Immediate chest compressions better cardiac arrest outcomes

A new study reported in BMC suggests that chest compressions prior to defibrillation are just as good as immediate electrical defibrillation and in some case the chest compression first approach may offer sudden cardiac arrest patients some extra benefits.

The review study showed that there was no difference between the chest compression first and immediate electrical defibrillation in terms of the rate of return of spontaneous circulation, survival to hospital discharge or neurological outcomes in patients who suffered out-of-hospital cardiac arrest.

Current guidelines recommend patients suffering out-of-hospital cardiac arrest should receive immediate electrical defibrillation, according to ABC News. Researchers were cited as saying defibrillation is still important, but the findings may have some impact on future recommendations on how to respond to cardiac arrest.

For the study, Dr. Pascal Meier of the University of Michigan and colleagues reviewed data from four randomized controlled trials involving 1,503 patients to compare the effects of the compression-first approach versus the defibrillation-first approach on outcomes for out-of-hospital cardiac arrest.

Dr. Meier et al. did find patients who were treated with the chest compression first approach had a better one-year survival and were more likely to leave the hospital after cardiac arrest than those treated with defibrillation only, 11 percent versus 8.6 percent.

Chest compressions are commonly performed as part of cardiopulmonary resuscitation

to revive cardiac arrest patients. One early study released in 2007 in The Lancet suggests that chest compression without rescue breaths is better than the conventional CPR method which requires mouth-to-mouth breaths.

The study conducted by Japanese researcher Ken Nagao of Surugadai Nihon University Hospital in Tokyo showed that patients treated with chest compression only were less likely to suffer severe brain damage induced by cardiac arrest. The favorable neurological outcome for chest compression was 19.4 percent compared to 11.2 percent for the traditional CPR.

Another study of about 2000 patients who suffered sudden cardiac arrest showed that chest compression only cardiopulmonary resuscitation saved 12.5% of patients who were able to live to hospital discharge after being resuscitated while the conventional CPR saved 11%.

The study was led by Thomas D. Rea, M.D. at the University of Washington and colleagues and reported in the July 29, 2010 issue of the New England Journal of Medicine.

In the same issue, Leif Svensson, M.D., Ph.D. at Karolinska Institutet in Sweden and colleagues reported that chest compression alone helped 8.7% of patients to survive for 30 days or more while the standard CPR helped just 7% of patients.

Sudden cardiac arrest is a condition in which the heart suddenly stops beating. When the condition is not corrected in a matter of 3 to 5 minutes, the patient would die because of massive brain damage due to lack of oxygen.

Cardiac arrest is often caused by arrhythmias meaning that the heart beats too fast or too slow or with an irregular rhythm. The condition differs from myocardial infarction or heart attack which occurs when blood flow to part of the heart muscle is blocked.

Defibrillation sends an electric shock to the heart to restore its normal rhythm. According to American Heart Association, an estimated 294,851 out-of-hospital cardiac arrests occur in the united States each year. Ninety five percent of patients with cardiac arrest can't survive.

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