Quality of cardiopulmonary resuscitation in out-of-hospital cardiac arrest is hampered by interruptions in chest compressions—A nationwide prospective feasibility study

Krarup, Niels; Terkelsen, Christian Juhl; Johnsen, Søren Paaske; Clemmensen, Peter; Olivecrona, Göran; Hansen, Troels Martin; Trautner, Sven; Lassen, Jens Flensted

doi:10.1016/j.resuscitation.2010.11.003

Cited by 71 publications

(48 citation statements)

References 30 publications

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“…Examples of these include pauses for intubation, handoff of care from first responder to paramedics, pulse check, and moving the patient. 3,4,10,24 Our findings indicate that reducing pauses for those interventions may be more important than further reducing pauses for defibrillation. Another implication is that, if a resuscitation team needs to perform multiple interventions requiring interruption of compressions, it might be better to perform them individually with compressions interspersed than to cluster them together into 1 longer pause.…”

Section: Discussionmentioning

confidence: 78%

“…1,2 Prolonged interruptions are considered to be particularly harmful and have been observed to occur commonly during resuscitation from out-of-hospital cardiac arrest (OHCA). [3][4][5][6][7] Prior clinical research evaluating the association between duration of individual interruptions and patient outcomes has focused on perishock pauses, interruptions associated with delivery of a defibrillation shock. [7][8][9] However, chest compressions are commonly interrupted for reasons other than shock delivery.…”

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confidence: 99%

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Association Between Chest Compression Interruptions and Clinical Outcomes of Ventricular Fibrillation Out-of-Hospital Cardiac Arrest

Brouwer

Walker²,

Chapman³

et al. 2015

Circulation

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Background-Minimizing pauses in chest compressions during cardiopulmonary resuscitation is a focus of current guidelines. Prior analyses found that prolonged pauses for defibrillation (perishock pauses) are associated with worse survival. We analyzed resuscitations to characterize the association between pauses for all reasons and both ventricular fibrillation termination and patient survival. Methods and Results-In 319 patients with ventricular tachycardia/fibrillation out-of-hospital cardiac arrest, we analyzed recordings from all defibrillators used during resuscitation and measured durations of all cardiopulmonary resuscitation pauses. Median durations were 32 seconds (25th and 75th percentile, 22 and 52 seconds) for the longest pause for any reason, 23 seconds (25th and 75th percentile, 14 and 34 seconds) for the longest perishock pause, and 24 seconds (25th and 75th percentile, 11 and 38 seconds) for the longest nonshock pause. Multivariable regression models showed lower odds for survival per 5-second increase in the longest overall pause (odds ratio, 0.89; 95% confidence interval, 0.83-0.95), longest perishock pause (odds ratio, 0.85; 95% confidence interval, 0.77-0.93), and longest nonshock pause (odds ratio, 0.83; 95% confidence interval, 0.75-0.91). In 36% of cases, the longest pause was a nonshock pause; this subgroup had lower survival than the group in whom the longest pause was a perishock pause (27% versus 44%, respectively; P<0.01) despite a higher chest compression fraction. Preshock pauses were 8 seconds (25th and 75th percentile, 4 and 17 seconds) for shocks that terminated ventricular fibrillation and 7 seconds (25th and 75th percentile, 4 and 13 seconds) for shocks that did not (P=0.18). Conclusions-Prolonged pauses have a negative association with survival not explained by chest compression fraction or decreased ventricular fibrillation termination rate. Ventricular fibrillation termination was not the mechanism linking pause duration and survival. Strategies shortening the longest pauses may improve outcome.

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Section: Discussionmentioning

confidence: 78%

mentioning

confidence: 99%

Association Between Chest Compression Interruptions and Clinical Outcomes of Ventricular Fibrillation Out-of-Hospital Cardiac Arrest

Brouwer

Walker²,

Chapman³

et al. 2015

Circulation

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show abstract

“…[6][7][8][9] An emergency medical system considering utilization of ECPR for refractory OHCA must balance two potentially competing factors: CPR quality and early access to ECPR. First, extrication and transport of patients with refractory arrest are associated with pauses in chest compressions, 10 which has been associated with decreased survival. 11 Thus, earlier transport for those who would have achieved return of spontaneous circulation (ROSC) with continued on-scene conventional resuscitation may worsen outcomes.…”

Section: Introductionmentioning

confidence: 99%

Relationship between Time-to-ROSC and Survival in Out-of-hospital Cardiac Arrest ECPR Candidates: When is the Best Time to Consider Transport to Hospital?

Grunau

Reynolds

Scheuermeyer

et al. 2016

Prehospital Emergency Care

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“…In out-of-hospital cardiac arrest (OHCA), transferring patient from arrest situation to ambulance is also a reason of no flow time (NFT) [41]. Rescuers should be educated that transferring cardiac arrest patient can lead to NFT.…”

Section: Minimalize Chest Compression Interruptionsmentioning

confidence: 99%

Chest Compression-Only Cardiopulmonary Resuscitation

Chen¹,

Lin²

2017

Resuscitation Aspects

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The survival rate of out-of-cardiac arrest (OHCA) was very low, which was mainly due to the victims who do not receive cardiopulmonary resuscitation (CPR) immediately. It was estimated that if people who quickly get chest compression-only CPR while awaiting medical treatment have double or even triple the chance of surviving. In the true world, many individuals are unwilling to do mouth-to-mouth breathing due to fear of infections or unable to do mouth-to-mouth breathing at the same time in the situation of only one bystander. This article has performed an extensive review in order to update the concept of chest compression-only CPR.

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Quality of cardiopulmonary resuscitation in out-of-hospital cardiac arrest is hampered by interruptions in chest compressions—A nationwide prospective feasibility study

Cited by 71 publications

References 30 publications

Association Between Chest Compression Interruptions and Clinical Outcomes of Ventricular Fibrillation Out-of-Hospital Cardiac Arrest

Association Between Chest Compression Interruptions and Clinical Outcomes of Ventricular Fibrillation Out-of-Hospital Cardiac Arrest

Relationship between Time-to-ROSC and Survival in Out-of-hospital Cardiac Arrest ECPR Candidates: When is the Best Time to Consider Transport to Hospital?

Chest Compression-Only Cardiopulmonary Resuscitation

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