Impact of bystander cardiopulmonary and cerebral resuscitation in the prehospital setting on survival rates in the short and long term

Background

The results of CPCR attempts after cardiac arrest (CA) are very poor because of the irreversible brain damage, myocardium damage and other organ damage that may occur within 4 min of no blood flow. Early initiation of CPCR by a bystander is crucial, in order to obtain a low blood flow up to the arrival of the mobile intensive care unit (MICU).

Objective

To evaluate the impact of resuscitation by a bystander on the short-term outcome (STO) and long-term outcome (LTO).

Methods

A consecutive and prospective study over a period of 5.5 years (1 January 1999–9 July 2004) was conducted. The patients were treated by the MICU of the Academic Hospital of the Vrije Universiteit Brussel (AZ-VUB) onsite and later on in the Emergency Department (ED).

Results

In patients who were initially resuscitated by a bystander before arrival of the MICU, ROSC was achieved in 66 (35.29%) cases, while 114 (60.96%) patients were declared dead on the scene. CPCR was continued during transport to the ED in seven (3.74%) patients. When CPCR was initiated by the MICU, ROSC was achieved in 207 (13.81) patients, and 1278 (85.26%) did not achieved ROSC. CPCR was continued during transport to the ED for 14 (0.93%) patients.

One year after resuscitation, 66 (44.07%) of the patients that were initially resuscitated by a bystander and thereby resumed ROSC were still alive, and 33 (55.93%) were declared dead. Out of the patients that were initially resuscitated by the MICU or the first tier and achieved a ROSC, 20 (15.50%) were still alive 1 year after the event and 109 (84.50%) were dead.

Conclusion

Bystander CPCR plays a crucial role in the chain of survival. Compared with patients that were initially not resuscitated by a bystander, significant differences in the STO and LTO are observed.