Chest Compression Only Cardiopulmonary Resuscitation for Primary Cardiac Arrest
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Cardiovascular disease continues to be the leading cause of death in most industrialized nations of the world. Unfortunately, the first sign of cardiovascular disease often is the last, because the first sign is frequently sudden cardiac arrest.
Despite Standards in 1974, Standards and Guidelines in 1980, Guidelines in 1986, and Updates of Guidelines in 1992, 2000, and 2005, the survival rate of patients with out-of-hospital cardiac arrest (OHCA) in the United States averaged 7.6% and was unchanged from 1978 to 2008. Likewise, survival of patients with OHCA secondary to ventricular fibrillation (VF), those dramatically more likely to survive, also was unchanged for >2 decades, averaging 17.7%.
A major reason for these previously low rates of survival was the lack of bystander cardiopulmonary resuscitation (CPR) because of the decades-old requirement of mouth-to-mouth ventilation as the first step. Most bystanders, including medical personnel, would call but then await the arrival of emergency medical services personnel. Such OHCA patients rarely survived.
Our University of Arizona Sarver Heart Center Resuscitation Research Group found in animal models of ventricular fibrillation (VF) arrest that survival was better with continuous chest compressions than with no CPR until defibrillation at 10 minutes. As a result, since the early 1990s, we have recommended chest compression only CPR (CO-CPR) as the initial therapy for witnessed primary cardiac arrest, defined as, “An unexpected, seen or heard, collapse of a …