ShareThisBystander CPR.
Whether you or your neighbor is ready and willing to do it may quadruple the odds of survival for someone down on the street in cardiac arrest.
Researchers aren't sure exactly why, but only about a third of some 166,000 people whose hearts stop outside a hospital get cardiopulmonary resuscitation from a bystander. A recent study in Ontario is the latest to note that only about 1 in 3 bystanders attempts to help.
Yet the study also noted that for patients who did get help from a bystander, the survival rate is about four times better (nearly 50 percent) than for someone who gets no help. The typical survival rate for sudden cardiac arrest outside a hospital is 5 percent to 10 percent.
Experts say the lack of intervention is particularly troubling since doing CPR has been simplified in most instances.
"Bystanders who witness the sudden collapse of an adult should immediately call 911 and start what we call hands-only CPR,'' said Dr. Michael Sayre, who headed an American Heart Association team that issued new guidelines last year.
"This involves providing high-quality (as in firm enough that the chest recoils, but not rib-cracking) chest compressions by pushing hard and fast in the middle of the victim's chest without stopping until emergency medical responders arrive," he said. Ideally, the rate of compressions should be about 100 per minute.
Since the guidelines came out, even more scientific evidence has surfaced showing how important compressions are.
One analysis of more than 500 Canadian and U.S. patients found that when EMS workers devoted 81 percent to 100 percent of CPR time to chest compressions, as opposed to taking pauses to deliver a breath, start an IV line or check a pulse, the patients' hearts returned to spontaneous circulation up to 79 percent of the time.
Investigators said even the pros often give chest compressions only about 50 percent of the time.
"Chest compressions move blood with oxygen to the heart and brain to save the brain and prepare the heart to start up its own rhythm when a shock is delivered with a defibrillator. We found that even short pauses in chest compressions were quite detrimental," said Dr. Jim Christenson, lead author of the study published in the AHA journal Circulation in September. He is a clinical professor of emergency medicine at the University of British Columbia.
Just last week, the National Heart, Lung and Blood Institute shut down a study comparing different CPR duration strategies before an attempt is made to shock the heart.
All results of the research -- which had already looked at more than 11,000 patients under EMS care -- found that it made no difference whether a defibrillator was used 30 to 90 seconds into CPR, or if medics waited at least three minutes before analyzing heart rhythm and applying a jolt if indicated. The professionals in the study were doing traditional, not hands-only, CPR, for the most part, but the key is that going a bit longer with effective CPR does not make much difference to outcomes.
"Many times, people nearby don't help because they're afraid that they will hurt the victim and aren't confident in what they're doing,'' Sayre said. "We want people to know that they can help many victims just by calling for help and doing chest compressions."
However, it's important to note that hands-only CPR should not be used for infants or children, or for adults whose cardiac arrest is from a respiratory cause, such as a drug overdose or near drowning, or when the initial cardiac arrest isn't witnessed. In those situations, conventional CPR with a combination of chest compressions and breaths is still recommended.
On the Net: http:www.americanheart.org/handsonlycpr
(Contact Lee Bowman at BowmanL(at)shns.com)
(Distributed by Scripps Howard News Service, http://www.scrippsnews.com)
THE MEDICAL JOURNAL
