Elsevier

Resuscitation

Volume 50, Issue 3, September 2001, Pages 273-279
Resuscitation

Bystander initiated actions in out-of-hospital cardiopulmonary resuscitation: results from the Amsterdam Resuscitation Study (ARRESUST)

https://doi.org/10.1016/S0300-9572(01)00354-9Get rights and content

Abstract

The objective of this study was to analyze the functioning of the first two links of the chain of survival: ‘access’ and ‘basic cardiopulmonary resuscitation (CPR)’. In a prospective study, all bystander witnessed circulatory arrests resuscitated by emergency medical service (EMS) personnel, were recorded consecutively. Univariate differences in survival were calculated for various witnesses, the performance of basic CPR, the quality of CPR, the performers of CPR and the delays. A logistic regression model for survival was developed from all potential predictors of these first two links.

From the 922 included patients, 93 survived to hospital discharge. In 21% of the cases, the witness did not immediately call 112, but first called others, resulting in a longer delay and a lower survival. Family members were frequent witnesses of the arrest (44%), but seldom started basic CPR (11%). Survival, when basic CPR performers were untrained and had no previous experience, was similar to that when no basic CPR was performed (6%). Not performing basic CPR, delay in basic CPR, the interval between basic CPR and EMS arrival, and being both untrained and inexperienced in basic CPR were independent predictors for survival. Basic CPR performed by persons trained a long time ago did not appear to have a negative influence on outcome, nor did basic CPR limited to chest compressions alone. The mere reporting that basic CPR has been performed does not describe adequately the actual value of basic CPR. The interval from collapse to initiation of basic CPR, and the training and experience of the performer must be taken into account. Policy makers for basic CPR training should focus on partners of the patients, who are most likely witness of an arrest.

Sumàrio

O objectivo deste estudo foi analisar o funcionamento dos 2 primeiros elos da “cadeia de sobrevivência”: “pedido de ajuda” e “suporte básico de vida” (SBV). Num estudo prospectivo registaram-se todas as paragens cardio-respiratória (PCR) consecutivas presenciadas por leigos e reanimadas pelo serviço de emergência médica (SEM). Foi feita análise univariada e calculadas as diferenças para os vários tipos de testemunhas, o desempenho de SBV, a qualidade do SBV, os reanimadores de SBV e os tempos decorridos. Desenhou-se um modelo de regressão logı́stica para todos os potenciais preditores de sobrevida destes 2 elos.

Dos 922 doentes incluı́dos, 93 tiveram alta hospitalar. Em 21% dos casos a testemunha do colapso não chamou de imediato o 112, pediu outras ajudas e daı́ resultou atraso e pior sobrevida. Os familiares das vı́timas foram frequentemente as testemunhas do colapso (44%) mas raramente iniciaram SBV (11%). A sobrevida quando o SBV foi feito por pessoas não treinadas e sem experiência prévia foi semelhante á das situações em que não foi realizado SBV (6%). Os preditores independentes de sobrevida identificados foram: não inı́cio de SBV; atraso no inı́cio do SBV; o intervalo de tempo entre o inicio de SBV e a chegada do SEM; falta de experiência e falta de treino em SBV. O SBV feito por pessoas treinadas muito tempo antes não pareceu influenciar a sobrevida, o mesmo sendo verdade para a realização de SBV só com compressões torácicas. O mero relato de que foi feito SBV não é suficiente para avaliar o valor do SBV. O intervalo entre o colapso e o inı́cio de SBV bem como a experiência de quem faz o SBV devem ser tidos em conta. O ênfase deve ser colocado no treino dos companheiros ou cônjuges dos doentes uma vez que são estes que mais frequentemente presenciam a PCR.

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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