Cardiopulmonary resuscitation: Improving the weakest link in the chain of survival for out-of-hospital cardiac arrest

Abstract

Background. Bystander CPR is associated with improved survival from cardiac arrest, the first cause of mortality in Canada. Objectives. To improve bystander CPR rates and survival from out-of-hospital cardiac arrest. Methods. A retrospective and prospective analysis of data on cardiac arrest, a systematic review of bystander CPR, a trial designed for improving survival from out-of-hospital cardiac arrest. Results. 7707 out-of-hospital cardiac arrests (1995--2000) with bystander CPR rate (16.5%) and overall survival to discharge (4%). Cardiac arrests are in residential locations (84.7%). Increasing bystander CPR rates could significantly improve survival in residential dwellings (OR 3.6; 95%CI 2.9--4.6). We systematically reviewed 221 publications to plan the intervention for our suggested cluster randomized trial. The study is feasible over a 3 to 5-year period. Conclusions. Public health intervention in the field of bystander CPR will improve survival from cardiac arrest. Our study could significantly affect other international communities equipped with an existing EMS.