A Randomized Controlled Trial of Compression Rates during Cardiopulmonary Resuscitation

Abstract

The objective of this study was to compare the efficacy of cardiopulmonary resuscitation (CPR) with 120 compressions per minute (CPM) to CPR with 100 CPM in patients with non-traumatic out-of-hospital cardiac arrest. We randomly assigned patients with non-traumatic out-of-hospital cardiac arrest into two groups upon arrival to the emergency department (ED). The patients received manual CPR either with 100 CPM (CPR-100 group) or 120 CPM (CPR-120 group). The primary outcome measure was sustained restoration of spontaneous circulation (ROSC). The secondary outcome measures were survival discharge from the hospital, one-month survival, and one-month survival with good functional status. Of 470 patients with cardiac arrest, 136 patients in the CPR-100 group and 156 patients in the CPR-120 group were included in the final analysis. A total of 69 patients (50.7%) in the CPR-100 group and 67 patients (42.9%) in the CPR-120 group had ROSC (absolute difference, 7.8% points; 95% confidence interval [CI], -3.7 to 19.2%; P = 0.183). The rates of survival discharge from the hospital, one-month survival, and one-month survival with good functional status were not different between the two groups (16.9% vs. 12.8%, P = 0.325; 12.5% vs. 6.4%, P = 0.073; 5.9% vs. 2.6%, P = 0.154, respectively). We did not find differences in the resuscitation outcomes between those who received CPR with 100 CPM and those with 120 CPM. However, a large trial is warranted, with adequate power to confirm a statistically non-significant trend toward superiority of CPR with 100 CPM. (Clinical Trial Registration Information: www.cris.nih.go.kr, cris.nih.go.kr number, KCT0000231)

The Author's Response: Compression Rate during Cardiopulmonary Resuscitation

“…Cardiopulmonary resuscitation (CPR) provided by bystander and/or EMS personnel may confound the results of our study because randomization and intervention were made at the emergency department (ED) instead of at initiation of resuscitation effort at the pre-hospital phase. In our study, most subjects (93.4% of the CPR-100 group and 92.9% of the CPR-120 group) received EMS CPR ( 1 ). During the study period, the subjects received manual CPR according to the 2010 CPR guidelines, which recommended compression rate of at least 100 CPM but not exceeding 120 CPM ( 2 ).…”

Adult Basic Life Support

“…In addition to the 14 studies identified in the 2015 CoSTR for BLS, 3 , 4 an additional 8 studies 123 , 124 , 125 , 126 , 127 , 128 , 129 were identified, so a total of 22 studies were included in this ScopRev, which has been published in full. 122 Five observational studies examined both chest compression rate and chest compression depth.…”

“… 122 Five observational studies examined both chest compression rate and chest compression depth. 127 , 128 , 129b , 130 , 131 One RCT, 124 1 crossover trial, 132 and 6 observational studies 125 , 129 , 133 , 134 , 135 , 136 examined chest compression rate only. One RCT 137 and 6 observational studies examined chest compression depth only, 67 , 138 , 139 , 140 , 141 , 142 and 2 observational studies examined chest wall recoil.…”

Letter to the Editor: Chest Compression Rate, Rescuer's Fatigue and Patient's Survival

“…I have read the report by Hwang et al ( 1 ) with great interest. Although there were no significant differences between the outcomes of 100/min chest compression rate (CCR) group and 120/min CCR group, it was worthy of notice that the one-month survival rate of 100/min CCR group was almost twice compared to the 120/min CCR group.…”