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Bystander/first responder CPR: ten years experience in a paramedic system
Annals of Emergency Medicine
|June 1, 1986
Summary
Bystander cardiopulmonary resuscitation (CPR) before paramedic arrival did not improve hospital discharge rates in witnessed cardiac arrests. However, CPR initiation before advanced life support showed benefit in patients with electromechanical dissociation.
Area of Science:
- Emergency Medicine
- Cardiology
- Resuscitation Science
Background:
- The effectiveness of bystander cardiopulmonary resuscitation (CPR) in prehospital settings has been questioned.
- Previous studies have yielded conflicting results regarding the impact of early CPR on patient outcomes.
- Understanding the role of bystander CPR is crucial for optimizing emergency medical services protocols.
Purpose of the Study:
- To evaluate the effectiveness of bystander CPR initiated before paramedic advanced life support (ALS) in witnessed cardiorespiratory arrests.
- To compare hospital discharge rates between patients who received bystander CPR and those who did not.
- To analyze the impact of bystander CPR across different initial cardiac rhythms.
Main Methods:
- A ten-year retrospective review of prehospital data from November 1, 1973, to October 31, 1983.
- Inclusion criteria: bystander-witnessed arrests with attempted paramedic resuscitation; exclusion criteria: traumatic/poisoning arrests and patients under 18.
- Comparison of save rates (hospital discharge) for patients receiving CPR before paramedic ALS versus those receiving CPR only after paramedic arrival.
Main Results:
- Overall save rates were similar: 14.6% (182/1,248) with pre-arrival CPR vs. 15% (38/252) without (P = NS).
- For specific rhythms: ventricular fibrillation (23.6% vs. 23.2%), asystole (4.7% vs. 4.9%), and ventricular tachycardia (40% vs. 0%).
- A significant improvement in save rates was observed only in patients with initial electromechanical dissociation (EMD) who received CPR before paramedic arrival (5.3% vs. 0%).
Conclusions:
- In this prehospital system, bystander/first responder CPR did not improve overall hospital discharge rates for witnessed cardiorespiratory arrests.
- The findings suggest that early CPR initiation may not benefit all cardiac arrest rhythms.
- Bystander CPR demonstrated a potential benefit specifically for patients with an initial rhythm of electromechanical dissociation.