TY - JOUR
T1 - Survival Increases with CPR by Emergency Medical Services before defibrillation of out-of-hospital ventricular fibrillation or ventricular tachycardia
T2 - Observations from the Resuscitation Outcomes Consortium
AU - Bradley, Steven M.
AU - Gabriel, Erin E.
AU - Aufderheide, Tom P.
AU - Barnes, Roxy
AU - Christenson, Jim
AU - Davis, Daniel P.
AU - Stiell, Ian G.
AU - Nichol, Graham
N1 - Funding Information:
Tom Aufderheide reported that he is a member of the American Heart Association BLS Subcommittee; has received research grants from the National Institutes of Health (NIH); and has served as a consultant for Take Heart America, JoLife, and Medtronic. Graham Nichol reported that he is a member of the American Heart Association ACLS Subcommittee and the Medic One Foundation Board of Directors; has received research grants from the NIH; has received equipment donations to support overseas medical missions from the Asmund S. Laerdal Foundation for Acute Medicine, Laerdal Inc., and Medtronic Physio-Control Inc.; has received travel expenses payments from INNERcool Inc. and Radiant Inc., and has served as a consultant to Northfield Laboratories Inc. and Paracor Medical Inc. No other disclosures were reported.
Funding Information:
The ROC is supported by a series of cooperative agreements to 10 regional clinical centers and one Data Coordinating Center ( 5U01 HL077863, HL077881, HL077871, HL077872, HL077866, HL077908, HL077867, HL077885, HL077887, HL077873, HL077865 ) from the National Heart, Lung and Blood Institute in partnership with the National Institute of Neurological Disorders and Stroke, U.S. Army Medical Research & Material Command, The Canadian Institutes of Health Research (CIHR)-Institute of Circulatory and Respiratory Health, Defence Research and Development Canada, the American Heart Association and the Heart and Stroke Foundation of Canada.
Funding Information:
The authors have no commercial affiliation or consultancy that could be construed as a conflict of interest with respect to the submitted data. In the interest of full disclosure, Tom Aufderheide reported that he is a member of the American Heart Association BLS Subcommittee; has received research grants from the National Institutes of Health (NIH); and has served as a consultant for Take Heart America, JoLife, and Medtronic. Graham Nichol reported that he is a member of the American Heart Association ACLS Subcommittee and the Medic One Foundation Board of Directors; has received research grants from the NIH; has received equipment donations to support overseas medical missions from the Asmund S. Laerdal Foundation for Acute Medicine, Laerdal Inc., and Medtronic Physio-Control Inc.; has received travel expenses payments from INNERcool Inc. and Radiant Inc., and has served as a consultant to Northfield Laboratories Inc. and Paracor Medical Inc. No other disclosures were reported.
PY - 2010/2
Y1 - 2010/2
N2 - Background: Immediate defibrillation is the traditional approach to resuscitation of cardiac arrest due to ventricular fibrillation or tachycardia (VF/VT). Delaying defibrillation to provide chest compressions may improve survival. We examined the effect of the duration of Emergency Medical Services (EMS) cardiopulmonary resuscitation (CPR) prior to first defibrillation on survival in patients with out-of-hospital VF/VT. Materials and methods: From a prospective multi-center observational registry of EMS-treated out-of-hospital cardiac arrest, we identified 1638 EMS-treated cardiac arrests with first recorded rhythm VF/VT or "shockable" and complete data for analysis. Survival to hospital discharge was determined as a function of EMS CPR duration prior to first shock. Results: Compared to the reference group of first EMS CPR duration ≤45 s, the odds of survival was greater among patients who received between 46 and 195 s of EMS CPR before first shock (46-75 s odds ratio [OR] 1.15, 95% confidence interval [CI] 0.71-1.87; 76-105 s, OR 1.37, 95% CI 0.80-2.35; 106-135 s, OR 1.53, 95% CI 0.96-2.45; 136-165 s, OR 1.24, 95% CI 0.71-2.15; 166-195 s, OR 1.47, 95% CI 0.85-2.52). The benefit of EMS CPR before defibrillation was reduced when the duration of CPR exceeded 195 s (196-225 s, OR 0.95, 95% CI 0.47-1.81; 226-255 s, OR 0.91, 95% CI 0.46-1.79; 256-285 s, OR 0.46, 95% CI 0.17-1.29; 286-315 s, OR 1.29, 95% CI 0.59-2.85). An optimal EMS CPR duration was not identified and no duration achieved statistical significance. Conclusion: In this observational analysis of VF/VT arrest, between 46 and 195 s of EMS CPR prior to defibrillation was weakly associated with improved survival compared to ≤45 s. Randomized trials are needed to confirm the optimal duration of EMS CPR prior to defibrillation and to assess the impact of first CPR duration on all initial rhythms.
AB - Background: Immediate defibrillation is the traditional approach to resuscitation of cardiac arrest due to ventricular fibrillation or tachycardia (VF/VT). Delaying defibrillation to provide chest compressions may improve survival. We examined the effect of the duration of Emergency Medical Services (EMS) cardiopulmonary resuscitation (CPR) prior to first defibrillation on survival in patients with out-of-hospital VF/VT. Materials and methods: From a prospective multi-center observational registry of EMS-treated out-of-hospital cardiac arrest, we identified 1638 EMS-treated cardiac arrests with first recorded rhythm VF/VT or "shockable" and complete data for analysis. Survival to hospital discharge was determined as a function of EMS CPR duration prior to first shock. Results: Compared to the reference group of first EMS CPR duration ≤45 s, the odds of survival was greater among patients who received between 46 and 195 s of EMS CPR before first shock (46-75 s odds ratio [OR] 1.15, 95% confidence interval [CI] 0.71-1.87; 76-105 s, OR 1.37, 95% CI 0.80-2.35; 106-135 s, OR 1.53, 95% CI 0.96-2.45; 136-165 s, OR 1.24, 95% CI 0.71-2.15; 166-195 s, OR 1.47, 95% CI 0.85-2.52). The benefit of EMS CPR before defibrillation was reduced when the duration of CPR exceeded 195 s (196-225 s, OR 0.95, 95% CI 0.47-1.81; 226-255 s, OR 0.91, 95% CI 0.46-1.79; 256-285 s, OR 0.46, 95% CI 0.17-1.29; 286-315 s, OR 1.29, 95% CI 0.59-2.85). An optimal EMS CPR duration was not identified and no duration achieved statistical significance. Conclusion: In this observational analysis of VF/VT arrest, between 46 and 195 s of EMS CPR prior to defibrillation was weakly associated with improved survival compared to ≤45 s. Randomized trials are needed to confirm the optimal duration of EMS CPR prior to defibrillation and to assess the impact of first CPR duration on all initial rhythms.
KW - Cardiopulmonary resuscitation
KW - Defibrillation
KW - Heart arrest
KW - Registries
KW - Survival
UR - http://www.scopus.com/inward/record.url?scp=74649084037&partnerID=8YFLogxK
U2 - 10.1016/j.resuscitation.2009.10.026
DO - 10.1016/j.resuscitation.2009.10.026
M3 - Article
C2 - 19969407
AN - SCOPUS:74649084037
SN - 0300-9572
VL - 81
SP - 155
EP - 162
JO - Resuscitation
JF - Resuscitation
IS - 2
ER -