Intervention improves survival following out-of-hospital cardiac arrest

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 - ambulance, EMS

A statewide intervention in North Carolina improved survival and led to an increased number of people receiving bystander and first-responder-initiated CPR and defibrillation following out-of-hospital cardiac arrest. The efforts were enacted after the American Heart Association issued a policy statement in 2010 asking for regional centers to care for patients who suffer from cardiac arrest.

Fewer than 10 percent of people survive after out-of-hospital cardiac arrest, according to lead researcher Carolina Malta Hansen, MD, of the Duke Clinical Research Institute in Durham, N.C. She added that without interventions, the chances of survival decrease approximately 10 percent per minute.

However, approximately half of patients survive if CPR and defibrillation with automated external defibrillators (AEDs) are delivered within the first few minutes. Hansen and colleagues published their results online in JAMA on July 21.

With ambulance response times typically between 8 and 15 minutes, Hansen said training bystanders and first-responders is important to improve survival.

First-responders were defined as police officers, firefighters, rescue squad and life-saving crew who were trained to perform CPR until the EMS arrived and transported patients to the hospital. Bystanders were other people who intervened following out-of-hospital cardiac arrest.

“It’s a really time sensitive issue,” Hansen told Cardiovascular Business. “The chances of survival rely entirely on initiating CPR and performing defibrillation within the first few minutes.”

During the past 20 to 30 years, multiple initiatives to increase bystander CPR and first-responder programs have been implemented in the U.S., although Hansen said most of them have been implemented in large metropolitan areas such as Chicago and Seattle.

In this analysis, the researchers identified 4,961 patients from the CARES (Cardiac Arrest Registry to Enhance Survival) registry who had out-of-hospital cardiac arrest in 11 counties in North Carolina. All patients had resuscitation attempted on them. The median age was 65, and 61.7 percent of patients were men.

In 2010, North Carolina initiated the RACE-CARS (North Carolina Regional Approach to Cardiovascular Emergencies Cardiac Arrest Resuscitation System) program, in which the state trained bystanders and first-responders on identifying cardiac arrest and using and initiating CPR and AEDs.

Between 2010 and 2013, the proportion of patients receiving bystander-initiated CPR and first-responder defibrillation increased from 14.1 percent to 23.1 percent, while survival with favorable neurological outcomes increased from 7.1 percent to 9.7 percent.

The survival rates were 33.6 percent following bystander-initiated CPR and defibrillation, 25.2 percent following first-responder CPR and defibrillation, 24.2 percent following bystander CPR and first-responder defibrillation and 15.2 percent following EMS-initiated CPR and defibrillation.

“For many years, there has basically been no development whatsoever in outcomes for cardiac arrest patients except for in metropolitan areas where very strong initiatives were put in,” Hansen said. “This is very encouraging because we could see that following these statewide and multi-faceted initiatives to improve care and outcomes, we actually saw an improvement in all of the links of the chain of survival.”

Hansen said improving survival following cardiac arrest depends on a few factors. First, people need to identify that someone is having cardiac arrest, which she said is sometimes not clear. People should then call 911, initiate CPR, deliver a shock with an AED as soon as possible and continue with additional medical treatment in the ambulance and hospital.

“The whole process of care for these patients is really complicated and has been very difficult because it’s so fragmented in the U.S.,” Hansen said. “What this initiative was able to do was try to integrate everybody and build one system so everybody felt like they were part of this one system of care.”