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Impact of Updating the Cardiopulmonary Resuscitation Guidelines on Out-of-Hospital Shockable Cardiac Arrest: A
Tsukasa Yagi1, Ken Nagao1, Naohiro Yonemoto2
1Department of Cardiology Nihon University Hospital Tokyo Japan.
Insights
Cardiopulmonary resuscitation (CPR) updates in 2005 and 2010 significantly improved neurologically intact survival for out-of-hospital cardiac arrest in Japan. These advancements in CPR guidelines demonstrate a positive trend in patient outcomes over time.
Area of Science:
- Emergency Medicine
- Cardiovascular Science
- Public Health
Background:
- International consensus on cardiopulmonary resuscitation (CPR) and emergency cardiovascular care science and treatment recommendations (CoSTR) are updated every five years.
- Few population-based studies have assessed the effectiveness of CPR guideline updates for out-of-hospital cardiac arrest (OHCA) with shockable rhythms.
- The study investigates the impact of CPR guidelines from 2000, 2005 (CoSTR), and 2010 (CoSTR) on OHCA outcomes in Japan.
Purpose of the Study:
- To determine if CPR based on CoSTR 2005 or 2010 guidelines was associated with improved outcomes in Japan compared to Guidelines 2000.
- To evaluate the effectiveness of updated CPR maneuvers on neurologically intact survival rates for OHCA patients.
Main Methods:
- Analysis of 73,578 adult patients with shockable OHCA from the All-Japan Utstein Registry (2005-2015).
- Comparison of outcomes across three eras: Guidelines 2000 (2005), CoSTR 2005 (2006-2010), and CoSTR 2010 (2011-2015).
- Outcomes assessed included favorable neurological outcomes at 30 days post-OHCA, stratified by witness (bystander or EMS responder) and subgroups.
Main Results:
- In bystander-witnessed OHCA, adjusted odds ratios for favorable neurological outcomes at 30 days increased annually from 1.19 in 2006 to 3.01 in 2015.
- Similar positive trends in neurological outcomes were observed in the EMS responder-witnessed group and various subgroups.
- The study demonstrates a consistent year-over-year improvement in outcomes associated with later CPR guidelines.
Conclusions:
- CPR maneuver updates in CoSTR 2005 and 2010 were associated with improved neurologically intact survival for shockable OHCA in Japan compared to Guidelines 2000.
- The observed improvements suggest that updated CPR guidelines positively impact patient survival.
- Increased public awareness and broader dissemination of basic life support (BLS) are potential contributing factors to the improved outcomes.
Background:
International consensus on cardiopulmonary resuscitation (CPR) and emergency cardiovascular care science and treatment recommendations (CoSTR) have reported updates on CPR maneuvers every 5 years since 2000. However, few national population-based studies have investigated the comprehensive effectiveness of those updates for out-of-hospital cardiac arrest due to shockable rhythms. The primary objective of the present study was to determine whether CPR based on CoSTR 2005 or 2010 was associated with improved outcomes in Japan, as compared with CPR based on Guidelines 2000.
Methods And Results:
From the All-Japan Utstein Registry between 2005 and 2015, we included 73 578 adults who had shockable out-of-hospital cardiac arrest witnessed by bystanders or emergency medical service responders. The study outcomes over an 11-year period were compared between 2005 of the Guidelines 2000 era, from 2006 to 2010 of the CoSTR 2005 era, and from 2011 to 2015 of the CoSTR 2010 era. In the bystander-witnessed group, the adjusted odds ratios for favorable neurological outcomes at 30 days after out-of-hospital cardiac arrest by enrollment year increased year by year (1.19 in 2006, and 3.01 in 2015). Similar results were seen in the emergency medical service responder-witnessed group and several subgroups.
Conclusions:
Compared with CPR maneuvers for shockable out-of-hospital cardiac arrest recommended in the Guidelines 2000, CPR maneuver updates in CoSTR 2005 and 2010 were associated with improved neurologically intact survival year by year in Japan. Increased public awareness and greater dissemination of basic life support may be responsible for the observed improvement in outcomes.
Registration:
URL: https://www.umin.ac.jp/ctr/; Unique identifier: 000009918.
