Faculty Collaboration Database

Survival increases with CPR by Emergency Medical Services before defibrillation of out-of-hospital ventricular fibrillation or ventricular tachycardia: observations from the Resuscitation Outcomes Consortium. Resuscitation 2010 Feb;81(2):155-62

Date

12/09/2009

Pubmed ID

19969407

Pubmed Central ID

PMC2814939

DOI

10.1016/j.resuscitation.2009.10.026

Scopus ID

2-s2.0-74649084037 (requires institutional sign-in at Scopus site)   44 Citations

Abstract

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 < or =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 < or =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.

Author List

Bradley SM, Gabriel EE, Aufderheide TP, Barnes R, Christenson J, Davis DP, Stiell IG, Nichol G, Resuscitation Outcomes Consortium Investigators

Author

Tom P. Aufderheide MD Professor in the Emergency Medicine department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Aged
Cardiopulmonary Resuscitation
Electric Countershock
Female
Humans
Male
Middle Aged
Multicenter Studies as Topic
Prospective Studies
Survival Rate
Tachycardia, Ventricular
Ventricular Fibrillation