Journal Club - Recent Additions

May - 2017

   

Showing Journal 8 of 8

Bystander Efforts and 1-Year Outcomes in Out-of-Hospital Cardiac Arrest

Kristian Kragholm, Mads Wissenberg, Rikke N. Mortensen, et al New Eng J Med, 2017, 376:1737-1747

Comment

Does bystander CPR affect long-term neurological recovery? This analysis of the Denmark nationwide OHCA database sets out to answer this by examining the association between bystander CPR and anoxic brain damage (from ICD code) or nursing home admission and of death from any cause among patients who survived to day 30.

They report;
- During the study period 2001-2012 there were 42089 OHCA,
- 30-d survival increased from 3.9% to 12.4% during the study period
- The cohort analysed in this study, the 2855 who survived to 30-d, are presented by baseline variable categorised as no bystander CPR, bystander CPR, bystander defib, EMS witnessed, unknown. Overall the bystander CPR group were younger, more likely to be male, lower comorbidity, more likely to have shockable rhythm
- In the 30-d survivor group 9.7% died during subsequent year, and 10.2% had brain damage or nursing home admission.
- During the period from 2001 through 2012, the rates of bystander CPR and bystander defibrillation increased significantly among the 30-day survivors. During this same interval, the proportion of 30-day survivors with anoxic brain damage diagnosed or admitted to nursing home during subsequent year, as well as the proportion who died during 1 year of follow-up, decreased significantly
- In adjusted analyses, bystander CPR and defibrillation were both associated with significantly lower risk of anoxic brain damage or nursing home admission than no bystander resuscitation. Sensitivity analyses performed with the use of multiple imputation to account for missing data, analysis by cause of death, revealed similar result.
- The absolute 1-year risk of anoxic brain damage or nursing home admission was lowest in the group with EMS-witnessed cardiac arrest (3.7%; 95% CI 2.5 to 4.9).
- The lowest absolute 1-year risk of death was seen in the bystander-defibrillation group (2.0%; 95% CI, 0.0 to 4.2).
- The no- bystander-resuscitation group had highest risk of brain damage or nursing home admission (18.6%; 95% CI, 16.0 to 22.2) and death from any cause (15.5%; 95% CI, 12.5 to 18.6).
- These results were consistent when multiple imputation methods were applied; across groups defined according to age, sex, and Charlson comorbidity index score; among survivors with cardiac arrest of presumed cardiac causes and witnessed cardiac arrest; and among survivors who received defibrillation in a prehospital setting.

Overall this comprehensive observational national registry study of the association between bystander CPR or defibrillation and longterm neurological outcomes after OHCA tells us that;
- Outcomes have improved over time, but remain sobering. A rough calculation suggest about 7-8% of OHCA patients are alive and don't have anoxic brain injury at 1-year
- Early resuscitative efforts by bystanders are associated with a lower 1-year risk of anoxic brain damage or nursing home admission, supporting the view that bystander interventions can improve functional outcomes and strategies that help bystanders initiate CPR and facilitate public access to automated external defibrillators may be of benefit

 

Abstract

BACKGROUND
The effect of bystander interventions on long-term functional outcomes among survivors of out-of-hospital cardiac arrest has not been extensively studied.
METHODS
We linked nationwide data on out-of-hospital cardiac arrests in Denmark to functional outcome data and reported the 1-year risks of anoxic brain damage or nursing home admission and of death from any cause among patients who survived to day 30 after an out-of-hospital cardiac arrest. We analyzed risks according to whether bystander cardiopulmonary resuscitation (CPR) or defibrillation was performed and evaluated temporal changes in bystander interventions and outcomes.
RESULTS
Among the 2855 patients who were 30-day survivors of an out-of-hospital cardiac arrest during the period from 2001 through 2012, a total of 10.5% had brain damage or were admitted to a nursing home and 9.7% died during the 1-year follow-up period. During the study period, among the 2084 patients who had cardiac arrests that were not witnessed by emergency medical services (EMS) personnel, the rate of bystander CPR increased from 66.7% to 80.6% (P<0.001), the rate of bystander defibrillation increased from 2.1% to 16.8% (P<0.001), the rate of brain damage or nursing home admission decreasedfrom10.0%to7.6%(P<0.001),and all-cause mortality decreased from 18.0% to 7.9% (P=0.002). In adjusted analyses, bystander CPR was associated with a risk of brain damage or nursing home admission that was significantly lower than that associated with no bystander resuscitation (hazard ratio, 0.62; 95% confidence interval [CI], 0.47 to 0.82), as well as a lower risk of death from any cause (hazard ratio, 0.70; 95% CI, 0.50 to 0.99) and a lower risk of the composite end point of brain damage, nursing home admission, or death (hazard ratio, 0.67; 95% CI, 0.53 to 0.84). The risks of these outcomes were even lower among patients who received bystander defibrilla- tion as compared with no bystander resuscitation.
CONCLUSIONS
In our study, we found that bystander CPR and defibrillation were associated with risks of brain damage or nursing home admission and of death from any cause that were significantly lower than those associated with no bystander resuscitation. (Funded by TrygFonden and the Danish Heart Foundation.)

May


Previous Comments

No Comments yet.

Add Your Comments : *