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Success of cardiopulmonary resuscitation after heart attack in hospital and outside hospital

^a Centre for Clinical Epidemiology and Biostatistics, Faculty of Medicine and Health Sciences, The University of Newcastle, New South Wales, Australia

Correspondence to: Professor R F Heller, Centre for Clinical Epidemiology and Biostatistics, David Maddison Clinical Sciences Building, Royal Newcastle Hospital, Newcastle, NSW 2300, Australia.

Abstract

Objectives: To determine factors associated with cardiopulmonary resuscitation being attempted after cardiac arrest from myocardial infarction, in or outside hospital, and estimate short term and long term survival rates.
Design: Descriptive cross sectional and cohort study.
Setting: Community based register of all suspected heart attacks and sudden cardiac deaths in Lower Hunter region of New South Wales, Australia.
Subjects: 4924 men and women aged 25-69.
Main outcome measures: Rates of attempted cardiopulmonary resuscitation and survival after successful resuscitation.
Results: Cardiopulmonary resuscitation was attempted in 41% of cases of cardiac arrest after myocardial infarction outside hospital and 63% of cases in hospital. Survival rates at 28 days were 12% and 39% respectively. Among the survivors, although 41% had another myocardial infarction (or coronary death), 81% of both groups were still alive two years later. Younger and better educated people were more likely to receive cardiopulmonary resuscitation in either setting, and being married predicted cardiopulmonary resuscitation being attempted outside hospital. Younger age predicted better survival rates after attempted resuscitation in hospital.
Conclusions: The reasons for better education to predict cardiopulmonary resuscitation being attempted need explanation. The higher survival rate after cardiopulmonary resuscitation in hospital compared with outside hospital and the good long term prognosis for survivors in both settings suggest that attempts to improve success of cardiopulmonary resuscitation outside hospital may be worth while.

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Key messages
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* This study showed that cardiopulmonary
resuscitation was attempted in 41% of cases of
cardiac arrest outside hospital and in 63% of
cases in hospital

* In both settings resuscitation was more likely
to be attempted in younger people and in those
with a higher level of education

* Survival rates at 28 days after the event were
12% and 39% for cases outside hospital and in
hospital respectively; younger age in hospital
was the only factor to predict survival

* Most (81%) of those who survived to 28 days
were still alive two years later

* There is a need to understand why socioeconomic
status seems to be associated with
receiving resuscitation and to try to improve
success of resuscitation outside hospital

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