Survival outcomes from cardiac arrest among hospital staff and visitors versus inpatients with matching age, gender, race, prior residence and functional status, and presenting rhythms: The role of response time and optimal cardiopulmonary resuscitation (CPR)

Abstract

Dr. Adams and colleagues published a study of in-hospital cardiac arrest comparing survival outcomes among hospital staff and visitors to inpatients with matching age, gender, race, prior residence and functional status, and presenting rhythms.1Adams B.D. Jones R.J. Delgado R.E. Larkin G.L. The American Heart Association National Registry of Cardiopulmonary Resuscitation InvestigatorsCardiac arrests of hospital staff and visitors: experience from the national registry of cardiopulmonary resuscitation.Resuscitation. 2009; 80: 65-68Abstract Full Text Full Text PDF PubMed Scopus (8) Google Scholar They found that 24-h survival and survival to discharge were higher for visitors but found no difference in return of spontaneous circulation and first shock success. They point out that while one would expect better outcomes among presumably healthier hospital visitors and staff, the response time in public areas of the hospital can indeed be much slower than for inpatients in the same hospital2Adams B.D. Cardiac arrest of nonpatients within hospital public areas.Am J Cardiol. 2005; 95: 1370-1371Abstract Full Text Full Text PDF PubMed Scopus (7) Google Scholar; therefore adversely affecting survival. More than half the arrests in this study occurred within public areas where medical staff and equipment are generally not readily present. They concluded that the survival outcomes of hospital visitors compared unfavorably to that of out-of-hospital cardiac arrest victims in other high-traffic buildings such as airports, casinos, or schools. However, there is one other important factor that significantly impacts survival; namely the quality of first-responder/bystander cardiopulmonary resuscitation (CPR). In animals, chest compressions are beneficial only when applied with optimal depth; the quality of chest compressions during cardiopulmonary resuscitation overrides importance of timing of defibrillation.3Ristagno G. Tang W. Chang Y.T. et al.The quality of chest compressions during cardiopulmonary resuscitation overrides importance of timing of defibrillation.Chest. 2007; 132: 70-75Crossref PubMed Scopus (66) Google Scholar A human study of prompt defibrillation likely demonstrates the additional beneficial effects on survival of optimal CPR performed by first-responders prior to initial defibrillation.4Valenzuela T.D. Roe D.J. Nichol G. Clark L.L. Spaite D.W. Hardman R.G. Outcomes of rapid defibrillation by security officers after cardiac arrest in casinos.N Engl J Med. 2000; 343: 1206-1209Crossref PubMed Scopus (1134) Google Scholar In a study of outcomes of rapid defibrillation by security officers after cardiac arrest in casinos, overall survival for witnessed arrests with an initial rhythm of ventricular fibrillation (VF) was 59%. Among subjects whose collapse was witnessed, the survival rate was 74% for those who received their first defibrillation no later than 3 min after collapse and 49% for those who received their first defibrillation more than 3 min after collapse. It was suggested that the substantially higher survival rates for arrests in casinos compared to elsewhere can be attributed to arrests being more frequently witnessed and recognized and treatment being initiated sooner. However, one possible explanation for significantly higher survival not considered was that optimal CPR was performed prior to defibrillation. Fifty-four percent (54%) of all witnessed arrests with an initial rhythm of VF received CPR prior to initial defibrillation; however, 61% of these subjects received CPR from properly trained security officers. Survival was excellent regardless of whether CPR preceded the initial defibrillation and/or whether defibrillation was provided in less than 3 min. However, security officers (the majority of rescuers), who are generally physically fit larger-sized men, likely performed optimal CPR (with both an optimal rate and depth of compression) and were likely responsible for significantly increased overall survival. This concept of subjects receiving optimal CPR from “law enforcement personnel” has also been evidenced in a study where survival was highest among subjects who had an initial rhythm of VF and who received bystander CPR from police officers (32.4%) versus 10.0, 16.8, 25.5 and 8.5% for laypersons, medical personnel, ambulance staff and others, respectively.5Holmberg M. Holmberg S. Herlitz J for the Swedish Cardiac Arrest RegistryFactors modifying the effect of bystander cardiopulmonary resuscitation on survival in out-of-hospital cardiac arrest patients in Sweden.Eur Heart J. 2001; 22: 511-519Crossref PubMed Scopus (181) Google Scholar Therefore, emergency-rescuers performing CPR should have similar physical qualities. None to declare.