Bystander cardiopulmonary resuscitation: Effects, attitudes and reactions. An evaluation of teaching CPR in the community

Abstract

Sudden cardiac arrest accounts for a high proportion of deaths in the western societies and the majority of these cases occur out-of-hospital. During the last three decades a huge effort has been made to improve the prognosis in this patient population. One link in this development has been ìearly cardiopulmonary resuscitationî (CPR). The aim of the present thesis is to evaluate the dissemination of CPR knowledge in the community. Survival after pre-hospital cardiac arrest (CA) and prevalence of bystander CPR were described out from 3,434 CAs during 1980-92. The effect of bystander CPR on survival was described from 1,660 cases of witnessed CAs from the same 3,434 cases. Bystander-initiated CPR, the circumstances, the bystanders and their experiences were described from 742 bystandersí reports (1990-94). An attempt to identify the factors influencing the bystandersí reactions to performing CPR was made based on 544 reports from bystanders who had performed CPR 1992-95. The attitudes among lay people trained in CPR, in terms of performance in an emergency, as well as differences with regard to gender, age, residential area and occupation were described from 1,012 questionnaires received from rescuers trained in CPR in January 1997. A qualitative method was used to describe the bystandersí conceptions of the initial phase of their CPR intervention. Nineteen bystanders who had performed CPR during 1997-98 were interviewed.Introduction of first responder defibrillation in G teborg has lead to a shortened interval between CA and first defibrillation with three minutes. The survival rate of patients with pre-hospital CA improved significantly, probably due to this shortened interval. Despite considerable efforts to disseminate CPR skills in the community, the prevalence of bystander CPR increased only moderately over time, from 16% to 20%. However, the effects of bystander CPR were maintained VF and a threefold increase in survival in patients with witnessed CA before arrival of EMS. The bystanderís intervention seemed to be motivated by a sense of humanity. The bystander feels an obligation to intervene and has the courage to do so, but in order to intervene the bystanders have to overcome some unwanted feelings of exposure. Most of the bystanders performed CPR on an unknown person and less than 10% of the bystanders were related to the victim. Trained rescuers are highly willing to perform CPR on a relative (97%), while only 70% were sure about starting CPR on a stranger. Rescuers from rural areas are more frequently positive about starting CPR than those from metropolitan areas. Lack of debriefing (odds ratio 9.6) and fatal victim outcome (odds ratio 3.8) were found to be predictors of bystandersí negative reactions to their intervention. Ninety-three per cent of the bystanders regarded their intervention as a positive experience and 99.5% were prepared to start CPR again.Conclusion: Teaching CPR in the community is both feasible and necessary, to improve the prognosis in the pre-hospital CA population. Lay people can cope with this mission. However, they need some help to overcome any traumatic feelings initially after the event.