Immediate chest compressions better cardiac arrest outcomes

A new study published in the BioMed Central (BMC) Medicine journal September 9, 2010 suggests that chest compressions prior to defibrillation are just as good as immediate electrical defibrillation, and in some cases the chest compression first approach may offer sudden cardiac arrest patients some extra benefits.

The 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, 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. found that 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% versus 6% respectively.

Chest compressions are commonly performed as part of cardiopulmonary resuscitation to revive cardiac arrest patients.  An earlier 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, Surugadai Nihon University Hospital, 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% compared to 11.2% for the traditional CPR.

Reported in the July 29, 2010 issue of the New England Journal of Medicine, a study led by Thomas D. Rea, MD, Unviersity of Washington and colleagues revealed that 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%. 

In the same issue, Leif Svensson, M.D., Ph.D., Karolinska Institutet, 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. Death is imminent if this condition is not corrected in three to five minutes due to massive brain damage from lack of oxygen.

Cardiac arrest is often caused by arrhythmias meaning that the heart beats too fast, 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 the American Heart Association, an estimated 294,851 out-of-hospital cardiac arrests occur in the United States each year.   Survival rate for cardiac arrest patients is less than 5%.

The National Lung Heart and Blood Institute says that a beneficial healthy diet should include fruits, vegetables and grains and foods should be low in saturated fat, trans fat, salt, added sugar and cholesterol. 

By David Liu and editing by Laura Lamp King