Emergency Medical Services
Background: Out-of-hospital cardiac arrest outcomes from advanced cardiovascular life support depend on patients receiving rapid, high-quality CPR. It has been demonstrated that patients who receive bystander CPR are more likely to have an automated external defibrillator (AED) applied. Witnessed arrest, AED application, public location of the arrest, and shockable rhythm on initial ECG are associated with return of spontaneous circulation (ROSC) and improved outcomes. It is important for survival of patients that community members feel comfortable starting CPR. This study examines the outcomes of out-of-hospital arrest to assess the need for community education.
Methods: This prospective observational study investigated CPR data for out-of-hospital cardiac arrest resuscitations brought by emergency medical systems (EMS) to George Washington University Hospital between December 2017 and October 2018 (n=44). Represented cases had data from video recording, chart review, and EMS-provided data parameters including outpatient bystander CPR, bystander location, and outcomes. Data were described using summary statistics.
Results: Of the 44 cases analyzed, the mean age was 58.4 ± 12.9. 20 (45.5%) of the arrests were witnessed. Of the witnessed arrests, only 7 (35%) received bystander CPR. Of the unwitnessed arrests, 9 (37.5%) patients received bystander CPR.
Conclusion: Analysis of resuscitation videos and EMS data suggests a low rate of bystander CPR in Washington, DC. The observed rates of bystander CPR for witnessed and unwitnessed cardiac arrests are comparable to those from a 2015 study on prevalence of bystander CPR. The literature shows that there is a need for increased public awareness and education about CPR to improve survival for out-of-hospital cardiac arrest. Identified barriers to initiation of CPR include lack of knowledge of CPR, fear of litigation, fear of hurting the patient, environmental factors, and other personal factors. Studies have shown that training initiatives reduce reported likelihood of barriers as well as increase reported likelihood of CPR. The current case series suggests that additional efforts are needed to increase CPR uptake in the Washington D.C. area. There is a need to further elucidate the role these barriers play in the initiation of CPR and to identify points of intervention.