Chest Compression Rates and Survival Following Out-of-Hospital Cardiac Arrest*

Idris, Ahamed H.; Guffey, Danielle; Pepe, Paul E.; Brown, Siobhan P.; Brooks, Steven C.; Callaway, Clifton W.; Christenson, Jim; Davis, Daniel P.; Daya, Mohamud; Gray, Randal; Kudenchuk, Peter J.; Larsen, Jonathan; Lin, Steve; Menegazzi, James J.; Sheehan, Kellie; Sopko, George; Stiell, Ian G.; Nichol, Graham; Aufderheide, Tom P.

doi:10.1097/ccm.0000000000000824

Cited by 291 publications

(202 citation statements)

References 23 publications

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“…8,9 Observational studies in humans found improved shock success 10 and better return of spontaneous circulation (ROSC) rates and long-term survival with deeper chest compressions. 11,12 Faster chest compression rates (> 100 minutes) are associated with improved survival [13][14][15] and ensuring that the chest is allowed to recoil between sequential chest compressions also appears to be important. 16 Interruptions in CPR are harmful.…”

Section: High-quality Cardiopulmonary Resuscitationmentioning

confidence: 99%

Prehospital randomised assessment of a mechanical compression device in out-of-hospital cardiac arrest (PARAMEDIC): a pragmatic, cluster randomised trial and economic evaluation

Gates

Lall

Quinn

et al. 2017

Health Technol Assess

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BackgroundMechanical chest compression devices may help to maintain high-quality cardiopulmonary resuscitation (CPR), but little evidence exists for their effectiveness. We evaluated whether or not the introduction of Lund University Cardiopulmonary Assistance System-2 (LUCAS-2; Jolife AB, Lund, Sweden) mechanical CPR into front-line emergency response vehicles would improve survival from out-of-hospital cardiac arrest (OHCA).ObjectiveEvaluation of the LUCAS-2 device as a routine ambulance service treatment for OHCA.DesignPragmatic, cluster randomised trial including adults with non-traumatic OHCA. Ambulance dispatch staff and those collecting the primary outcome were blind to treatment allocation. Blinding of the ambulance staff who delivered the interventions and reported initial response to treatment was not possible. We also conducted a health economic evaluation and a systematic review of all trials of out-of-hospital mechanical chest compression.SettingFour UK ambulance services (West Midlands, North East England, Wales and South Central), comprising 91 urban and semiurban ambulance stations. Clusters were ambulance service vehicles, which were randomly assigned (approximately 1 : 2) to the LUCAS-2 device or manual CPR.ParticipantsPatients were included if they were in cardiac arrest in the out-of-hospital environment. Exclusions were patients with cardiac arrest as a result of trauma, with known or clinically apparent pregnancy, or aged < 18 years.InterventionsPatients received LUCAS-2 mechanical chest compression or manual chest compressions according to the first trial vehicle to arrive on scene.Main outcome measuresSurvival at 30 days following cardiac arrest; survival without significant neurological impairment [Cerebral Performance Category (CPC) score of 1 or 2].ResultsWe enrolled 4471 eligible patients (1652 assigned to the LUCAS-2 device and 2819 assigned to control) between 15 April 2010 and 10 June 2013. A total of 985 (60%) patients in the LUCAS-2 group received mechanical chest compression and 11 (< 1%) patients in the control group received LUCAS-2. In the intention-to-treat analysis, 30-day survival was similar in the LUCAS-2 (104/1652, 6.3%) and manual CPR groups [193/2819, 6.8%; adjusted odds ratio (OR) 0.86, 95% confidence interval (CI) 0.64 to 1.15]. Survival with a CPC score of 1 or 2 may have been worse in the LUCAS-2 group (adjusted OR 0.72, 95% CI 0.52 to 0.99). No serious adverse events were noted. The systematic review found no evidence of a survival advantage if mechanical chest compression was used. The health economic analysis showed that LUCAS-2 was dominated by manual chest compression.LimitationsThere was substantial non-compliance in the LUCAS-2 arm. For 272 out of 1652 patients (16.5%), mechanical chest compression was not used for reasons that would not occur in clinical practice. We addressed this issue by using complier average causal effect analyses. We attempted to measure CPR quality during the resuscitation attempts of trial participants, but were unable to do so.ConclusionsThere was no evidence of improvement in 30-day survival with LUCAS-2 compared with manual compressions. Our systematic review of recent randomised trials did not suggest that survival or survival without significant disability may be improved by the use of mechanical chest compression.Future workThe use of mechanical chest compression for in-hospital cardiac arrest, and in specific circumstances (e.g. transport), has not yet been evaluated.TriaI registrationCurrent Controlled Trials ISRCTN08233942.FundingThis project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full inHealth Technology Assessment; Vol. 21, No. 11. See the NIHR Journals Library website for further project information.

