Community-Based CPR: What have we learned?

Cobb LA, Hallstrom AP Annuals of the New York Academy of Science 1982 Pages 330-342 OF HISTORICAL INTEREST

The article reviews Community-Based CPR in Seattle and surrounds. During the previous 9 years, more than 175,000 residents of Seattle had received basic CPR training. In one year, 43% of patients (47/109) found in a state of ventricular fibrillation survived to hospital discharge when bystanders initiated CPR. By comparison, only 21% (43/207) lived when CPR was delayed until fire department personnel arrived on the scene (p<.001). There was little influence of bystander-initiated CPR on the rate of immediate resuscitation (67% with bystanders vs. 61% in the others), importantly however, hospital mortality in resuscitated patients was halved if bystanders had initiated CPR. As well, at the time of hospital admission, half of the patients who had received bystander CPR showed at least some form of conscious behaviour. In contrast, only 6% of patients for whom resuscitation had been delayed until the arrival of the fire department showed such responses. Similarly, there was significantly less neurologic impairment at discharge. It is important to emphasize however, that citizen-initiated CPR is a temporizing measure, only one of many links in the EMS chain. In the Seattle experience for example, initial fire department response averages 3 minutes with secondary ALS response of 5-6 minutes. As such, the duration of citizen CPR is generally but a few minutes. It is the author's position that virtually everyone of high-school age and older should be taught when and how to perform CPR. With continued early application of CPR and more rapid deployment of advanced life support measures, it seems possible that a survival rate approaching 50% in patients with ventricular fibrillation can be obtained in some urban communities.