Resuscitation outcomes consortium roc primed trial of early rhythm analysis versus later analysis in out-of-hospital cardiac arrest

Stiell, Ian G.; Nichol, Graham; Rea, Thomas D.; Ornato, Joseph P.; Powell, Jill; Christenson, Jim; Callaway, Clifton W.; Kudenchuk, Peter J.; Aufderheide, Tom P.; Idris, Ahamed H.; Daya, Mohamud; Wang, H.E.; Morrison, Laurie J.; Davis, Daniel P.; Andrusiek, Douglas; Stephens, Shannon W.; Cheskes, Sheldon; Schmicker, Rob; Fowler, Ray; Vaillancourt, Christian; Hostler, David; Zive, Dana; Pirrallo, Ronald G.; Vilke, Gary M.; Sopko, George; Weisfeldt, Myron L.

doi:10.1016/j.resuscitation.2010.09.074

Cited by 4 publications

(3 citation statements)

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“…This study represents an analysis of consecutive OHCA cases prospectively gathered in the recent ROC Prehospital Resuscitation Impedance Valve and Early Versus Delayed Analysis (PRIMED) trial or in the ROC Epistry-Cardiac Arrest. 24 The ROC PRIMED trial used a partial factorial design, whereby most patients were randomly assigned to 2 concurrent protocols. The first protocol compared early rhythm analysis versus later rhythm analysis, and the second protocol compared use of an impedance threshold device versus use of a sham impedance threshold device.…”

Section: Design and Settingmentioning

confidence: 99%

What Is the Optimal Chest Compression Depth During Out-of-Hospital Cardiac Arrest Resuscitation of Adult Patients?

et al. 2014

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Background-The 2010 American Heart Association guidelines suggested an increase in cardiopulmonary resuscitation compression depth with a target >50 mm and no upper limit. This target is based on limited evidence, and we sought to determine the optimal compression depth range. Methods and Results-We studied emergency medical services-treated out-of-hospital cardiac arrest patients from the Resuscitation Outcomes Consortium Prehospital Resuscitation Impedance Valve and Early Versus Delayed Analysis clinical trial and the Epistry-Cardiac Arrest database. We calculated adjusted odds ratios for survival to hospital discharge, 1-day survival, and any return of circulation. We included 9136 adult patients from 9 US and Canadian cities with a mean age of 67.5 years, mean compression depth of 41.9 mm, and a return of circulation of 31.3%, 1-day survival of 22.8%, and survival to hospital discharge of 7.3%. For survival to discharge, the adjusted odds ratios were 1.04 (95% CI, 1.00-1.08) for each 5-mm increment in compression depth, 1.45 (95% CI, 1.20-1.76) for cases within 2005 depth range (>38 mm), and 1.05 (95% CI, 1.03-1.08) for percentage of minutes in depth range (10% change). Covariate-adjusted spline curves revealed that the maximum survival is at a depth of 45.6 mm (15-mm interval with highest survival between 40.3 and 55.3 mm) with no differences between men and women. Conclusions-This large study of out-of-hospital cardiac arrest patients demonstrated that increased cardiopulmonary resuscitation compression depth is strongly associated with better survival. Our adjusted analyses, however, found that maximum survival was in the depth interval of 40.3 to 55.3 mm (peak, 45.6 mm), suggesting that the 2010 American Heart Association cardiopulmonary resuscitation guideline target may be too high. Clinical Trial Registration-URL: http://www.clinicaltrials.gov. Unique identifier: NCT00394706. 14 found that longer perishock and preshock pauses were independently associated with a decrease in survival to hospital discharge in patients presenting in a shockable rhythm. Idris et al 15 described an association between chest compression rate and return of spontaneous circulation.Chest compression depth is another aspect of CPR for which data are limited. Current CPR guidelines for compression rate and depth have been, for the most part, derived with relatively little robust human data to support them. 3,16 The 2005 guidelines recommended a depth range of 38 to 50 mm, whereas the new 2010 guidelines recommend a depth of ≥50 mm (2 in) with no upper limit specified. For compression depth, clinical studies to date have been small, with insufficient power to evaluate clinically important outcomes. 7,[17][18][19][20][21][22] Our group studied 1029 OHCA cases and found lower-than-recommended compression depth in half of patients by 2005 guideline standards and almost all by 2010 standards, as well as an inverse association between compression depth and rate. 23 We found a strong association between survival outcomes and increase...

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Section: Design and Settingmentioning

confidence: 99%

What Is the Optimal Chest Compression Depth During Out-of-Hospital Cardiac Arrest Resuscitation of Adult Patients?

et al. 2014

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“…2,5 Large randomized out-of-hospital studies have demonstrated that high-quality CPR may "prime" the heart before defibrillation, as suggested by the 3-phase model. [6][7][8] Regardless of the theoretical construct(s) upon which the original recommendations were based, we agree with Mr. Stewart that these are misapplied to the inpatient setting that allow for expeditious attempts at defibrillation and stacking of subsequent attempts.…”

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confidence: 73%

The authors reply, “A focused investigation of expedited, stack of three shocks versus chest compressions first followed by single shocks for monitored ventricular fibrillation/ventricular tachycardia cardiopulmonary arrest in an in‐hospital setting”

Davis

Aguilar

2016

Journal of Hospital Medicine

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“…[47][48][49] In 2011, an international multicenter randomized controlled trial of nearly 10,000 patients failed to show a difference in survival with good neurologic outcomes between the two strategies. 50 Preclinical data suggest that the VF waveform can be used to guide the optimal timing of defibrillation. Certain waveform characteristics (eg, amplitude, frequency, periodicity) are associated with coronary perfusion pressure and myocardial ATP concentration.…”

Section: Energy Selection and Delivery Methodsmentioning

confidence: 99%

Cardiac Arrest Resuscitation

Guyette

Reynolds

Frisch

2015

Emergency Medicine Clinics of North America

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Resuscitation outcomes consortium roc primed trial of early rhythm analysis versus later analysis in out-of-hospital cardiac arrest

Cited by 4 publications

References 0 publications

What Is the Optimal Chest Compression Depth During Out-of-Hospital Cardiac Arrest Resuscitation of Adult Patients?

What Is the Optimal Chest Compression Depth During Out-of-Hospital Cardiac Arrest Resuscitation of Adult Patients?

The authors reply, “A focused investigation of expedited, stack of three shocks versus chest compressions first followed by single shocks for monitored ventricular fibrillation/ventricular tachycardia cardiopulmonary arrest in an in‐hospital setting”

Cardiac Arrest Resuscitation

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