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Push hard, push fast, if you're downtown: a citation review of urban-centrism in American and European basic life support guidelines.

Orkin AM - Scand J Trauma Resusc Emerg Med (2013)

Bottom Line: The cited studies suggest either no survival benefit or harm arising from compression-only CPR in settings with extended ambulance response times.The evidentiary basis for 2010 AHA and ERC bystander CPR guidelines does not attend to settings without rapid ambulance response times or dispatch services.Standardized bystander CPR guidelines may require adaptation or reconsideration in these settings.

View Article: PubMed Central - HTML - PubMed

Affiliation: Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, ON M5S 3M2, Canada. aaron.orkin@mail.utoronto.ca

ABSTRACT
Bystander cardiopulmonary resuscitation (CPR) improves out-of-hospital cardiac arrest (OHCA) survival. In settings with prolonged ambulance response times, skilled bystanders may be even more crucial. In 2010, American Heart Association (AHA) and European Resuscitation Council (ERC) introduced compression-only CPR as an alternative to conventional bystander CPR under some circumstances. The purpose of this citation review and document analysis is to determine whether the evidentiary basis for 2010 AHA and ERC guidelines attends to settings with prolonged ambulance response times or no formal ambulance dispatch services. Primary and secondary citations referring to epidemiological research comparing adult OHCA survival based on the type of bystander CPR were included in the analysis. Details extracted from the citations included a study description and primary outcome measure, the geographic location in which the study occurred, EMS response times, the role of dispatchers, and main findings and summary statistics regarding rates of survival among patients receiving no CPR, conventional CPR or compression-only CPR. The inclusion criteria were met by 10 studies. 9 studies took place exclusively in urban settings. Ambulance dispatchers played an integral role in 7 studies. The cited studies suggest either no survival benefit or harm arising from compression-only CPR in settings with extended ambulance response times. The evidentiary basis for 2010 AHA and ERC bystander CPR guidelines does not attend to settings without rapid ambulance response times or dispatch services. Standardized bystander CPR guidelines may require adaptation or reconsideration in these settings.

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Related in: MedlinePlus

2010 American heart association and European resuscitation council basic life support algorithms.
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Figure 1: 2010 American heart association and European resuscitation council basic life support algorithms.

Mentions: The 2010 AHA Guidelines encourage hands-only CPR for untrained lay-rescuers and trained lay-rescuers who are not able to perform rescue breaths, indicating that ‘no prospective study of adult cardiac arrest has demonstrated that layperson conventional CPR provides better outcomes than hands-only CPR when provided before EMS arrival’ and that ‘Observational studies of adults with cardiac arrest treated by lay rescuers showed similar survival rates among victims receiving Hands-Only CPR versus conventional CPR with rescue breaths’ [11]. The associated BLS protocol from the AHA Guidelines is provided in Figure 1. The 2010 AHA guidelines emphasized that ‘chest compressions should take priority in the resuscitation of an adult’ and de-emphasized airway and respiratory measures in basic resuscitation, especially for untrained laypeople.


Push hard, push fast, if you're downtown: a citation review of urban-centrism in American and European basic life support guidelines.

Orkin AM - Scand J Trauma Resusc Emerg Med (2013)

2010 American heart association and European resuscitation council basic life support algorithms.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3643884&req=5

Figure 1: 2010 American heart association and European resuscitation council basic life support algorithms.
Mentions: The 2010 AHA Guidelines encourage hands-only CPR for untrained lay-rescuers and trained lay-rescuers who are not able to perform rescue breaths, indicating that ‘no prospective study of adult cardiac arrest has demonstrated that layperson conventional CPR provides better outcomes than hands-only CPR when provided before EMS arrival’ and that ‘Observational studies of adults with cardiac arrest treated by lay rescuers showed similar survival rates among victims receiving Hands-Only CPR versus conventional CPR with rescue breaths’ [11]. The associated BLS protocol from the AHA Guidelines is provided in Figure 1. The 2010 AHA guidelines emphasized that ‘chest compressions should take priority in the resuscitation of an adult’ and de-emphasized airway and respiratory measures in basic resuscitation, especially for untrained laypeople.

Bottom Line: The cited studies suggest either no survival benefit or harm arising from compression-only CPR in settings with extended ambulance response times.The evidentiary basis for 2010 AHA and ERC bystander CPR guidelines does not attend to settings without rapid ambulance response times or dispatch services.Standardized bystander CPR guidelines may require adaptation or reconsideration in these settings.

View Article: PubMed Central - HTML - PubMed

Affiliation: Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, ON M5S 3M2, Canada. aaron.orkin@mail.utoronto.ca

ABSTRACT
Bystander cardiopulmonary resuscitation (CPR) improves out-of-hospital cardiac arrest (OHCA) survival. In settings with prolonged ambulance response times, skilled bystanders may be even more crucial. In 2010, American Heart Association (AHA) and European Resuscitation Council (ERC) introduced compression-only CPR as an alternative to conventional bystander CPR under some circumstances. The purpose of this citation review and document analysis is to determine whether the evidentiary basis for 2010 AHA and ERC guidelines attends to settings with prolonged ambulance response times or no formal ambulance dispatch services. Primary and secondary citations referring to epidemiological research comparing adult OHCA survival based on the type of bystander CPR were included in the analysis. Details extracted from the citations included a study description and primary outcome measure, the geographic location in which the study occurred, EMS response times, the role of dispatchers, and main findings and summary statistics regarding rates of survival among patients receiving no CPR, conventional CPR or compression-only CPR. The inclusion criteria were met by 10 studies. 9 studies took place exclusively in urban settings. Ambulance dispatchers played an integral role in 7 studies. The cited studies suggest either no survival benefit or harm arising from compression-only CPR in settings with extended ambulance response times. The evidentiary basis for 2010 AHA and ERC bystander CPR guidelines does not attend to settings without rapid ambulance response times or dispatch services. Standardized bystander CPR guidelines may require adaptation or reconsideration in these settings.

Show MeSH
Related in: MedlinePlus