Abstract
Methods: This prospective, randomised, double blinded clinical intervention trial enrolled 874 prehospital cardiopulmonary arrest patients encountered in a prehospital urban, suburban, and rural regional emergency medical service (EMS) area. This group underwent conventional advanced cardiac life support intervention followed by empiric early administration of sodium bicarbonate (1 mEq/l), monitoring conventional resuscitation parameters. Survival was measured as presence of vital signs on emergency department (ED) arrival. Data were analysed using χ2 with Pearson correlation and odds ratio where appropriate.
Results: The overall survival rate was 13.9% (110 of 792) of prehospital cardiac arrest patients. The mean (SD) time until provision of bystander cardiopulmonary resuscitation (ByCPR) by laymen was 2.08 (2.77) minutes, and basic life support (BLS) by emergency medical technicians was 6.62 (5.73) minutes. There was improved survival noted with witnessed cardiac arrest—a 2.2-fold increase in survival, 18.9% (76 of 402) versus 8.6% (27 of 315) compared with unwitnessed arrests (p<0.001) with a decreased risk ratio of mortality of 0.4534 (95% CI, 0.0857 to 0.1891). The presence of ByCPR occurred in 32% (228 of 716) of patients, but interestingly did not correlate with survival. The survival rate was 18.2% (33 of 181) if ByCPR was performed within two minutes and 12.8% (6 of 47), if performed >two minutes (p = 0.3752).
Conclusions: Survival after prehospital cardiac arrest is more likely when witnessed, but not necessarily when ByCPR was performed by laymen.
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Selected References
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- Abramson N. S., Safar P. Deferred consent: use in clinical resuscitation research. Brain Resuscitation Clinical Trial II Study Group. Ann Emerg Med. 1990 Jul;19(7):781–784. doi: 10.1016/s0196-0644(05)81703-2. [DOI] [PubMed] [Google Scholar]
- Dracup K., Heaney D. M., Taylor S. E., Guzy P. M., Breu C. Can family members of high-risk cardiac patients learn cardiopulmonary resuscitation? Arch Intern Med. 1989 Jan;149(1):61–64. [PubMed] [Google Scholar]
- Eisenberg M., Bergner L., Hallstrom A. Paramedic programs and out-of-hospital cardiac arrest: II. Impact on community mortality. Am J Public Health. 1979 Jan;69(1):39–42. doi: 10.2105/ajph.69.1.39. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Garnett A. R., Glauser F. L., Ornato J. P. Hypercarbic arterial acidemia following resuscitation from severe hemorrhagic shock. Resuscitation. 1989 Feb;17(1):55–61. doi: 10.1016/0300-9572(89)90079-8. [DOI] [PubMed] [Google Scholar]
- Hodgetts T. J., Brown T., Driscoll P., Hanson J. Pre-hospital cardiac arrest: room for improvement. Resuscitation. 1995 Feb;29(1):47–54. doi: 10.1016/0300-9572(94)00818-z. [DOI] [PubMed] [Google Scholar]
- Martens P. R., Mullie A., Calle P., Van Hoeyweghen R. Influence on outcome after cardiac arrest of time elapsed between call for help and start of bystander basic CPR. The Belgian Cerebral Resuscitation Study Group. Resuscitation. 1993 Jun;25(3):227–234. doi: 10.1016/0300-9572(93)90119-b. [DOI] [PubMed] [Google Scholar]
- Roth R., Stewart R. D., Rogers K., Cannon G. M. Out-of-hospital cardiac arrest: factors associated with survival. Ann Emerg Med. 1984 Apr;13(4):237–243. doi: 10.1016/s0196-0644(84)80470-9. [DOI] [PubMed] [Google Scholar]
- Swor R. A., Boji B., Cynar M., Sadler E., Basse E., Dalbec D. L., Grubb W., Jacobson R., Jackson R. E., Maher A. Bystander vs EMS first-responder CPR: initial rhythm and outcome in witnessed nonmonitored out-of-hospital cardiac arrest. Acad Emerg Med. 1995 Jun;2(6):494–498. doi: 10.1111/j.1553-2712.1995.tb03246.x. [DOI] [PubMed] [Google Scholar]
- Swor R. A., Jackson R. E., Cynar M., Sadler E., Basse E., Boji B., Rivera-Rivera E. J., Maher A., Grubb W., Jacobson R. Bystander CPR, ventricular fibrillation, and survival in witnessed, unmonitored out-of-hospital cardiac arrest. Ann Emerg Med. 1995 Jun;25(6):780–784. doi: 10.1016/s0196-0644(95)70207-5. [DOI] [PubMed] [Google Scholar]
- Troiano P., Masaryk J., Stueven H. A., Olson D., Barthell E., Waite E. M. The effect of bystander CPR on neurologic outcome in survivors of prehospital cardiac arrests. Resuscitation. 1989 Feb;17(1):91–98. doi: 10.1016/0300-9572(89)90082-8. [DOI] [PubMed] [Google Scholar]
- Troiano P., Masaryk J., Stueven H. A., Olson D., Barthell E., Waite E. M. The effect of bystander CPR on neurologic outcome in survivors of prehospital cardiac arrests. Resuscitation. 1989 Feb;17(1):91–98. doi: 10.1016/0300-9572(89)90082-8. [DOI] [PubMed] [Google Scholar]
- Wilson B. H., Severance H. W., Jr, Raney M. P., Pressley J. C., McKinnis R. A., Hindman M. C., Smith M., Wagner G. S. Out-of-hospital management of cardiac arrest by basic emergency medical technicians. Am J Cardiol. 1984 Jan 1;53(1):68–70. doi: 10.1016/0002-9149(84)90685-4. [DOI] [PubMed] [Google Scholar]