Do Modifications of the American Heart Association Guidelines Improve Survival of Patients with Out-of-Hospital Cardiac Arrest?

Abstract

Major predictors of survival of patients with out-of-hospital primary cardiac arrest are witnessed collapse and a shockable rhythm. Since early bystander initiated resuscitation efforts prolong the electrical or shockable phase of untreated ventricular fibrillation, areas with higher rates of early-onset bystander resuscitation efforts and shorter emergency medical services (EMS) response times have higher survival rates.1,2 These areas enjoyed and enjoy acceptable survival rates by following the American Heart Association Guidelines for Cardiopulmonary Resuscitation (CPR) and Emergency Cardiac Care (ECC),3,4 hereafter referred to as “guidelines.” However, because these 2 survival criteria (early bystander CPR and rapid EMS response times) are not present in most areas, the survival of individuals with out-of-hospital cardiac arrest (OHCA) overall remains suboptimal.5,6 Article see p 2597 In an effort to improve survival, chest compressions only for bystanders was advocated in the 1990s, and modifications of the 2000 guidelines for EMS providers were instituted by the Sarver Heart Center Resuscitation Research Group in 2003.7–11 The major elements of the EMS modifications were (1) eliminating the decades-long emphasis on early intubation and positive pressure ventilations, (2) eliminating the recommendation for immediate defibrillation and the use of stacked shocks, (3) eliminating all unnecessary interruptions of chest compressions, and (4) advocating chest compressions before and immediately after a single defibrillation shock, and the early administration of epinephrine. This approach for patients with OHCA was called cardiocerebral resuscitation. 8 to differentiate it from cardiopulmonary resuscitation , which we think should be reserved for cardiac arrest secondary to respiratory arrest or failure. Our first 2 outcomes reports using cardiocerebral resuscitation were published by Kellum and associates.12,13 In the first report from Rock and Walworth counties in Wisconsin, survival of patients with OHCA and an initially shockable rhythm was 18/92 (20%) …