“Prearrival care” (interventions provided by bystanders before trained medical providers arrive on the scene) can mean the difference between life and death for cardiac arrest victims, according to a landmark article published today in The New England Journal of Medicine. “Lay Responder Care for an Adult with Out-of-Hospital Cardiac Arrest,” by William Brady, MD, Amal Mattu, MD, and Corey Slovis, MD, observes that the most important links in the Chain of Survival are the earliest ones—recognition of cardiac arrest and initiation of CPR, both of which are performed largely by bystanders. The article further highlights the importance of emergency dispatcher guidance in influencing the likelihood that bystanders will perform CPR before EMS arrival and retrieve the nearest automated external defibrillator (AED). It also describes a recent review of 41 studies of public access defibrillation which found that the median rate of survival to hospital discharge is 53% when defibrillation is provided by lay bystanders, compared with 28.6% when defibrillation is provided by emergency first responders. The authors conclude that physicians should encourage the public to participate in pre-arrival care, endorse lay provider education, and advocate for placement of public-access AEDs. “If prearrival measures are initiated early in out-of-hospital cardiac arrest,” said the authors, “they have the potential to significantly increase the likelihood of meaningful survival.”
Reference: N Engl J Med 2019;381:2242-51.