Resuscitation Outcomes Consortium (ROC) PRIMED cardiac arrest trial methods

Aufderheide, Tom P.; Kudenchuk, Peter J.; Hedges, Jerris R.; Nichol, Graham; Kerber, Richard E.; Dorian, Paul; Davis, Daniel P.; Idris, Ahamed H.; Callaway, Clifton W.; Emerson, Scott S.; Stiell, Ian G.; Terndrup, Thomas E.

doi:10.1016/j.resuscitation.2008.01.028

Cited by 47 publications

(35 citation statements)

References 31 publications

(29 reference statements)

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“…Detailed description of methodology has been given previously. [15,16] PRIMED studied two different resuscitation strategies: thirty-seconds vs. three-minutes of CPR prior to initial rhythm analysis, and an impedance valve vs. sham device during OHCA. [13,14] Research personnel at participating sites prospectively collected patient-level data, including prehospital data streams and audio recordings, from consecutive OHCA subjects.…”

Section: Methodsmentioning

confidence: 99%

Association Between Duration of Resuscitation and Favorable Outcome After Out-of-Hospital Cardiac Arrest

et al. 2016

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Background Little evidence guides the appropriate duration of resuscitation in out-of-hospital cardiac arrest (OHCA), and case features justifying longer or shorter durations are ill-defined. We estimated the impact of resuscitation duration on the probability of favorable functional outcome in OHCA using a large, multi-center cohort. Methods Secondary analysis of a North American, single blind, multi-center, cluster-randomized clinical trial (ROC-PRIMED) of consecutive adults with non-traumatic, EMS-treated, OHCA. Primary exposure was duration of resuscitation in minutes (onset of professional resuscitation to return of spontaneous circulation [ROSC] or termination of resuscitation). Primary outcome was survival to hospital discharge with favorable outcome (modified Rankin scale [mRS] 0-3). Subjects were additionally classified as survival with unfavorable outcome (mRS 4-5), ROSC without survival (mRS 6), or without ROSC. Subject accrual was plotted as a function of resuscitation duration, and the dynamic probability of favorable outcome at discharge was estimated for the whole cohort and subgroups. Adjusted logistic regression models tested the association between resuscitation duration and survival with favorable outcome. Results The primary cohort included 11,368 subjects (median age 69 years [IQR: 56-81 years]; 7,121 men [62.6%]). Of these, 4,023 (35.4%) achieved ROSC, 1,232 (10.8%) survived to hospital discharge, and 905 (8.0%) had mRS 0-3 at discharge. Distribution of CPR duration differed by outcome (p<0.00001). For CPR duration up to 37.0 minutes (95%CI 34.9-40.9 minutes), 99% with eventual mRS 0-3 at discharge achieved ROSC. Dynamic probability of mRS 0-3 at discharge declined over elapsed resuscitation duration, but subjects with initial shockable cardiac rhythm, witnessed cardiac arrest, and bystander CPR were more likely to survive with favorable outcome after prolonged efforts (30-40 minutes). Adjusting for prehospital (OR 0.93; 95%CI 0.92-0.95) and inpatient (OR 0.97; 95%CI 0.95-0.99) covariates, resuscitation duration was associated with survival to discharge with mRS 0-3. Conclusions Shorter resuscitation duration was associated with likelihood of favorable outcome at hospital discharge. Subjects with favorable case features were more likely to survive prolonged resuscitation up to 47 minutes.

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Section: Methodsmentioning

confidence: 99%

Association Between Duration of Resuscitation and Favorable Outcome After Out-of-Hospital Cardiac Arrest

et al. 2016

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“…The structure, surveillance methodology, and participants of the ROC have been reported elsewhere. 10 In brief, the ROC is a clinical research consortium with 10 sites in the United States and Canada. The ROC conducts population-level regional OHCA surveillance, as well as clinical trials for the prehospital treatment of OHCA and major trauma.…”

