New AHA statement focuses on improving rates and success of bystander CPR

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January 22, 2008 By Benjamin A. Olenchock, M.D. Ph.D. [1]

A statement released by the American Heart Association is addressing ways to improve the occurrence and success of bystander-initiated cardiopulmonary resuscitation (CPR). Conspicuously absent from the recommendations is a discussion of the future of chest compression-only resuscitation.

There are over 150,000 cases of out of hospital cardiac arrest each year, and survival to hospital discharge is dismal, with estimates of less than 2%. The low rate of bystander-initiated CPR, occurring in only 15-30% of cases, contributes to poor outcomes. Studies have consistently documented poor quality of CPR as well, with excess time spent on rescue breathing. The underlying reluctance to perform CPR is related to fears of failure, liability, and risk of acquiring transmissible diseases by mouth-to-mouth resuscitation.

The purpose of the new AHA statement is to raise awareness and discuss options for improving rates and success of CPR. They propose broadening of CPR training and encouragement of dispatcher-assisted CPR over the telephone. Additionally, the statement provides reassurance regarding the health safety of CPR and the legal protection provided by Good Samaritan laws.

Absent from the AHA statement is a discussion of chest compression-only resuscitation in the community setting. As previously reported by Wikidoc, recent animal and human studies have demonstrated non-inferiority or even improved outcomes following CPR without rescue breathing. A change in the recommended method of CPR is certainly outside the purview of this AHA statement, which focused only on reducing barriers to bystander-initiated CPR. However, reluctance to provide rescue breaths has been documented as a major barrier to bystander willingness to provide resuscitation, and the AHA policy regarding recommendation of rescue breaths is intimately related to discussions about public willingness to provide CPR.

REFERENCES

1. Benjamin S. Abella, Tom P. Aufderheide, Brian Eigel, Robert W. Hickey, W. T. Longstreth Jr, Vinay Nadkarni, Graham Nichol, Michael R. Sayre, Claire E. Sommargren, and Mary Fran Hazinski. Reducing Barriers for Implementation of Bystander-Initiated Cardiopulmonary Resuscitation. A Scientific Statement From the American Heart Association for Healthcare Providers, Policymakers, and Community Leaders Regarding the Effectiveness of Cardiopulmonary Resuscitation Circulation 2008: published online before print January 14.
2. Bohm K, Rosenqvist M, Herlitz J, Hollenberg J, Svensson L. Survival is similar after standard treatment and chest compression only in out-of-hospital bystander cardiopulmonary resuscitation. Circulation. 2007 Dec 18;116(25):2908-12. Epub 2007 Dec 10. PMID: 18071077
3. Iwami T, Kawamura T, Hiraide A, Berg RA, Hayashi Y, Nishiuchi T, Kajino K, Yonemoto N, Yukioka H, Sugimoto H, Kakuchi H, Sase K, Yokoyama H, Nonogi H. Effectiveness of bystander-initiated cardiac-only resuscitation for patients with out-of-hospital cardiac arrest. Circulation. 2007 Dec 18;116(25):2900-7. Epub 2007 Dec 10. PMID: 18071072
4. Ewy GA, Zuercher M, Hilwig RW, Sanders AB, Berg RA, Otto CW, Hayes MM, Kern KB. Improved neurological outcome with continuous chest compressions compared with 30:2 compressions-to-ventilations cardiopulmonary resuscitation in a realistic swine model of out-of-hospital cardiac arrest. Circulation. 2007 Nov 27;116(22):2525-30.

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