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Are new resuscitation guidelines better? Experience of an Asian metropolitan hospital

Shih Wen Hung1, Chien Chih Chen, Hsin Chin Shih

  • 1Emergency Department, Shin-Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan.

Annals of the Academy of Medicine, Singapore
|August 11, 2010
PubMed

Insights

New cardiopulmonary resuscitation (CPR) guidelines did not improve survival for out-of-hospital cardiac arrest (OHCA) patients in Asia. Increasing bystander CPR rates is crucial for improving OHCA survival.

Area of Science:

  • Emergency Medicine
  • Cardiology
  • Public Health

Background:

  • Cardiopulmonary resuscitation (CPR) guidelines were updated in 2005.
  • The impact of these updated guidelines on out-of-hospital cardiac arrest (OHCA) survival in Asia remained unevaluated.
  • This study assessed the effect of new CPR guidelines in an Asian metropolitan area.

Purpose of the Study:

  • To evaluate the impact of implementing the 2005 CPR guidelines on OHCA patient survival.
  • To identify factors influencing discharge survival among OHCA patients in an Asian city.

Main Methods:

  • An observational cohort study compared OHCA patients before (Nov 2003-Oct 2005) and after (May 2006-Oct 2008) guideline implementation.
  • Data collected using the Ustein style template.
  • Statistical analysis included chi-squared tests, t-tests, and logistic regression.

Main Results:

  • No significant benefits in recovery of spontaneous circulation (ROSC), survival-to-ICU, or survival-to-hospital discharge were observed after guideline implementation.
  • Rates of ventricular fibrillation/pulseless VT, witnessed arrest, and bystander CPR were lower than in Western studies.
  • Witnessed arrest and initial rhythm of VF/pulseless VT were independent predictors of discharge survival.

Conclusions:

  • The 2005 CPR guidelines did not demonstrably improve OHCA survival rates in this Asian population.
  • Factors independently associated with survival-to-hospital discharge were witnessed arrest and initial rhythm of VF/pulseless VT.
  • Enhancing bystander CPR rates and training may be more impactful than frequent guideline revisions for improving OHCA survival in Asia.
Abstract

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