Bystander CPR and Defibrillation Are Associated with Better Long-Term Outcomes

Summary and Comment |
May 3, 2017

Bystander CPR and Defibrillation Are Associated with Better Long-Term Outcomes

  1. Ali S. Raja, MD, MBA, MPH

Survivors of out-of-hospital cardiac arrest had significantly lower rates of mortality, brain damage, and nursing home admission at 1 year if bystanders had jumped in to help.

  1. Ali S. Raja, MD, MBA, MPH

Bystander cardiopulmonary resuscitation (CPR) and defibrillation have been shown to improve short-term outcomes for patients with out-of-hospital cardiac arrest (OHCA; NEJM JW Emerg Med Dec 2013 and JAMA 2013; 310:1377; NEJM JW Emerg Med Sep 2015 and JAMA 2015; 314:247). However, it is unclear whether 1-year outcomes, including nursing home admission, anoxic brain injury, and death, are also improved. To determine the effect of bystander interventions on these longer-term outcomes, Danish investigators reviewed all 30-day survivors of OHCA between 2001 and 2012 whose arrest was not witnessed by emergency medical services.

A total of 2084 survivors were included, of whom 534 (26%) did not receive bystander resuscitation. Rates of both bystander CPR and bystander defibrillation increased significantly during the study period (from 67% to 81% and from 2% to 17%, respectively). Concurrently, there were significant decreases in 1-year rates of nursing home admission or brain injury (from 10.0% to 7.6%) and all-cause mortality (from 18.0% to 7.9%). In adjusted regression analyses, bystander resuscitation was associated with significantly lower risks of nursing home admission or brain injury (hazard ratio, 0.62) and mortality (hazard ratio, 0.70).

Comment

While short-term outcomes data have been nice to know, I've always wondered about longer-term outcomes from these bystander interventions: Are we saving patients' lives only to relegate them to nursing homes with anoxic brain injury? This study's findings are convincing — having bystanders perform CPR and defibrillation truly is better for patients with OHCA, even in the long term. Efforts to increase public-access defibrillation and CPR training improve outcomes by any measure.

Editor Disclosures at Time of Publication

  • Disclosures for Ali S. Raja, MD, MBA, MPH at time of publication Speaker's bureau Airway Management Education Center Leadership positions in professional societies Society for Academic Emergency Medicine (Board Member); American College of Emergency Physicians (Chair, Trauma and Injury Prevention Section)

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