Journal Article Advantage of CPR-first over call-first actions for out-of-hospital cardiac arrests in nonelderly patients and of noncardiac aetiology

Kamikura, Takahisa  ,  Iwasaki, Hose  ,  Myojo, Yasuhiro  ,  Sakagami, Satoru  ,  Takei, Yutaka  ,  Inaba, Hideo

96pp.37 - 45 , 2015-11-01 , Elsevier
Aim: To assess the benefit of immediate call or cardiopulmonary resuscitation (CPR) for survival from out-of-hospital cardiac arrests (OHCAs). Methods: Of 952,288 OHCAs in 2005-2012, 41,734 were bystander-witnessed cases without prehospital involvement of physicians but with bystander CPR (BCPR) on bystander's own initiative. From those OHCAs, we finally extracted the following three call/BCPR groups: immediate Call + CPR (N= 10,195, emergency call/BCPR initiated at 0 or 1 min after witness, absolute call-BCPR time interval = 0 or 1. min), immediate Call-First (N= 1820, emergency call placed at 0 or 1 min after witness, call-to-BCPR interval = 2-4. min), immediate CPR-First (N= 5446, BCPR initiated at 0 or 1. min after witness, BCPR-to-call interval = 2-4 min). One-month neurologically favourable survivals were compared among the groups. Critical comparisons between Call-First and CPR-First groups were made considering arrest aetiology, age, and bystander-patient relationship after confirming the interactions among variables. Results: The overall survival rates in immediate Call + CPR, Call-First, and CPR-First groups were 11.5, 12.4, and 11.5%, respectively without significant differences (p= 0.543). Subgroup analyses by multivariate logistic regression following univariate analysis disclosed that CPR-first group is more likely to survive in subgroups of noncardiac aetiology (adjusted odds ratio; 95% confidence interval, 2.01; 1.39-2.98) and of nonelderly OHCAs (1.38; 1.09-1.76). Conclusions: Immediate CPR-first action followed by an emergency call without a large delay may be recommended when a bystander with sufficient skills to perform CPR witnesses OHCAs in nonelderly people and of noncardiac aetiology. © 2015 Elsevier Ireland Ltd.

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