Chest Compression Fraction Determines Survival in Patients With Out-of-Hospital Ventricular Fibrillation

Abstract

Background Quality CPR contributes to cardiac arrest survival. The proportion of time in which chest compressions are performed in each minute of CPR is an important modifiable aspect of quality CPR. We sought to estimate the effect of an increasing proportion of time spent performing chest compressions during cardiac arrest on survival to hospital discharge in patients with out-of hospital ventricular fibrillation or pulseless ventricular tachycardia. Methods and Results This is a prospective observational cohort study of adult patients from the Resuscitation Outcomes Consortium Cardiac Arrest Epistry with confirmed ventricular fibrillation or ventricular tachycardia, no defibrillation prior to emergency medical services arrival, electronically recorded cardiopulmonary resuscitation prior to the first shock and a confirmed outcome. Patients were followed to discharge from hospital or death. In the 506 cases, the mean age was 64 years, 80% were male, 71% were witnessed by a bystander, 51% received bystander cardiopulmonary resuscitation, 34% occurred in a public location, and 23% survived. After adjustment for age, gender, location, bystander cardiopulmonary resuscitation, bystander witness status, and response time the odds ratios of surviving to hospital discharge in the two highest categories of chest compression fraction compared to the reference category were 3.01 (95% CI, 1.37, 6.58) and 2.33 (95% CI, 0.96, 5.63). The estimated adjusted linear effect on odds ratio of survival for a 10% change in chest compression fraction was 1.11 (95% CI, 1.01, 1.21). Conclusion Increased chest compression fraction is independently predictive of better survival in patients suffering a prehospital ventricular fibrillation/tachycardia cardiac arrest.

Extracorporeal Membrane Oxygenation (ECMO) for Severe Toxicological Exposures: Review of the Toxicology Investigators Consortium (ToxIC)

“…Attempting to initiate ECMO during cardiac arrest is difficult as it requires pauses in CPR in order to cannulate and initiate the procedure. Prolonged CPR with periods without effective chest compressions may lead to increased morbidity and mortality [40,41]. The use of ECMO prior to cardiovascular collapse in the majority of our patients may have led to improved overall survival.…”

The impact of chest compression rates on quality of chest compressions – A manikin study

“…4 In an out-of-hospital cardiac arrest, Christenson and colleagues observed an improved survival to discharge in patients who received a higher chest compression fraction, i.e., fewer interruptions in chest compressions. 7 In this study survivors also received mean chest compression rates above 110 min -1 .…”

The impact of prehospital resuscitation research on in-hospital care

“…Previous work by Christenson et al provided evidence to suggest that patients with an initial rhythm of ventricular fibrillation or ventricular tachycardia who had higher CCF (>61%) were more likely to achieve return of spontaneous circulation (ROSC) and survive to hospital discharge. 15 Vaillancourt et al conducted a similar investigation on the effects of CCF on patients with a presenting rhythm of asystole or pulseless electrical activity and found that patients with CCFs greater than 81% had the highest probability of obtaining ROSC. 16 …”