Advertisement

Survival of out-of-hospital cardiac arrest with early initiation of cardiopulmonary resuscitation

  • Richard O. Cummins
    Correspondence
    Address reprint requests to Dr. Commins: Room 508, Smith Tower, 506 Second Ave., Seattle, WA 98104.
    Affiliations
    Department of Medicine, University of Washington, Seattle, Washington, USA.

    Department of Biostatistics, University of Washington, Seattle, Washington, USA.

    the King County Emergency Medical Services Division, King County Health Department, Seattle, Washington, USA.
    Search for articles by this author
  • Mickey S. Eisenberg
    Affiliations
    Department of Medicine, University of Washington, Seattle, Washington, USA.

    Department of Biostatistics, University of Washington, Seattle, Washington, USA.

    the King County Emergency Medical Services Division, King County Health Department, Seattle, Washington, USA.
    Search for articles by this author
  • Alfred P. Hallstrom
    Affiliations
    Department of Medicine, University of Washington, Seattle, Washington, USA.

    Department of Biostatistics, University of Washington, Seattle, Washington, USA.

    the King County Emergency Medical Services Division, King County Health Department, Seattle, Washington, USA.
    Search for articles by this author
  • Paul E. Litwin
    Affiliations
    Department of Medicine, University of Washington, Seattle, Washington, USA.

    Department of Biostatistics, University of Washington, Seattle, Washington, USA.

    the King County Emergency Medical Services Division, King County Health Department, Seattle, Washington, USA.
    Search for articles by this author
      This paper is only available as a PDF. To read, Please Download here.

      Abstract

      Records on 1,297 people with witnessed out-of-hospital cardiac arrest, caused by heart disease and treated by both emergency medical technicians (EMTs) and paramedics, were examined to determine whether or not early cardiopulmonary resuscitation (CPR) initiated by bystanders independently improved survival. Bystanders initiated CPR for 579 patients (bystander CPR); for the remaining 718 patients, CPR was delayed until the arrival of EMTs (delayed CPR). Survival was significantly better (P < 0.05) in the bystander-CPR group (32%) than in the delayed-CPR group (22%). Multivariate analysis revealed that the superior survival in the bystander-CPR group was due almost entirely to the much earlier initiation of CPR (1.9 minutes for the Bystander-CPR group and 5.7 minutes for the delayed-CPR group; P < 0.001). There were significantly more people with ventricular fibrillation (VF) in the bystander-CPR group (80%) than in the delayed-CPR group (68%); and, for people in VF, the survival rate was significantly better if they had received bystander-CPR (37% versus 29%). The authors conclude that early initiation of CPR by bystanders significantly improves survival from out-of-hospital cardiac arrest, and they suggest that it may do so by prolonging the duration of VF after collapse and by increasing cardiac susceptibility to defibrillation. The benefit of this early CPR, however, appears to exist within a rather narrow window of effectiveness. It must be started within 4–6 minutes from the time of collapse and must be followed within 10–12 minutes of the collapse by advanced life support in order to be effective.

      Keywords

      To read this article in full you will need to make a payment
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to The American Journal of Emergency Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Babbs CF
        A renaissance of CPR research.
        Crit Care Med. 1980; 8: 119
        • Luce JM
        • Cary JM
        • Ross BK
        • et al.
        New developments in cardiopulmonary resuscitation.
        JAMA. 1980; 244: 1366-1370
        • White JD
        The New CPR.
        in: Jacobson S Resuscitation. Churchill Livingstone, New York1983: 27-37
        • Weisfeldt ML
        • Chandra N
        Physiology of cardiopulmonary resuscitation.
        Annu Rev Med. 1981; 32: 435-442
        • Ditchey RV
        • Winkler JV
        • Rhodes CA
        Relative lack of coronary blood flow during closed-chest resuscitation in dogs.
        Circulation. 1982; 66: 297-302
        • Luce JM
        • Ross BK
        • O'Quin RJ
        • et al.
        Regional blood flow during cardiopulmonary resuscitation in dogs using simultaneous and nonsimultaneous compression and ventilation.
        Circulation. 1983; 67: 258-265
        • Bellamy RF
        • DeGuzman LR
        • Pedersen DC
        Coronary blood flow during cardiopulmonary resuscitation in swine.
        Circulation. 1983; 69: 174-180
        • Maier GW
        • Tyson GS
        • Olsen CO
        • et al.
        The physiology of external cardiac massage: High-impulse cardiopulmonary resuscitation.
        Circulation. 1984; 70: 86-101
        • Cummins RO
        • Eisenberg MS
        Prehospital cardiopulmonary resuscitation: is it effective?.
        JAMA. 1985; (in press)
        • Tweed WA
        • Wilson E
        Is CPR on the right track?.
        Can Med Assoc J. 1984; 131: 429-433
        • Eisenberg MS
        Who shall Live? Who Shall Die?.
        in: Eisenberg MS Bergner L Hallstrom AP Sudden Cardiac Death in the Community. Praeger Scientific, Philadelphia1984: 44-58
        • Eisenberg MS
        • Bergner L
        • Hallstrom A
        Paramedic programs and out-of-hospital cardiac arrest: I. Factors associated with successful resuscitation.
        Am J Public Health. 1979; 69: 30-38
        • Truett J
        • Cornfield J
        • Kannel WB
        A multivariate analysis of the risk of coronary heart disease in Framingham.
        J Chron Dis. 1967; 20: 511-524
        • Thompson RG
        • Hallstrom AP
        • Cobb LA
        Bystander-initiated cardiopulmonary resuscitation in the management of ventricular fibrillation.
        Ann Intern Med. 1979; 90: 737-740
        • Roth R
        • Stewart RO
        • Rogers K
        • et al.
        Out-of-hospital cardiac arrests: Factors associated with survival.
        Ann Emerg Med. 1984; 13: 237-243
        • Cobb LA
        • Werner JA
        • Trobaugh GB
        Sudden Cardiac death: I. A decade's experience with out-of-hospital resuscitation.
        Mod Concepts Cardiovasc Dis. 1980; 49: 31-36
        • Cobb LA
        • Hallstrom AP
        Community-based cardiopulmonary resuscitation: What have we learned?.
        Ann NY Acad Sci. 1982; 382: 330-342
        • Cobb LA
        • Hallstrom AO
        • Thompson RG
        • et al.
        Community cardiopulmonary resuscitation.
        Annu Rev Med. 1980; 31: 453-462
        • Carter WB
        • Eisenberg MS
        • Hallstrom AP
        • et al.
        Development and implementation of emergency CPR instructions via telephone.
        Ann Emerg Med. 1984; 13: 695-700