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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 27, No 5, September/October 2016
AFRICA
275
Out-of-hospital cardiac arrest
Terminology may drive our perceptions of activities and our
actions in response to the events we see occurring around us. Is
it time to take the P (pulmonary) out of CPR (cardiopulmonary
resuscitation) when referring to witnessed out-of-hospital
cardiac arrests (OHCA)? I was prompted to consider this when
I was personally involved in resuscitation of an individual who
suffered an out-of-hospital cardiac arrest when walking his dog,
as I was walking mine, in a park near our home. He collapsed a
few metres in front of me, immediately after tossing a ball for
his dog to chase, and when I examined him he was wheezing,
cyanosed and pulseless.
I immediately started compression-only CPR (CO-CPR) as
I understood this was the accepted standard. It was gratifying
to see the cyanosis resolve. Fortunately paramedics with a
defibrillator arrived within 15 minutes and the patient was
transferred to hospital in a stable condition and discharged,
neurologically intact, after implantation of an implantable
cardiac defibrillator.
I was interested in the responses of fellow citizen bystanders,
some of whom felt that compression only, neglecting ventilation,
was incorrect, and tried to correct my approach. First-responder
ambulance personnel similarly seemed anxious to interrupt chest
compression to place an oral airway despite the fact that the
patient was pink (as opposed to earlier cyanosis) and there was
audible air exchange.
By happy coincidence, shortly after that incident, I reviewed,
for our departmental journal club, an article that reinforced
my opinions and one that I believe should be more widely
disseminated. In a perspective article in
Circulation
, Gordon
Ewy
1
clearly describes the benefits of CO-CPR for witnessed
out-of-hospital arrest, the experimental animal work supporting
it, and its successful implementation in the state of Arizona.
The results were impressive. In all patients with OHCA, the
survival rate was 7.8% in those receiving guidelines CPR and
13.3% in those receiving CO-CPR. In the subset of patients with
witnessed cardiac arrest and a shockable rhythm, survival rate
was 17.7% in those receiving guidelines CPR and 34% in those
receiving CO-CPR.
It is emphasised that this applies to OHCA were oxygenation
immediately prior to the arrest is normal, and does not apply in
other circumstances, such as in hospital, where hypoxia may in
fact contribute to the arrest. This report documents succinctly
and clearly one of the few real advances and successes in the
management of witnessed out-of-hospital cardiac arrest in
several decades and should be read and widely disseminated.
1.
Ewy GA.
Circulation
2016;
134
: 695–697. doi: 10.1161/
CIRCULATIONAHA.116.023017.
PJ Commerford
Editor-in-Chief
From the Editor’s Desk
Professor PJ Commerford