The American Heart Association released new CPR guidelines Thursday that emphasize the role of bystanders and encourage health systems and emergency responders to develop better plans to treat patients in cardiac arrest.
The guidelines encourage the implementation of widespread, simple CPR training and the establishment of formal plans to follow through on past clinical recommendations.
“I think the things we see in the new guidelines ... are the real importance of having systems of care that deliver the interventions that we've been preaching for a long time more reliably,” said Dr. Clifton Callaway, chair of the AHA's Emergency Cardiovascular Care Committee and a professor of emergency medicine at the University of Pittsburgh.
While heart attacks result from problems with circulation, cardiac arrest is an electrical issue that occurs when the heart malfunctions and unexpectedly stops beating. Less than 6% of patients survive cardiac arrest outside of the hospital, but there are widely available, effective treatments for specific types of cardiac arrest that could reduce deaths and disability if they are more efficiently implemented.
The chain of events for treatment of cardiac arrest that takes place outside of a hospital ultimately starts with bystanders, Callaway said. Immediate CPR can make a big difference in a patient's chances of survival, so hospitals and public health authorities need to put more resources into teaching simple hands-only CPR to the masses, and 911 dispatchers should receive further training on how to most quickly and effectively provide instructions for performing CPR.
“Laypeople need to understand the actions of the person who is the first to help the collapsed (patient) is just as much a part of the system,” Callaway said. “That person is just as important as any part of that chain.”
For the EMS providers stabilizing patients and transporting them to the hospital, there have to be better plans in place as to where they should be taken, Callaway said. While the protocol of many EMS providers is to take the patient to the nearest hospital, that practice may be hurting their chances of survival.
Patients may be better served in hospitals with advanced services like cardiac interventionists, neurocritical care, a cardiac catheter lab or a dedicated ICU. The AHA report said multiple studies show an association between improved survival and transport to hospitals that have providers who specialize in cardiac arrest care.
Emergency personnel need to work with hospitals to create protocols that consider the capabilities of area hospitals when deciding where to take a cardiac arrest patient, Callaway said.
“Those are changes that are happening now and you're seeing many regions evolve and create plans of care for patients after cardiac arrest just like we did in the late 1990s or the early 2000s for acute myocardial infarctions (also known as heart attacks),” Callaway said.
For healthcare professionals, especially, the AHA guidelines discuss a number of other technical recommendations, including the importance of ensuring that chest compressions are performed at a depth of at least 2 inches into the body to ensure CPR is effective, while avoiding pushing further than 2.4 inches. It also discusses the need to simultaneously perform tasks necessary before adult CPR, among other guidelines.
The Institute of Medicine released a report earlier this year pointing to "unacceptable" disparities in cardiac arrest survival rates across the U.S. The report's authors called for a revamp of the national cardiac arrest treatment strategy to standardize surveillance, coordination, data collection, public education and the sharing of best practices pertaining to the condition.