ContextDefibrillation as soon as possible is standard treatment for patients with ventricular fibrillation. A nonrandomized study indicates that after a few minutes of ventricular fibrillation, delaying defibrillation to give cardiopulmonary resuscitation (CPR) first might improve the outcome.ObjectiveTo determine the effects of CPR before defibrillation on outcome in patients with ventricular fibrillation and with response times either up to or longer than 5 minutes.Design, Setting, and PatientsRandomized trial of 200 patients with out-of-hospital ventricular fibrillation in Oslo, Norway, between June 1998 and May 2001. Patients received either standard care with immediate defibrillation (n = 96) or CPR first with 3 minutes of basic CPR by ambulance personnel prior to defibrillation (n = 104). If initial defibrillation was unsuccessful, the standard group received 1 minute of CPR before additional defibrillation attempts compared with 3 minutes in the CPR first group.Main Outcome MeasurePrimary end point was survival to hospital discharge. Secondary end points were hospital admission with return of spontaneous circulation (ROSC), 1-year survival, and neurological outcome. A prespecified analysis examined subgroups with response times either up to or longer than 5 minutes.ResultsIn the standard group, 14 (15%) of 96 patients survived to hospital discharge vs 23 (22%) of 104 in the CPR first group (P = .17). There were no differences in ROSC rates between the standard group (56% [58/104]) and the CPR first group (46% [44/96]; P = .16); or in 1-year survival (20% [21/104] and 15% [14/96], respectively; P = .30). In subgroup analysis for patients with ambulance response times of either up to 5 minutes or shorter, there were no differences in any outcome variables between the CPR first group (n = 40) and the standard group (n = 41). For patients with response intervals of longer than 5 minutes, more patients achieved ROSC in the CPR first group (58% [37/64]) compared with the standard group (38% [21/55]; odds ratio [OR], 2.22; 95% confidence interval [CI], 1.06-4.63; P = .04); survival to hospital discharge (22% [14/64] vs 4% [2/55]; OR, 7.42; 95% CI, 1.61-34.3; P = .006); and 1-year survival (20% [13/64] vs 4% [2/55]; OR, 6.76; 95% CI, 1.42-31.4; P = .01). Thirty-three (89%) of 37 patients who survived to hospital discharge had no or minor reductions in neurological status with no difference between the groups.ConclusionsCompared with standard care for ventricular fibrillation, CPR first prior to defibrillation offered no advantage in improving outcomes for this entire study population or for patients with ambulance response times shorter than 5 minutes. However, the patients with ventricular fibrillation and ambulance response intervals longer than 5 minutes had better outcomes with CPR first before defibrillation was attempted. These results require confirmation in additional randomized trials.

Background: Most newborns manage the transition from intra- to extrauterine life without interventions, yet neonatal morbidity caused by failure of transition remains an important health problem. Objective: To determine the incidence of neonatal stabilization and resuscitation measures and guideline compliance during the first minutes after birth. Methods: This is a prospective, observational study of all births in three Norwegian hospitals. All interventions performed, including suctioning, use of pulse oximetry, continuous positive airway pressure (CPAP), positive pressure ventilation (PPV), supplemental oxygen, intubation, and administration of drugs, were registered at every on-call team shift during the study period. Results: A total of 1,507 live-born infants were included, of whom 264 (18%) were brought to the resuscitation crib. Oropharyngeal suctioning was performed in 77 (5%), deep blind suctioning was carried out in 10 (1%) and 84 (6%) were monitored using pulse oximetry. PPV was provided in 58 cases (4%) - 8 (21%) of <34 weeks and 50 (3%) of ≥34 weeks of gestation. Sustained inflation is not routinely used in these departments. CPAP (without PPV) was provided in 17 cases (1%) - 4 (0.3%) were intubated and ventilated through the endotracheal tube. Supplemental oxygen was given to 39 infants (3%) - 9 without pulse oximetry monitoring. The median (interquartile range) birth weight and gestational age of the newborns requiring PPV and/or CPAP were 3,220 g (2,643-3,858) and 39 weeks (37-41), respectively. Conclusion: In this study, the need for resuscitation and/or stabilization measures was commonly considered, and 4% of all newborns received PPV. Despite strong guideline emphasis on the use of pulse oximetry to guide oxygen administration, many infants received oxygen treatment without pulse oximetry monitoring.