For patients not in the hospital, the critical factor determining survival and long-term recovery after a heart attack is how quickly CPR is started, not who performs it, according to results presented at this year’s ESC Acute Cardiovascular Care Congress in Florence, Italy.
In general, the chances of survival for patients having a cardiac arrest outside the hospital are between 1% and 10%. Even for those who survive the initial event and are taken to hospital, the chances of survival are low.
While it is encouraging that the number of bystanders who perform CPR has increased over the past few years, as 80% of out-of-hospital cardiac arrests (OHCA) occur in residential settings, it is crucial to increase public education and Basic Life Support (BLS) skills to improve survival rates.
“Over time, the proportion of layperson rescuers constantly increased. Rapid return of spontaneous circulation was crucial for in-hospital survival, independently of rescuer type. Also, similar long-term survival was observed comparing patients with initial layperson or emergency medical service cardiopulmonary resuscitation. Our data highlights the importance of immediate resuscitation and underlines the importance to promote population awareness and BLS training to further improve survival after out-of-hospital cardiac arrest,” write the authors from the University of Trieste, Italy.
The authors analysed data from over 3000 patients with myocardial infarction (a type of heart attack caused by a complete blockage of a major heart artery) admitted to the cardiology department at University Hospital Trieste over 22 years (2003-2024). Among them, 172 suffered a heart attack without medical care, and 44 of these received CPR from a bystander. First, the authors noticed a significant increase in the number of patients receiving CPR done by bystanders. Results showed the proportion of patients receiving bystander CPR increased from 26% in 2003-2007 to 69% in 2020-2024.
On average, it took patients about 10 minutes to recover circulation, but this time was longer for if CPR was performed by bystanders (about 20 minutes) compared to professional healthcare providers (only 5 minutes). In addition, patients who received bystander CPR were more likely to need endotracheal intubation (ET) (91% for bystander CPR versus 65% for those receiving EMS CPR).
However, mortality was more influenced by how long it took for patients to receive CPR and not necessarily who was performing it. Statistical analysis revealed a longer time to recover circulation, not rescuer type, led to increased mortality rates. More precisely, each 5-minute delay was associated with a 38% increased risk of mortality.