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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.
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Article Info
Publication History
Accepted:
October 23,
1984
Received:
October 22,
1984
Footnotes
☆Supported in part by grants from the National Center for Health Services Research (nos. HS-04894, HS-03215, HS-04000, HS-02456, and HS-05174).
☆☆Presented at the Fifth Purdue Conference on CPR and Defibrillation, West Lafayette, Indiana, September 25–26, 1984.
Identification
Copyright
© 1985 Published by Elsevier Inc.
