How Valuable is CPR in treating cardiac arrest?

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From the May 2011 Issue | Sunday, May 1, 2011


This month, a column by Bryan E. Bledsoe, DO, FACEP, FAAEM, that questions the effectiveness of CPR created quite a buzz among readers (“CPR Effectiveness,” JEMS.com). Should providers be practicing other, more effective methods in the field? Also, an EMS Mythbuster’s article by William T. Ballo, NREMT-P, and Melissa A. Bentley, BS, NREMT-P, (“Credit Scores,” March JEMS) stirs a dialogue on the value of accreditation in EMS education.

CPR Debate
I also read Gust H. Bardy’s article, and I found several significant problems with it, and by proxy, Bryan Bledsoe’s. Although it’s difficult, and probably unethical, to do a randomized prospective study on CPR with defibrillation vs. defibrillation alone, a plethora of studies and evidence back up this procedure, possibly more than almost any other treatment.

There’s a significant difference in outcomes of patients with bystander CPR vs. no CPR prior to EMS arrival. This alone indicates the value of CPR and CPR training.

As a paramedic, I can certainly say my experience shows that patients who receive CPR from bystanders prior to EMS arrival have had better outcomes than those who didn’t.

This article appears to be a half-hearted attempt to put one foot on Dr. Bardy’s bandwagon just in case he’s proved right in the future. Challenging the status quo is fine if you have at least a shred of evidence to back up your case.
RWales
Via Facebook

Author Bryan E. Bledsoe, DO, FACEP, FAAEM, responds: People are talking; that was my point. Always challenge the status quo. My personal belief is more in line with Kellerman’s meta-analysis. Compressions-only CPR, quicker defibrillation and field return of spontaneous circulation (ROSC) have the best outcomes.
The summary in Kellerman’s paper reads as follows: “This meta-analysis brings together almost 30 years of research, involving more than 142,000 patients. Our findings conclusively affirm the value of bystander CPR, the critical importance of ‘shockable’ rhythms, and the predictive value of ROSC in the field.

“Focused strategies designed to boost rates of bystander CPR, deliver earlier defibrillation, and achieve ROSC before transport are likely to do more to improve aggregate rates of out-of-hospital cardiac arrest (OHCA) survival than interventions applied later in a patient’s treatment. Currently, 92% of individuals who experience OHCA each year do not survive to hospital discharge. This dismal statistic can be improved.”

That said, there should never be an EMS crew doing CPR in a moving ambulance unless the patient re-arrests en route. If it all works together, and ROSC is attained in the field, then transport can be calm and deliberate.

People (some) are thinking outside the box after the article. That was my sole intention.

For the complete discussion, visit jems.com/article/patient-care/cpr-exercise-futility

Accreditation Advice
Attending a program that provides national accreditation is important, but if providers desire to earn a bachelor’s or master’s degree, then they should do some further studying on the matter.

Regional accreditation is much more important than national in furthering one’s education. Many brick-and-mortar universities won’t accept work done under national accreditation alone. Online universities will accept work done under these different univer-sities, but the same doesn’t always happen in reverse.

I commend Ballo and Bentley for their in-depth study, but it’s important to remind students that once the test is over, only the future remains.
James A. Urquhart
Versailles, Kentucky

I’m all for a higher level of professionalism, better training and more education. But has anyone thought seriously how we’re going to pay these better educated paramedics? In this country, a parallel exists between more education and a higher salary. Thus, a paramedic graduating from a degree program may well expect to make more than what’s being offered in the low- to mid-range salary areas. I don’t see Medicare creating a payment level for a bachelor’s degree crew, nor do I see insurance companies willing to pay more.
Steve Webb
Via Facebook


CORRECTION

In the March JEMS Mythbusters column, author William T. Ballo, BS, NREMT-P’s credentials and title were incorrectly listed. He is currently obtaining his Master’s of Public Health at the University of South Florida and was a research fellow, not an intern, while writing the article. We apologize for the errors. JEMS

This article originally appeared in May 2011 JEMS as “Letters: In Your Words.”




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Related Topics: Patient Care, Airway and Respiratory, William T. Ballo, Melissa Bentley, Letters, cpr, Bryan Bledsoe, accreditation, Jems Letters

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