Bystander CPR Boosts Cardiac Arrest Survival

Bystanders who initiate cardiopulmonary resuscitation (CPR) improve survival and neurological outcomes for patients experiencing out-of-hospital cardiac arrest (OHCA).

Following statewide initiatives to improve bystander and first-responder resuscitation efforts in North Carolina, researchers reviewed survival outcomes for 4961 OHCA patients who received CPR from bystanders and first responders before being transported to the hospital by emergency medical services.

In this study, “bystanders” were defined as other persons who were present at the scene and intervened but had not been dispatched, while “first responders” were defined as “personnel who responded to the medical emergency in an official capacity as part of an organized medical response team but who were not the designated transporter of the patient to the hospital.”

OHCA patients resuscitated by bystanders and first responders were more likely to achieve sustained return of spontaneous circulation, survive to discharge, and ultimately live with a positive neurological outcome, the researchers found. When the study results were controlled for the group initially administering CPR, however, survival with favorable neurological outcomes only increased over the 4-year study period among OHCA patients who received bystander-initiated CPR.

In this study period, 45.7% of OHCA patients received CPR from bystanders prior to EMS arrival, compared with 40.6% from first responders. By the end of the study period, the number of those receiving bystander-initiated CPR significantly increased from 39.3% in 2010 to 49.4% in 2013. Conversely, both first responder- and EMS-initiated CPR decreased in this same period.

Lead study author Carolina Malta Hansen, MD, told Pharmacy Times that these results showcase how CPR training can help improve outcomes for cardiac arrest patients.

“Following 4 years of multifaceted statewide intervention, bystander CPR, first responder defibrillation, and the combination of those increased substantially over this short period,” she noted.

In an accompanying editorial, Graham Nichol, MD, MPH, FRCP, and Francis Kim, MD, wrote that “further improvements in outcomes will require additional coordinated efforts to improve resuscitation care.”

“Despite increased knowledge and use of bystander CPR as well as improved survival over time, ongoing efforts are needed to improve outcomes after OHCA,” they wrote.

Both the study and editorial appeared in JAMA.