Outcome of CPR in a Large Metropolitan Area: Where Are the Survivors
ABSTRACT Survival from out-of-hospital cardiac arrest in cities with populations of more than 1 million has not been studied adequately. This study was undertaken to determine the overall survival rate for Chicago and the effect of previously reported variables on survival, and to compare the observed survival rates with those previously reported.
Consecutive prehospital arrest patients were studied prospectively during 1987.
The study area was the city of Chicago, which has more than 3 million inhabitants in 228 square miles. The emergency medical services system, with 55 around-the-clock ambulances and 550 paramedics, is single-tiered and responds to more than 200,000 emergencies per year.
We studied 3,221 victims of out-of-hospital cardiac arrest on whom paramedics attempted resuscitation.
Ninety-one percent of patients were pronounced dead in emergency departments, 7% died in hospitals, and 2% survived to hospital discharge. Survival was significantly greater with bystander-witnessed arrest, bystander-initiated CPR, paramedic-witnessed arrest, initial rhythm of ventricular fibrillation, and shorter treatment intervals.
The overall survival rates were significantly lower than those reported in most previous studies, all based on smaller communities; they were consistent with the rates reported in the one comparable study of a large city. The single factor that most likely contributed to the poor overall survival was the relatively long interval between collapse and defibrillation. Logistical, demographic, and other special characteristics of large cities may have affected the rates. To improve treatment of cardiac arrest in large cities and maximize the use of community resources, we recommend further study of comparable metropolitan areas using standardized terms and methodology. Detailed analysis of each component of the emergency medical services systems will aid in making improvements to maximize survival of out-of-hospital cardiac arrest.
- SourceAvailable from: Peter B Richman
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- "Out-of-hospital cardiac arrest continues to represent a significant public health issue in need of improvement because published survival rates remain less than 5% in most locations     . Along with defibrillation, bystander CPR continues to be one of the few interventions that improve survival rates. "
ABSTRACT: The aim of this study is to compare rates of bystander cardiopulmonary resuscitation (CPR) for Hispanic and non-Hispanic out-of-hospital cardiac arrest (OOHCA) victims in Arizona. This is a secondary analysis of consecutive OOHCA victims prospectively enrolled into our statewide OOHCA quality improvement database between November 2004 and November 2006. Continuous data are presented as means +/- SDs and analyzed using t tests; categorical data are presented as frequency of occurrence and analyzed using chi(2). The primary outcome was whether bystander CPR rates were different for Hispanic vs non-Hispanic OOHCA victims. Secondary comparisons were initial cardiac rhythms and survival to hospital discharge. There were 2411 OOHCA victims during the period of analysis. A total of 952 arrests were excluded because ethnicity was not documented; 80 arrests were excluded because they were traumatic. A total of 1379 arrests were included for analysis, of which 273 (19.8%) were Hispanic. Hispanics were less likely to receive bystander CPR than non-Hispanics (32.2% vs 41.5%; P < .0001). Hispanics and non-Hispanics were dissimilar with respect to age (53.2 +/- 25 vs 64.5 +/- 19.3 years; P = .0001), paramedic response time (5.1 vs 5.5 minutes; P = .0006), initial rhythm asystole (53.8% vs 44.5%; P = .005), and initial rhythm ventricular fibrillation (20.5% vs 26.7%; P = .036). Survival to hospital discharge (8.1% vs 7.1%) was not statistically different. In the state of Arizona, significantly fewer Hispanic OOHCA victims receive bystander CPR than non-Hispanics.The American journal of emergency medicine 08/2008; 26(6):655-60. DOI:10.1016/j.ajem.2007.10.002 · 1.15 Impact Factor
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- "It is difficult to predict the outcome from prehospital cardiac arrest because of a diversity of arrest populations. Becker et al  published a thought-provoking article in 1991 that reported a realistic survival rate to hospital discharge of only 1.7% in the large (3224-patient) urban study, compared with a historic range of survival from 1% to 33%. "
ABSTRACT: This study evaluates the effect of early administration of an empirical (1 mEq/kg) sodium bicarbonate dose on survival from prehospital cardiac arrest within brief (<5 minutes), moderate (5-15 minutes), and prolonged (>15 minutes) down time. Prospective randomized, double-blinded clinical intervention trial that enrolled 874 prehospital cardiopulmonary arrest patients managed by prehospital, suburban, and rural regional emergency medical services. Over a 4-year period, the randomized experimental group received an empirical dose of bicarbonate (1 mEq/kg) after standard advanced cardiac life support interventions. Outcome was measured as survival to emergency department, as this was a prehospital study. The overall survival rate was 13.9% (110/792) for prehospital arrest patients. There was no difference in the amount of sodium bicarbonate administered to nonsurvivors (0.859 +/- 0.284 mEq/kg) and survivors (0.8683 +/- 0.284 mEq/kg) (P = .199). Overall, there was no difference in survival in those who received bicarbonate (7.4% [58/420]), compared with those who received placebo (6.7% [52/372]) (P = .88; risk ratio, 1.0236; 0.142-0.1387). There was, however, a trend toward improved outcome with bicarbonate in prolonged (>15 minute) arrest with a 2-fold increase in survival (32.8% vs 15.4%; P = .007). The empirical early administration of sodium bicarbonate (1 mEq/kg) has no effect on the overall outcome in prehospital cardiac arrest. However, a trend toward improvement in prolonged (>15 minutes) arrest outcome was noted.American Journal of Emergency Medicine 03/2006; 24(2):156-61. DOI:10.1016/j.ajem.2005.08.016 · 1.15 Impact Factor
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- "When reported, survival to hospital discharge after resuscitation from out-of-hospital cardiac arrest has ranged from 3 to 33% and has been dependent upon the selection characteristics of the reported population  . Recent reports from several large metropolitan areas that include consecutive and unselected patients indicate that 2–5% of patients survive to hospital discharge   . However, Table 2 Patient characteristics associated with survival to hospital discharge with a Glasgow Coma Score ≥ 13 following out-of-hospital cardiac arrest "
ABSTRACT: No valid model has been developed to predict survival following out-of-hospital cardiac arrest. The purpose of this study was to develop a prediction model for meaningful survival following out-of-hospital cardiac arrest using variables available during resuscitation. This was a retrospective cohort study. Consecutive adult cardiac arrest patients were studied between 1994 and 2001. Variables included age, sex, race/ethnicity, arrest location, whether the arrest was witnessed, initial rhythm, whether CPR was performed, patient downtime, paramedic response time, survival to hospital discharge, and Glasgow Coma Score (GCS) at hospital discharge. Classification and Regression Tree analysis was used to develop decision rules to predict meaningful survival, as defined by the patient's discharge GCS. Of the 754 patients, 16 (2%) survived with a GCS > or =13, 15 (2%) survived with a GCS = 14, and 5 (0.7%) survived with a GCS = 15. The decision rule for survival with a GCS > or = 13 incorporated whether the arrest was witnessed and the patient's age, resulting in a negative predictive value (NPV) of 99.8%. The rule for survival with a GCS > or = 14 incorporated the initial arrest rhythm, whether the arrest was witnessed, and the patient's age, resulting in a NPV of 99.6%. The rule for survival with a GCS = 15 incorporated only the interval between collapse and the initiation of life support, resulting in a NPV of 99.8%. This study reports decision rules for potential meaningful survival following out-of-hospital cardiac arrest with high NPVs for each. Future studies need to be performed to prospectively validate these models.Resuscitation 11/2004; 63(2):145-55. DOI:10.1016/j.resuscitation.2004.04.014 · 3.96 Impact Factor