CPR Guidelines Emphasizing Chest Compressions Save More Lives

People suffering from a nonshockable out-of-hospital cardiac arrest (OHCA) are likelier to survive if given cardiopulmonary resuscitation (CPR) based on updated guidelines that emphasize chest compressions, according to a new study.

Researchers at the University of Washington (Seattle, WA, USA) studied 3,960 patients with nontraumatic OHCA from nonshockable initial rhythms that were treated by prehospital providers in King County (WA, USA), over a 10-year period. The outcomes during the 5-year intervention period that followed the adoption of new resuscitation guidelines were compared with the previous 5-year historical control period, with the primary outcome being one-year survival.

The results showed that the likelihood of survival to discharge from the hospital improved from 4.6% before the guideline changes to 6.8% after the new guideline changes, and one-year survival almost doubled, from 2.7% to 4.9%. The proportion of patients who survived with good brain function increased from 3.4% to 5.1% between the study periods. The study was published in the April 10, 2012, issue of Circulation.

“Now, for the first time, we have seen a treatment that improves survival specifically in these patients, and that treatment is simply providing the more intense, quality CPR recommended in the new guidelines,” said lead author Prof. Peter Kudenchuk, MD, of the division of cardiology. “By any measure--such as the return of pulse and circulation or improved brain recovery--we found that implementing the new guidelines in these patients resulted in better outcomes from cardiac arrest.”

Nonshockable cardiac arrest arrhythmias are asystole (flat line) and pulseless electrical activity (PEA) electromechanical disassociations, neither of which responds to defibrillation. While nonshockable rhythms are currently the predominant presentation of OHCA, this was not true in the past; 35 years ago, most cardiac arrests started out with either pulseless ventricular tachycardia or ventricular fibrillation (both shockable rhythms), that if not corrected rapidly progress to PEA or asystole, and ultimately death. The reasons for this decline are not entirely understood.

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