Have the latest CPR guidelines improved cardiac arrest outcomes?

CPR BEFORE DEFIBRILLATION?

The researchers of the ROC evaluated 2,913 VF/VT arrests occurring from 2005 to 2007.³³ They compared a control group of victims that had less than 45 seconds of initial CPR to those victims who had 46 to 195 seconds of CPR before defibrillation. The group with chest compressions from 46 to 195 seconds prior to defibrillation had improved survival to discharge.³³

HYPOTHERMIA IN THE POSTRESUSCITATION PERIOD

Postresuscitation hypothermia has been investigated for at least 10 years, and randomized trials comparing hypothermic to normothermic management have produced encouraging findings. In two trials in which postcardiac arrest patients' temperatures were reduced to 89°F to 93°F, improvements in survival to hospital discharge and neurologic function at 6 months were seen.10,34 Recommendation for hypothermia after return of spontaneous circulation was made by consensus, and the recommendations are being implemented in many parts of the country. The need for more research continues.

SURVIVING CARDIAC ARREST: IT ALL DEPENDS ON WHERE YOU LIVE

The survival rates for out-of-hospital sudden cardiac arrest (OHSCA) vary greatly by region.³⁵ For VF arrest rates, survival varies from 7.7% to 39.9%.³⁵ In a 2008 report from the ROC, survival rates of all EMS-treated OHSCA ranged from 3% to 16.3%35 (Table 3). On a local level, many factors can contribute to these differences, including EMS response times and postresuscitation care in hospitals.³⁵ Two leading resuscitation researchers suggest that communities implement the following recommendations to improve survival rates: (1) develop a community cardiac arrest registry; (2) establish rapid dispatch for cardiac arrest; (3) implement dispatcher-telephone CPR instructions; and (4) promote early defibrillation.³⁶

CONCLUSION

Historically, many recommendations for emergency cardiac care (ECC) have been made by expert consensus based on animal studies because there were few randomized controlled trials in humans. Now, however, data emerging from large human trials have demonstrated that minimally interrupted quality chest compressions with less emphasis on ventilation are key to improving survival rates for victims of sudden cardiac arrest. By the time that the new ECC and CPR guidelines are issued in 2010, a wealth of human resuscitation outcomes data will have been made available to inform the guidelines committee; and recommended changes will likely include continuous chest compression or minimally interrupted CPR. Most importantly, it is critical for health care providers to remain current regarding standards and guidelines for basic life support and for efforts to develop public CPR training and AED programs to continue. JAAPA

David Klocko is Assistant Professor and Clinical Coordinator, Department of Physician Assistant Studies, University of Texas Southwestern Medical Center at Dallas. He has indicated no relationships to disclose relating to the content of this article.

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