Bystander CPR, ventricular fibrillation, and survival in witnessed, unmonitored out-of-hospital cardiac arrest.

STUDY OBJECTIVE

To assess whether bystander CPR (BCPR) on collapse affects initial rhythm and outcome in patients with witnessed, unmonitored out-of-hospital cardiac arrest (OHCA).

DESIGN

Prospective cohort study. Student's t test, the chi 2 test, and logistic regression were used for analysis.

SETTING

Suburban emergency medical service (EMS) system.

PARTICIPANTS

Patients 19 years or older with witnessed OHCA of presumed cardiac origin who experienced cardiac arrest before EMS arrival between July 1989 and July 1993.

RESULTS

Of 722 patients who met the entry criteria, 153 received BCPR. Patients who received BCPR were younger than those who did not: 62.5 +/- 15.4 years versus 66.8 +/- 15.1 years (P < .01). We found no differences in basic or advanced life support response intervals or in frequency of AED use. More patients initially had ventricular fibrillation (VF) in the BCPR group: 80.9% versus 61.4% (P < .01). The interval to definitive care for ventricular tachycardia (VT)/VF was longer for the BCPR group (8.59 +/- 5.3 versus 7.45 +/- 4.7 minutes; P < .05). The percentage of patients discharged alive who were initially in VT/VF was higher in the BCPR group: 18.3% versus 8.4% (P < .001). In a multivariate model, BCPR is a significant predictor for VT/VF and live discharge with adjusted ORs of 2.7 (95% CI, 1.7 to 4.4) and 2.4 (95% CI, 1.5 to 4.0), respectively. For those patients in VT/VF, BCPR predicted live discharge from hospital with an adjusted OR of 2.1 (95% CI, 1.2 to 3.6).

CONCLUSION

Patients who receive BCPR are more often found in VT/VF and have an increased rate of live discharge, with controls for age and response and definitive care intervals. For VT/VF patients, BCPR is associated with an increased rate of live discharge.