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Section: High-quality Cardiopulmonary Resuscitationmentioning

confidence: 99%

Prehospital randomised assessment of a mechanical compression device in out-of-hospital cardiac arrest (PARAMEDIC): a pragmatic, cluster randomised trial and economic evaluation

Gates

Lall

Quinn

et al. 2017

Health Technol Assess

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“…There was a general improvement in CPR quality by cardiac arrest teams across all hospital sites. Some statistically significant improvements were observed, but the effect size of these improvements were small and their influence on clinical outcomes uncertain.. [21,24,25] The study found no evidence that interventions were associated with an effect on patient outcome, but the study was not powered to detect such differences.…”

Section: Discussionmentioning

confidence: 98%

An evaluation of three methods of in-hospital cardiac arrest educational debriefing: The cardiopulmonary resuscitation debriefing study

et al. 2016

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Copies of full items can be used for personal research or study, educational, or not-for-profit purposes without prior permission or charge. Provided that the authors, title and full bibliographic details are credited, a hyperlink and/or URL is given for the original metadata page and the content is not changed in any way. Conflicts of interestThe authors have no conflicts of interest to declare.Word count: 2802 Acknowledgements:We gratefully acknowledge the support of Dr Richard Field, Dr Joyce Yeung and Mr Mehboob Chilwan in extracting data from defibrillator records. AbstractBackground: The use of cardiac arrest educational debriefing has been associated with

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“…1 This study showed that patient survival to hospital discharge was highest when compressions were between 100 and 120 per minute, 1 which is reflected in the latest update of the resuscitation guideline from the American Heart Association. 2 …”

Section: Chest Compressions During Cardiopulmonary Resuscitation Shoumentioning

confidence: 98%

Cardiopulmonary resuscitation

Khan¹,

Weston²

2014

Medicine

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Chest compressions during cardiopulmonary resuscitation should be fast pushesIn adult patients with out-of-hospital cardiac arrest, a large multicentre prospective observational study reported that more than 50% of rescuers performing cardiopulmonary resuscitation (CPR) provided chest compressions faster than the recommended rate of 100 per minute. 1 This study showed that patient survival to hospital discharge was highest when compressions were between 100 and 120 per minute, 1 which is reflected in the latest update of the resuscitation guideline from the American Heart Association. 2 2 Perishock pauses should be limited to improve survival Perishock pauses are pauses before and after defibrillatory shock. In a recent large observational study on the impact of perishock pauses in patients with out-of-hospital cardiac arrest, survival to hospital discharge was significantly higher for those patients who received preshock pauses of less than 10 seconds and total perishock pauses of less than 20 seconds during CPR. 3 Perishock pauses are strong independent predictors of survival from out-of-hospital cardiac arrest; they should be minimized during CPR by performing compressions while the defibrillator is charging. Rescuers may adopt an interrupted or continuous CPR strategyBystander CPR is the most important predictor of survival from cardiac arrest. Any interruptions in chest compressions are associated with reduced blood flow and worse survival. For this reason, and because ventilation is a difficult skill to acquire for those who are not health care professionals, the guideline update recommends that members of the public provide uninterrupted continuous chest compressions. 2 Trained rescuers should provide 30 chest compressions that are interrupted by no more than 10 seconds to provide two ventilations. 2 Vasopressin offers no advantage over epinephrine in cardiac arrestThere is limited evidence to suggest that vasopressin and epinephrine can similarly improve return of spontaneous circulation and survival to hospital discharge. Because simplicity is important during resuscitation efforts, the guideline update specifically recommends that epinephrine be administered as soon as possible following onset of cardiac arrest. 4 5 A target temperature should be maintained in the postcardiac arrest period All adult patients who are comatose with return of spontaneous circulation following cardiac arrest should receive targeted temperature management. The guideline update recommends selecting and achieving a single target temperature between 32°C and 36°C, which should be maintained constantly for at least 24 hours. 5 PRACTICE | FIVE THINGS TO KNOW ABOUT

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Chest Compression Rates and Survival Following Out-of-Hospital Cardiac Arrest*

Abstract: After adjustment for chest compression fraction and depth, compression rates between 100 and 120 per minute were associated with greatest survival to hospital discharge.

Cited by 291 publications

References 23 publications

Prehospital randomised assessment of a mechanical compression device in out-of-hospital cardiac arrest (PARAMEDIC): a pragmatic, cluster randomised trial and economic evaluation

Prehospital randomised assessment of a mechanical compression device in out-of-hospital cardiac arrest (PARAMEDIC): a pragmatic, cluster randomised trial and economic evaluation

An evaluation of three methods of in-hospital cardiac arrest educational debriefing: The cardiopulmonary resuscitation debriefing study

Cardiopulmonary resuscitation

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