Statewide Initiatives Improved Out-of-Hospital Cardiac Arrest Care and Outcomes

Coordinated and comprehensive statewide public health initiatives have led to an increase in rates of bystander cardiopulmonary resuscitation (CPR) and first responder defibrillation for out out-of-hospital cardiac arrest (OHCA) patients.

These increases, which were observed at home in both groups and in public in the CPR group, resulted in improved survival and favorable neurological outcomes for this patient population.

“What’s interesting about this study is it’s the first time a statewide intervention has improved both public and residential cardiac arrest outcomes,” Christopher B. Fordyce, MD, lead study author of the Duke Clinical Research Institute, Durham, North Carolina, said in a press release.

The study was presented at the 2016 American College of Cardiology Scientific Sessions & Expo.

According to Dr Fordyce, OHCA survival is notoriously worse in private homes, where the majority of cardiac arrests occur.

“Little is known about whether broader efforts to teach people to recognize cardiac arrest and act quickly also impact home cardiac arrests, where the bystander is typically a family member,” Dr Fordyce said in a press release.

The study included data from the North Carolina Cardiac Arrest Registry to Enhance Survival from 2010 to 2014. The statewide program examined was part of the HeartRescue Project, which trains family members and bystanders to identify the signs of sudden cardiac arrest, quickly call emergency responders, and use CPR or automated external defibrillators.

Researchers examined temporal trends in bystander CPR and first-responder defibrillation (n=8269), which was stratified by home (n=5602; 68%) and pubic (n=2667; 32%) OHCA, and determined their relationship with survival and neurological outcomes.

Results indicated that the rate of patients who received bystander CPR increased at home (28.3% to 41.3%; P<.0001) and in public (61% to 70.6%; P=.007), whereas first-responder defibrillation increased at home (42.2% to 50.8%; P=.01) but not in public (33.1% to 37.8%; P=.16).

Overall, rate of survival to discharge increased at home (5.7% to 8.1%; P =.047) and in public (10.8% to 16.2%; P=.036). In addition, there was a trend toward favorable neurological outcome at home (4.9% to 6.1%; P=.06), which was statistically significant at public locations (9.5% to 14.7%; P=.02)

“The absolute rates are small, but the relative changes were pretty large,” Dr Fordyce said. “That’s only over 5 years, so if we continue to educate the public, we can continue to improve outcomes.”

Reference

Fordyce CB, Hansen CM, Kraghold K, et al. Presentation 1189-355/355. Statewide initiatives improve the care and outcomes of patients with out-of-hospital cardiac arrest at home and in public locations: results from the HeartRescue Project. Presented at the 65th Annual Scientific Session and Expo of the American College of Cardiology. April 2-4, 2016; Chicago, IL.