A new cardiopulmonary resuscitation advanced cardiac life support (CPR/ACLS) protocol implemented by the Los Angeles Fire Department resulted in a 70 percent improvement in the return of spontaneous circulation, or a restarted heart, according to a study presented Monday at the American College of Emergency Physicians (AECP) conference in Chicago.
“Cardiac arrest in the out-of-hospital setting has notoriously poor outcomes because of the challenge of restarting the heart within a narrow window of time,” said study author Marc Eckstein, MD, of the Keck School of Medicine of the University of Southern California, ,and the Los Angeles Fire Department in Los Angeles. “When EMS in Los Angeles treated cardiac arrest patients with the new protocol, which emphasizes 20 minutes of advanced life support efforts on the scene prior to transport, they restored a heartbeat 29 percent of the time versus 17 percent of the time under the old protocol. We obviously want to improve upon these numbers, but this is a big step forward.”
The new protocol for patients with out-of-hospital cardiac arrest (OOHCA) calls for two minutes of CPR by first responders prior to use of an automatic external defibrillator; emphasis on continuous, uninterrupted chest compressions; provision of a minimum of 20 minutes of advanced life support efforts at the scene prior to transport; avoiding hyperventilation; and minimizing transport of patients who do not achieve return of spontaneous circulation (ROSC).
The study compared all adult patients with non-traumatic, bystander witnessed OOCHA on whom resuscitative efforts were initiated in 2000 with similar patients in 2007, after the protocols were implemented. While there were fewer incidents of OOCHA in 2007 (1,607 versus 1,700), there was a much higher percentage of ROSC (29 vs. 17 percent).
“We have considerably improved our success in resuscitating patients who suffer cardiac arrest,” Eckstein said. “It’s very encouraging that a change of protocol could show such a dramatic improvement. These changes for our first responders and paramedics, along with implementation of compression-only CPR instructions for laypersons, should continue to improve survival rates from out-of-hospital cardiac arrest. ”