Bystanders can cut death rate from cardiac arrest with CPR

Studies show that quick use of CPR, automated defibrillators can save cardiac arrest victims dramatically in many cases

By Pete Aleshire

October 26, 2010

The paramedics riding the Payson Fire Department’s trucks save lives every year. But when it comes to saving victims of cardiac arrest, training citizens in how to give CPR and encouraging businesses to buy automated defibrillators could save more lives than adding firefighters and new stations. That’s the intriguing conclusion that emerges from recent studies on the expensive, frustrating, often futile effort to boost the survival rates of people who suffer cardiac arrest.

Fortunately, in conjunction with Mogollon Health Alliance, the Payson Fire Department every year trains about 800 Rim Country residents in the life-saving use of CPR.

In addition, the department has sought grants and encouraged local businesses to invest several thousand dollars in buying automated defibrillators — computerized machines that can allow even a bystander to safely administer shocks to jump-start a failing heart.

Recent studies suggest that CPR administered within two to five minutes by bystanders plus the use of automated defibrillators boost survival much more dramatically than small additional reductions in ambulance and fire department response times.

Payson Fire Chief Marty deMasi said each of the town’s fire trucks and ambulances carry the manual defibrillators. In addition, the department has trained citizens in the use of automated defibrillators at town hall and other locations around town.

Several private businesses have also invested in the machines, including the Mazatzal Hotel and Casino and several local doctors and dentists.

A host of new studies suggest that finding ways to get bystanders to start treatment immediately provides the best means to reduce tragically high cardiac arrest death rates.

Such defibrillators can dramatically increase cardiac arrest survival rates if used within about five minutes, according to a study published in the medical journal BMJ. By contrast, several studies show that most patients don’t get their first jolt from a defibrillator for 11 minutes if administered by the first-responding paramedics.

The study found that two-thirds of cardiac arrest victims who got a shock from one of the portable defibrillators administered by a bystander survived with good neurological status. That compares to survival rates of 5 to 33 percent in a range of studies that focused on treatment of cardiac arrest by first responders.

Towns like Payson spend millions every year to make sure that a fire truck manned by paramedics can show up on any doorstep in town within four minutes of receiving a 911 call, driven in part by the toll of cardiac arrest, which kills about 300,000 Americans annually.

Unfortunately, even if Payson spends heavily to cut a few minutes off the response time for the handful of cardiac arrest calls that come in each month, most of the patients will still die.

That’s the glum message that emerges from several recent studies on what impact quick response times have on the survival of cardiac arrest patients. Those studies demonstrate that even the quickest paramedics can’t save the majority of patients.

For instance, cutting several minutes off the response time increased the one-month survival rate of cardiac arrest patients from 6 percent to 17 percent, according to a 10-year study involving 43,000 people who suffered cardiac arrest outside the hospital, according to a study published in the medical journal Circulation.

In that case, the biggest gain came from a sharp increase from 19 percent to 36 percent in the number of people who got CPR from a bystander before the paramedics arrived. During the course of the study, the time it took to start CPR dropped from 9 minutes to 7 minutes and the time it took to administer the first shock to start the heart dropped from 19 minutes to 9 minutes.

As a result, a much larger percentage of the patients reached the hospital alive. However, the actual, one-month survival rate still remained below 17 percent. Almost none of the patients who had a cardiac arrest without a nearby witness survived.

Another study that focused on 604 cardiac arrest victims found that survival dropped sharply if patients didn’t get CPR within four minutes and “definitive care,” like that rendered in a hospital, within 10 minutes. Again, the study found that bystander-initiated CPR had a substantial impact, since paramedics can only very rarely arrive on the scene within four minutes and typically spend several more minutes on the scene before they can start CPR or shock the heart.

A study of 3,200 cardiac arrest patients in New York found almost everyone who suffered a cardiac arrest without any witnesses around to provide help died.

Even among those who had witnesses and help, only 5.4 percent survived, according to the study published in the Journal of the American Medical Association.

That was about the same survival rate as another study in Chicago, but dramatically lower that the 36 percent survival rate in a study done in rural, King County, Washington. The researchers said the high death rate reflected “lengthy elapsed time intervals at every step in the chain of survival.”