Resuscitation Rates in Out-of-Hospital Arrests Are Woeful

May 15, 2012

May 15, 2012 (Chicago, Illinois) New research shows that bystander cardiopulmonary resuscitation (CPR) and use of automated external defibrillators (AEDs) in the setting of an out-of-hospital cardiac arrest (OHCA) in the US remain woefully low [1].

Furthermore, there are significant differences between populations, with this work conducted in Philadelphia showing that black victims were significantly less likely to receive bystander CPR and AED application than whites, lead author Dr Roger A Band (University of Pennsylvania, Philadelphia) told heartwire .

It's profoundly important that we make these interventions early and appropriately and don't get lost in who we are doing it or not doing it on.

But Band says he doesn't want the "race thing" to detract from the main message, which is "that rates are low no matter who you are, with less than 10% of all victims receiving CPR. We are not doing nearly enough bystander CPR or using AEDs optimally. Mortality from this disease [OHCA] is astronomically high, so that without any intervention it's almost assured these patients will die. It's profoundly important that we make these interventions early and appropriately and don't get lost in who we are doing it or not doing it on. AEDs are not difficult to use, and now that the AHA has endorsed 'hands-only' CPR, there is even more reason to get involved."

Band's colleague, medical student Sarah K Wallace (University of Pennsylvania, Philadelphia), presented the findings here as a poster at the Society for Academic Emergency Medicine 2012 Annual Meeting.

Blacks 27% Less Likely to Get CPR, AED Applied

Wallace and colleagues examined, retrospectively, all adult OHCAs--which numbered almost 5000--that occurred in Philadelphia between January 2008 and February 2012. They excluded traumatic arrests and cases without attempted resuscitation.

The average patient was 63 years old, and 54.1% were male. Categorized by race, 52% of victims were white, 35.7% were black, 5.3% were Hispanic, 1.3% were Asian, and the remainder other or unknown.

Black patients were significantly less likely to achieve return of spontaneous circulation (ROSC) compared with whites (14.7% vs 17.1%; p=0.04). Blacks were also significantly less likely to receive bystander CPR than whites (5.6% vs 7.5%; p=0.01) or to have an AED applied (27.3% vs 34.4%; p<0.001). These discrepancies remained even after adjustment for patient-level and prehospital-care variables.

Adjusted Odds Ratio of ROSC, AED Use and Bystander CPR, Blacks vs Whites

Variable Adjusted OR* 95% CI p
ROSC 0.82 0.69-0.97 0.02
AED application 0.73 0.64-0.83 <0.001
Bystander CPR 0.73 0.57-0.94 0.01

*ORs adjusted for all patient-level and prehospital-care variables

Identifying Subtle Differences Will Help Inform Future Work

Dr Raina Merchant (University of Pennsylvania, Philadelphia) who--together with Band--is part of a group of emergency-medicine physicians striving to help develop a "map" identifying the locations of all AEDS in public places in the city of Philadelphia, told heartwire that research conducted almost 20 years ago identified race as a variable in who received CPR or AED use.

"But now we are moving away from studies that just identify disparities, because it's probably not just about race but about multiple factors. Now the focus should be on going a little beneath the surface and asking, 'How do we address these disparities?' " she says.

Band agrees: "Identifying subtle differences with regard to CPR and AED use in different populations will help inform future research so that we can start to understand why rates are low to begin with, why they are disparate in different populations, and how we can begin to make targeted interventions at a grass-roots level."

AEDs Rarely Found Close to Scene of Out-of-Hospital Arrests

In a separate poster reported at the same meeting, another clue emerged to explain the low rate of use of AEDs. Medical student Heather M Griffis and colleagues mapped where 3483 OHCAs took place and the locations of 2314 AEDs throughout Philadelphia.

I think that people generally would want to help and would want to do good if they could, but they often just have no idea where the devices are.

"We found that rarely were AEDs close to the arrest location," Merchant, who was second author on this paper, said. In fact, just 7% of cardiac arrests occurred within a 200-foot radius of an AED (approximately a two-minute walk, roundtrip, from the scene), 10% occurred within 400 feet (a four-minute walk), and 21% happened within 600 feet (a six-minute walk) of an AED. Since victims' chances of survival drop by about 10% with each minute that passes without CPR and defibrillation, patients who are shocked six minutes or more after arresting are likely to have very low survival rates, she says.

Merchant adds that prior work done by her team indicates that "lack of knowledge of the whereabouts of AEDs is a major component" to people not using them. "I think that people generally would want to help and would want to do good if they could, but they often just have no idea where the devices are." She adds that more work is needed to pinpoint the optimum places to locate AEDs "in the areas of highest risk for OHCA."

Comments

3090D553-9492-4563-8681-AD288FA52ACE
Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.

processing....