urgency to identify strategies for improving survival among these particularly vulnerable patients.”

To that end, Fordyce and his team reviewed records of 8,269 patients across North Carolina who experienced an OHCA between 2010 and 2014 and evaluated how outside parties responded to the emergencies. The majority of patients—67.7 percent—were at home during their cardiac arrests, while 32.3 percent were in public at the time. The average subject was between 64 and 68 years old.

The researchers focused on the impact of several public health initiatives, including training members of general communities in CPR and the user of automated external defibrillators, teaching first responders about team-based and high-performance CPR, and educating dispatch centers on recognition of cardiac arrest.

After these efforts to educate the public and raise awareness of OHCA, Fordyce and colleagues found an uptick in survival rates for OHCA patients, especially those who’d had at-home cardiac arrests. The amount of patients receiving bystander CPR at home increased from 28.3 percent to 41.3 percent, the authors wrote, and the percentage of first-responder defibrillation increased, too, from 42.2 percent to 50.8 percent.

In public settings, bystander CPR rates climbed from 61 percent to 70.5 percent, but emergency team responses to public OHCAs saw a slower improvement, shifting from 33.1 percent to 37.8 percent.

Fordyce and colleagues also found survival to hospital discharge improved at home by 2.4 percent. When compared with emergency medical services-administered CPR and resuscitation, the authors noted, survival was improved for patients who received bystander CPR or first-responder defibrillation.

“Initiatives to improve bystander CPR and early defibrillation are associated with better outcomes for OHCAs at home, where the prognosis has traditionally been poor,” Fordyce and colleagues wrote. “Adopting some of these public health initiatives may likely be helpful for communities aiming to improve outcomes of OHCA.”