A person performs CPR on a Adult CPR Training Manikin.
Many lives could be saved if more people performed CPR immediately after seeing someone go into cardiac arrest. (For Spectrum Health Beat)

Many lives could be saved if more people performed CPR immediately after seeing someone go into cardiac arrest, a new study contends.

To come to that conclusion, the researchers looked at the results of a four-year program in North Carolina that promoted bystander CPR.

“During that time, survival with good brain function increased from 7 to 10 percent for those who received bystander CPR,” said lead researcher Dr. Carolina Malta Hansen, of the Duke Clinical Research Institute in Durham, N.C.

In addition, patients who received CPR or defibrillation from bystanders, or defibrillation from first responders—such as police or firefighters—were more likely to survive, she said.

“Early intervention, whether it’s by bystanders or first responders, is associated with increased survival compared to EMS [emergency medical services],” Hansen said.

Hansen pointed out that many people are reluctant to do CPR; some are afraid of legal consequences. However, in states that have “Good Samaritan” laws people are protected from being sued, she said.

Still, being afraid to do something wrong or cause harm is the biggest issue to overcome, Hansen said.

But that fear should not prevent someone from doing CPR, she said. “No matter what you do, the person in cardiac arrest is dead. The only thing you can do is increase their chance of survival,” Hansen said.

The report was published July 21 in the Journal of the American Medical Association.

Sudden cardiac arrest occurs when the electrical system of the heart malfunctions. This causes the heart to beat erratically or to stop beating. As a result, blood isn’t pumped throughout the body.

Dr. Gregg Fonarow, a spokesman for the American Heart Association and a professor of cardiology at the University of California, Los Angeles, said, “It is estimated that 200,000 to 400,000 individuals suffer an out-of-hospital cardiac arrest each year in the United States, with survival rates of only 6 percent.”

In this study, despite intense efforts to get bystanders to give CPR and use automatic defibrillators, few patients survived, he noted.

“More advanced coordinated and collaborative efforts to improve resuscitation and to improve patient outcomes from cardiac arrest are urgently needed,” Fonarow said.

For the study, Hansen and colleagues analyzed nearly 5,000 out-of-hospital cardiac arrest cases in 11 North Carolina counties from 2010-2013. During those years, North Carolina had a campaign to encourage bystanders to perform chest compressions without having to do mouth-to-mouth resuscitation or use automated external defibrillators while waiting for an ambulance.

The campaign also promoted the use of portable defibrillators, which are becoming available in more public places and can be used by laypeople, to shock a heart back into normal rhythm.

The campaign increased survival with good brain function by 37 percent, the researchers said.

The program included training in defibrillators and compression-only—or “hands-only”—CPR at schools, hospitals and public events such as the North Carolina State Fair.

During the years covered by the study, slightly more than 86 percent of patients received CPR before EMS arrived, with more than 45 percent started by bystanders and more than 40 percent started by first responders.

During the study period, the proportion of patients receiving bystander CPR increased from about 39 percent in 2010 to slightly more than 49 percent in 2013.

In addition, the proportion of patients who received bystander CPR and were defibrillated by first responders increased from 14 percent in 2010 to 23 percent in 2013.

Of the more than 1,600 patients who received defibrillation, almost 54 percent were defibrillated before an ambulance arrived. Of these, almost 7 percent were defibrillated by bystanders and 47 percent were defibrillated by first responders. Defibrillation by first responders increased from almost 41 percent in 2010 to 52 percent in 2013, the researchers found.

“Cardiac arrest is a treatable condition,” said Dr. Graham Nichol, a professor of medicine at the University of Washington’s Harborview Center for Prehospital Emergency Care in Seattle and co-author of an accompanying journal editorial.

“Bystanders can save a life by performing CPR or using an automated defibrillator before EMS providers arrive on scene,” he said.