Improvements to the "chain of survival" increased survival and decreased residual neurological damage in out-of-hospital cardiac arrest patients in Japan, researchers report in Circulation: Journal of the American Heart Association.
Researchers considered 8,782 bystander-witnessed cardiac arrests from May 1998 to December 2006 in Osaka, Japan. During this time period, Japanese citizens received training in cardiopulmonary resuscitation (CPR), dispatcher instruction in CPR was introduced and procedures were changed to allow emergency service personnel to deliver shocks with a defibrillator without online physician oversight and to intubate patients in the field. Intubation is the placement of a flexible plastic tube into the trachea to protect the patient's airway and provide a means of mechanical ventilation.
As a result, the researchers said:
- One-month survival of witnessed cardiac arrests rose from 5 percent to 12 percent, an improvement over past reports in which out-of-hospital cardiac arrest survival doesn't exceed 5 percent in most communities and only 3 percent in urban areas.
- The median time from collapse to CPR decreased from 9 to 7 minutes due to citizen training.
- Bystander-initiated CPR increased from 19 percent to 36 percent.
- The neurologically intact one-month survival after witnessed ventricular fibrillation (VF) arrest increased from 6 percent to 17 percent.
- The median time from collapse to calling emergency services decreased from 4 to 2 minutes.
- The median time from collapse to first shock dropped from 19 to 9 minutes.
- Median time to intubation remained at 25 minutes, but only took 15 minutes when specially trained paramedics were available.
The links in the chain of survival are:
- Early recognition of the emergency and activation of the emergency medical services "phone 9-1-1".
- Early bystander CPR.
- Early delivery of a shock with a defibrillator
- Early advanced life support followed by post resuscitation care delivered by healthcare providers.
In Osaka (population, 8.8 million), about 120,000 citizens per year participated in conventional CPR training. There were no programs to train in compression-only CPR during this study period.
Only 24 patients received shocks administered by bystanders during this period, but the researchers expect this to increase with further spread of AEDs and training of the general public.
"We need to increase the number of automated external defibrillators in public places as well as train people in not only CPR but in use of AEDs," Iwami said. "In many areas of the world, there are serious delays in the use of CPR and AEDs. We hope this study encourages other EMS systems to start or continue their efforts to improve based on objective data."
In the United States, nearly 300,000 cardiac arrest victims are treated outside the hospital by EMS per year, according to the American Heart Association. About 8 percent of cardiac arrest victims survive to hospital discharge.
The Japanese Ministry of Education, Science, Sports, and Culture and The Japanese Ministry of Health, Labor and Welfare funded the study.
Co-authors are: Graham Nichol, M.D., M.P.H.; Atsushi Hiraide, M.D., Ph.D.; Yasuyuki Hayaski, M.D., Ph.D.; Tatsuya Nishiuchi, M.D.; Kentaro Kajino, M.D., Ph.D.; Hiroshi Morita, M.D., Ph.D.; Hidekazu Yukioka, M.D., Ph.D.; Hisashi Ikeuchi, M.D., Ph.D.; Hisashi Sugimoto, M.D., Ph.D.; Hiroshi Nonogi, M.D., Ph.D.; and Takashi Kawamura, M.D., Ph.D. Individual author disclosures are available on the manuscript.
The American Heart Association's guidelines recommend hands-only CPR for anyone who is unwilling or unable to provide ventilations while providing chest compressions. Experts continue to promote a combination of rescue breathing and chest compressions for victims of cardiac arrest due to non-cardiac causes, like near-drowning or electrocution, and for all victims of pediatric cardiac arrest. To find a CPR training class, visit http://www.americanheart.org/cpr.
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NR09 - 1009 (Circ/Iwami)
Source: Karen Astle
American Heart Association