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Survival Following Lay Resuscitation.
Holger Gässler1, Matthias Helm, Björn Hossfeld
1Department of Anesthesiology, Intensive Care Medicine, Emergency Medicine, and Pain Therapy, German Armed Forces Hospital Ulm; Department of Anesthesiology and Intensive Care Medicine, Alb-Fils Hospitals, Göppingen.
Deutsches Arzteblatt International
|February 27, 2021
Summary
Layperson resuscitation improves survival for out-of-hospital cardiac arrest (OHCA) from cardiac events and intoxication. Encouraging bystander CPR for all OHCA causes, except hypoxia, is recommended for better outcomes.
Area of Science:
- Emergency Medicine
- Cardiology
- Public Health
Background:
- Layperson resuscitation is crucial for bridging the time gap before emergency medical services arrive.
- The effectiveness of bystander cardiopulmonary resuscitation (CPR) in out-of-hospital cardiac arrest (OHCA) varies depending on the cause.
- Understanding the impact of lay resuscitation on survival rates across different OHCA etiologies is essential.
Purpose of the Study:
- To investigate the influence of layperson-initiated resuscitation on survival and neurological outcomes in OHCA patients.
- To analyze the effectiveness of bystander CPR based on the underlying cause of cardiac arrest.
- To provide evidence-based recommendations for public CPR initiatives.
Main Methods:
- Analysis of a large dataset (2007-2019) from the German Resuscitation Registry, including 40,604 OHCA cases.
- Descriptive and multivariate logistic regression analyses were performed to evaluate outcomes.
- Key endpoints included return of spontaneous circulation (ROSC), 30-day survival, and neurological function at discharge, stratified by OHCA cause.
Main Results:
- Lay resuscitation was performed in 35.1% of cases and was associated with significantly higher ROSC rates for cardiac events, drowning, intoxication, and CNS disorders.
- 30-day survival/hospital discharge was improved with lay resuscitation for most causes (except trauma/bleeding and sepsis), notably for cardiac events (OR 1.16) and intoxication (OR 1.81).
- Neurological function at discharge was significantly better with lay resuscitation across most OHCA causes, excluding trauma/bleeding, hypoxia, and sepsis.
Conclusions:
- Layperson resuscitation significantly improves 30-day survival for OHCA caused by cardiac events and intoxication, which constitute the majority of cases.
- A tendency towards improved survival was observed for other causes, reinforcing the recommendation for laypersons to perform CPR in all OHCA situations.
- Continued encouragement of bystander CPR is vital to enhance patient outcomes following out-of-hospital cardiac arrest.
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