HOT OFF THE PRESS!

Debra L. Beck and Eugene Braunwald, MD

Date Published: 14 Feb 2020

In this review article, Brady and colleagues discussed the role of lay responders in the care of individuals with out-of-hospital cardiac arrest (OHCA). Lay rescuers play an important role in the resuscitation of people with OHCA because they are most often the first responders and, therefore, responsible for the first steps in the “chain of survival,” that being the early recognition of cardiac arrest and activation of the emergency-response system and initiation of cardiopulmonary resuscitation (CPR).

Mortality rates for OHCA differ between countries and even locales within countries. In the US, where an estimated 155,000 person per year are treated by emergency medical services for OHCA, about 8% survive. In Europe, the corresponding numbers are 275,000 persons and 10%. “Prearrival” care is time sensitive—every minute that a person goes without CPR and defibrillation is associated with a 7 to 10% decrease in chance of survival.

Bystander CPR is initiated in less than 50% of OHCA cases, and automated external defibrillators (AEDs) are used in no more than 25% of appropriate patients. However, the Cardiac Arrest Registry to Enhance Survival shows considerable variation among 132 U.S. counties with respect to survival after OHCA (ranging from 3.4% to 22%), with this variation partially attributed to varying frequencies of bystander CPR performance and AED use.

Physicians have a role to play in promoting CPR education, appropriate AED placement, and educating the lay public about the proper steps to take when OHCA is suspected. They should also seek to enhance public awareness regarding the substantial effect bystander care has on survival.

References

1. Brady WJ, Mattu A, Slovis CM: Lay Responder Care for an Adult with Out-of-Hospital Cardiac Arrest. N Engl J Med. 381(iss): 2242-2251. 5 Dec 2019. 31800989

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