Bystander initiated actions in out-of-hospital cardiopulmonary resuscitation: results from the Amsterdam Resuscitation Study (ARRESUST)
Introduction
The chain of survival concept describes the actions necessary for an optimal chance to survive an out-of-hospital cardiac arrest [1]. The first two links in the chain of survival: access and basic cardiopulmonary resuscitation (CPR) are nearly always bystander initiated actions and the success of resuscitation efforts by health care professionals are highly dependent on the responsibly initial bystander. This study focussed on the period of circulatory arrest before the arrival of emergency medical service (EMS) personnel. We analyzed the actions and the quality of performance of the four groups most involved in the first two links: family, bystanders, general practitioners and police officers.
Section snippets
Emergency medical service system
The EMS system is a one tiered system serving 1.3 million inhabitants in the Amsterdam area of 1030 km2. The Netherlands has a national emergency telephone number 112, connected to regional dispatch centers. All ambulances were manned with a paramedic and a driver, who are trained to perform advanced CPR. Sometimes, the police were also activated after an emergency call for a suspected circulatory arrest. Telephone instructions for CPR were not used.
Study design
In a prospective study performed between June
The study cohort
In a study period of 26 months, 1685 patients had a circulatory arrest confirmed by EMS personnel. We excluded 400 patients who were not resuscitated by EMS personnel, 198 patients whose arrest was not witnessed and 165 patients whose onset of arrest was witnessed by EMS personnel. Of the remaining 922 patients, attempts to resuscitate were unsuccessful in 71% (658/922). After initial successful resuscitation 19% (171/922) of the patients died during hospital admission and eventually 10%
Discussion
This study focussed on the first two links in the chain of survival: ‘access’ and ‘basic CPR’. In multivariate analysis, basic CPR performance before arrival of EMS personnel substantially improved survival. If the start of basic CPR was delayed, survival decreased significantly. Furthermore, what did matter was the training or experience of the basic CPR performer and not who started basic CPR.
Basic CPR skills as tested on a manikin decline in time [5]. We could not demonstrate that such a
Acknowledgements
We thank the dedicated research personnel: I. Tulevski, P.S. Visser, D. Dalhuisen, B.P.W. de Gouw, E.J.P. Vlieger, M. Akarriou, F.R. Banga, L.A.M. Verkouteren, J.M. Immink, and S. Ritmeester who took part in the data collection. We also thank the personnel of the dispatch center, ambulance services, police departments and hospitals in Amsterdam and the region for their time spent in supplying us with necessary data. This study was supported by a grant from The Netherlands Heart Foundation no.
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