Prehospital CPR: A review, in perspective

Abstract

In this forum, I want to share with you some of our cardiopulmonary resuscitation (CPR) data, as originally presented. Then I would like to critically analyze our data and put it into perspective with published data from other centers. We have published six different papers on CPR with five different principal investigators. [l-6]. However, the three I am going to share with you are the largest ones that have been done. [4-61 Our data base is comprised of paramedic Advanced Life Support (ALS) transports. We generally exclude trauma arrests, poisoning arrests and children. Our system, is a two tiered system with fire department first responders responding to the scene with Emergency Medical Technician (EMT) basic life support in 2 min and paramedic ALS responding in 6 min. The overall save rate for a lo-year period of time (1900 patients1 was 16% [4]. If the patient is lucky enough to be witnessed as having their arrest in front of a paramedic. who can provide ALS, the save rate is 21% [S]. However, when we look at patients that were witnessed by a bystander who had CPR. the patients that were witnessed by a first responder and had CPR, and the patients that were witnessed by a bystander but did not have CPR until the arrival of the ALS system, we find no significant difference in the survival rate (Table I) [4]. Breaking this data down and comparing it as a function of rhythm, we see that controlling for rhythm makes no difference (Table 111[4]. One of the potential flaws of this study is that the ALS response time of patients with CPR was a little longer than for those patients without CPR (3.8 vs. 5.2 min respectively, P < 0.011. When statistically comparing the response times using a linear regression analysis, we found that there was a linear drop with no significant difference between the two slopes (Fig. 1) [4]. Our conclusion then and our conclusion now, remains the same. In an urban paramedic system with a rapid response time and early defibrillation, bystander initiated CPR has been shown not to effect hospital discharge rate. With that in mind, we reviewed our data on neurological outcome in a different study [5]. We analyzed 138 patients who had been transported to six major receiving hospitals. We used the modified Pittsburgh Cerebral Performance Categories Scale (CPC) [7] and gathered our data by contacting family, the patient directly or by a medical record review. We found that there was no