Section: Methodsmentioning

confidence: 99%

Regional incidence and outcome of out-of-hospital cardiac arrest associated with overdose

et al. 2016

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Background The frequency of lethal overdose due to prescription and non-prescription drugs is increasing in North America. The aim of this study was to estimate overall and regional variation in incidence and outcomes of out-of-hospital cardiac arrest due to overdose across North America. Methods We conducted a retrospective cohort study using case data for the period 2006–2010 from the Resuscitation Outcomes Consortium, a clinical research network with 10 regional clinical centers in United States and Canada. Cases of out-of-hospital cardiac arrest due to drug overdose were identified through review of data derived from prehospital clinical records. We calculated incidence of out-of-hospital cardiac arrest due to overdose per 100,000 person-years and proportion of the same among all out-of-hospital cardiac arrests. We analyzed the association between overdose cardiac arrest etiology and resuscitation outcomes. Results Included were 56,272 cases, of which 1351 were due to overdose. Regional incidence of out-of-hospital cardiac arrest due to overdose varied between 0.5 and 2.7 per 100,000 person years (p < 0.001), and proportion of the same among all treated out-of-hospital cardiac arrests ranged from 0.8% to 4.0%. Overdose cases were younger, less likely to be witnessed, and less likely to present with a shockable rhythm. Compared to non-overdose, overdose was directly associated with return of spontaneous circulation (OR: 1.55; 95% CI: 1.35–1.78) and survival (OR: 2.14; 95% CI: 1.72–2.65). Conclusions Overdose made up 2.4% of all out-of-hospital cardiac arrest, although incidence varied up to 5-fold across regions. Overdose cases were more likely to survive than non-overdose cases.

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“…PRIMED was a partial factorial design which tested two interventions: a brief versus longer period of CPR by EMS prior to analysis for defibrillation and assessing the effectiveness of an active vs. sham Impedance Threshold Device (ITD). (10, 11) Neither the CPR strategies nor the ITD device was significantly associated with survival to hospital discharge or functional outcome. (12, 13) Concurrently with PRIMED which recruited from 06/2007 to 03/2009, ROC also completed a real-time CPR feedback trial at selected EMS agencies from three sites which showed no significant difference in outcomes between control and intervention arms.…”

Section: Methodsmentioning

confidence: 99%

Variability in the initiation of resuscitation attempts by emergency medical services personnel during out-of-hospital cardiac arrest

et al. 2017

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Background Some patients with out-of-hospital cardiac arrest (OHCA) assessed by emergency medical services (EMS) do not receive attempts at resuscitation on the basis of perceived futility. Aims 1) To measure variability in the initiation of resuscitation attempts in EMS-assessed OHCA patients across EMS agencies, 2) to evaluate the association between selected EMS agency characteristics and the proportion of patients receiving resuscitation attempts, and 3) to evaluate the association between proportion receiving resuscitation attempts and survival. Methods A retrospective cohort study using data from 129 EMS agencies participating in the Resuscitation Outcomes Consortium (ROC) epidemiologic registry (EPISTRY) - Cardiac Arrest from 12/01/2005 to 12/31/2010. We included nontraumatic OHCA patients assessed by EMS. Results We included 86,912 OHCA patients. Overall, 54.8% had resuscitation attempted by EMS providers, varying from 23.9% to 100% (p=<0.001) across EMS agencies. The proportion of patients receiving a resuscitation attempt was 7.87 % less (95% CI 3.73-12.0) among agencies with longer average response intervals (≥6 minutes) compared with shorter average response intervals (<6 minutes) and 16.9% less (95% CI 11.9-21.9) among agencies with higher levels of advanced life support (ALS) availability (≥50% of available units) compared with lower levels of ALS availability (<50% of available units). There was a moderate positive correlation between the proportion of patients with resuscitation attempts and survival to hospital discharge (r=0.54, p<0.001). Conclusions The proportion of patients with OHCA who receive resuscitation attempts is variable across EMS agencies and is associated with EMS response interval, ALS unit availability and geographic region. On average, survival was higher among EMS agencies more likely to initiate resuscitation.

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Resuscitation Outcomes Consortium (ROC) PRIMED cardiac arrest trial methods

Cited by 47 publications

References 31 publications

Association Between Duration of Resuscitation and Favorable Outcome After Out-of-Hospital Cardiac Arrest

Association Between Duration of Resuscitation and Favorable Outcome After Out-of-Hospital Cardiac Arrest

Regional incidence and outcome of out-of-hospital cardiac arrest associated with overdose

Variability in the initiation of resuscitation attempts by emergency medical services personnel during out-of-hospital cardiac arrest

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