Time-Sensitive Emergency: OHCA and CPR
Out-of-hospital cardiac arrest (OHCA) during a heart attack is a medical emergency requiring immediate cardiopulmonary resuscitation (CPR). New research presented at the ESC Acute CardioVascular Care Congress in Florence, Italy (March 14-15), emphasizes that the speed of CPR initiation—not the identity of the rescuer—determines survival and long-term outcomes.
Study Highlights Growing Role of Bystander CPR
A research team led by Prof. Aneta Aleksova, including Dr. Alessandra Lucia Fluca and Dr. Milijana Janjusevic from the University of Trieste, Italy, in collaboration with interventional cardiologist Dr. Andrea Perkan, analyzed OHCA cases in the Friuli Venezia Giulia Region. Their findings show that bystander-performed CPR has increased significantly over the past two decades. However, since 80% of OHCAs occur in residential settings, expanding public education and Basic Life Support (BLS) training remains critical for improving survival rates.
Key Findings: Speed of CPR Determines Survival
The research team studied 3,315 patients admitted for ST-elevated myocardial infarction (STEMI) at the University Hospital Trieste from 2003 to 2024. Among them, 172 suffered OHCA, and 44 received CPR from a bystander. Dividing the study into five intervals (2003-2007, 2008-2011, 2012-2015, 2016-2019, and 2020-2024), researchers observed a rise in bystander CPR, increasing from 26% in 2003-2007 to 69% in 2020-2024.
The median time to return of spontaneous circulation (ROSC) was 10 minutes overall but differed significantly based on rescuer type: 20 minutes for bystander CPR and only 5 minutes for medical personnel. Patients receiving bystander CPR also underwent endotracheal intubation (ET) more often (91% vs. 65% for EMS-initiated CPR).
Predictors of In-Hospital Mortality
One in four patients (25.6%) died during their initial hospital stay. Those who did not survive were older (67 years vs. 62 years for survivors) and had more comorbidities. Statistical analysis identified three key predictors of in-hospital mortality:
- Each 5-minute delay in ROSC increased mortality risk by 38%.
- A 5-percentage-point decrease in left ventricular ejection fraction (LVEF) raised mortality risk by 38%.
- Every 5-year increase in age was associated with a 46% higher death risk.
During a median follow-up of 7 years, 14% of patients died, but mortality rates did not differ based on whether CPR was performed by a bystander or emergency personnel.
Higher Survival Rates: Possible Explanations
The survival rates observed in this study are higher than those typically seen in OHCA cases. Several factors may explain this:
- Patients in this study had STEMI-related cardiac arrests, which have better recovery prospects than other OHCA causes.
- A higher proportion of bystanders were trained in CPR.
- Strong emergency medical response systems enabled rapid intervention.
Call for Greater Public Awareness and CPR Training
As per the ESC Press release, the study underscores the life-saving importance of immediate CPR, regardless of who administers it. The authors stress the need to enhance public awareness and expand BLS training to further improve survival rates after OHCA. “Over time, the proportion of layperson rescuers has consistently increased. Rapid ROSC was crucial for in-hospital survival, independently of rescuer type. Promoting population awareness and BLS training is essential for improving survival outcomes,” the researchers concluded.