BACKGROUND: In a departure from the previous strategy of immediate defibrillation, the 2005 resuscitation guidelines from the American Heart Association-International Liaison Committee on Resuscitation suggested that emergency medical service (EMS) personnel could provide 2 minutes of cardiopulmonary resuscitation (CPR) before the first analysis of cardiac rhythm. We compared the strategy of a brief period of CPR with early analysis of rhythm with the strategy of a longer period of CPR with delayed analysis of rhythm. METHODS: We conducted a cluster-randomized trial involving adults with out-of-hospital cardiac arrest at 10 Resuscitation Outcomes Consortium sites in the United States and Canada. Patients in the early-analysis group were assigned to receive 30 to 60 seconds of EMS-administered CPR and those in the later-analysis group were assigned to receive 180 seconds of CPR, before the initial electrocardiographic analysis. The primary outcome was survival to hospital discharge with satisfactory functional status (a modified Rankin scale score of ≤3, on a scale of 0 to 6, with higher scores indicating greater disability). RESULTS: We included 9933 patients, of whom 5290 were assigned to early analysis of cardiac rhythm and 4643 to later analysis. A total of 273 patients (5.9%) in the later-analysis group and 310 patients (5.9%) in the early-analysis group met the criteria for the primary outcome, with a cluster-adjusted difference of -0.2 percentage points (95% confidence interval, -1.1 to 0.7; P=0.59). Analyses of the data with adjustment for confounding factors, as well as subgroup analyses, also showed no survival benefit for either study group. CONCLUSIONS: Among patients who had an out-of-hospital cardiac arrest, we found no difference in the outcomes with a brief period, as compared with a longer period, of EMS-administered CPR before the first analysis of cardiac rhythm. (Funded by the National Heart, Lung, and Blood Institute and others; ROC PRIMED ClinicalTrials.gov number, NCT00394706.).
RCT Entities:
BACKGROUND: In a departure from the previous strategy of immediate defibrillation, the 2005 resuscitation guidelines from the American Heart Association-International Liaison Committee on Resuscitation suggested that emergency medical service (EMS) personnel could provide 2 minutes of cardiopulmonary resuscitation (CPR) before the first analysis of cardiac rhythm. We compared the strategy of a brief period of CPR with early analysis of rhythm with the strategy of a longer period of CPR with delayed analysis of rhythm. METHODS: We conducted a cluster-randomized trial involving adults with out-of-hospital cardiac arrest at 10 Resuscitation Outcomes Consortium sites in the United States and Canada. Patients in the early-analysis group were assigned to receive 30 to 60 seconds of EMS-administered CPR and those in the later-analysis group were assigned to receive 180 seconds of CPR, before the initial electrocardiographic analysis. The primary outcome was survival to hospital discharge with satisfactory functional status (a modified Rankin scale score of ≤3, on a scale of 0 to 6, with higher scores indicating greater disability). RESULTS: We included 9933 patients, of whom 5290 were assigned to early analysis of cardiac rhythm and 4643 to later analysis. A total of 273 patients (5.9%) in the later-analysis group and 310 patients (5.9%) in the early-analysis group met the criteria for the primary outcome, with a cluster-adjusted difference of -0.2 percentage points (95% confidence interval, -1.1 to 0.7; P=0.59). Analyses of the data with adjustment for confounding factors, as well as subgroup analyses, also showed no survival benefit for either study group. CONCLUSIONS: Among patients who had an out-of-hospital cardiac arrest, we found no difference in the outcomes with a brief period, as compared with a longer period, of EMS-administered CPR before the first analysis of cardiac rhythm. (Funded by the National Heart, Lung, and Blood Institute and others; ROC PRIMED ClinicalTrials.gov number, NCT00394706.).
Authors: Mark S Link; Dianne L Atkins; Rod S Passman; Henry R Halperin; Ricardo A Samson; Roger D White; Michael T Cudnik; Marc D Berg; Peter J Kudenchuk; Richard E Kerber Journal: Circulation Date: 2010-11-02 Impact factor: 29.690
Authors: Tom P Aufderheide; Graham Nichol; Thomas D Rea; Siobhan P Brown; Brian G Leroux; Paul E Pepe; Peter J Kudenchuk; Jim Christenson; Mohamud R Daya; Paul Dorian; Clifton W Callaway; Ahamed H Idris; Douglas Andrusiek; Shannon W Stephens; David Hostler; Daniel P Davis; James V Dunford; Ronald G Pirrallo; Ian G Stiell; Catherine M Clement; Alan Craig; Lois Van Ottingham; Terri A Schmidt; Henry E Wang; Myron L Weisfeldt; Joseph P Ornato; George Sopko Journal: N Engl J Med Date: 2011-09-01 Impact factor: 91.245
Authors: Steven M Bradley; Erin E Gabriel; Tom P Aufderheide; Roxy Barnes; Jim Christenson; Daniel P Davis; Ian G Stiell; Graham Nichol Journal: Resuscitation Date: 2009-12-06 Impact factor: 5.262
Authors: Paul W Baker; Jane Conway; Chris Cotton; Dale T Ashby; James Smyth; Richard J Woodman; Hugh Grantham Journal: Resuscitation Date: 2008-11-04 Impact factor: 5.262
Authors: Thomas D Rea; Andrea J Cook; Ian G Stiell; Judy Powell; Blair Bigham; Clifton W Callaway; Sumeet Chugh; Tom P Aufderheide; Laurie Morrison; Thomas E Terndrup; Tammy Beaudoin; Lynn Wittwer; Dan Davis; Ahamed Idris; Graham Nichol Journal: Ann Emerg Med Date: 2009-11-27 Impact factor: 5.721
Authors: Henry E Wang; Daniel Szydlo; John A Stouffer; Steve Lin; Jestin N Carlson; Christian Vaillancourt; Gena Sears; Richard P Verbeek; Raymond Fowler; Ahamed H Idris; Karl Koenig; James Christenson; Anushirvan Minokadeh; Joseph Brandt; Thomas Rea Journal: Resuscitation Date: 2012-06-01 Impact factor: 5.262
Authors: Siobhan P Brown; Henry Wang; Tom P Aufderheide; Christian Vaillancourt; Robert H Schmicker; Sheldon Cheskes; Ron Straight; Peter Kudenchuk; Laurie Morrison; M Riccardo Colella; Joseph Condle; George Gamez; David Hostler; Tami Kayea; Sally Ragsdale; Shannon Stephens; Graham Nichol Journal: Am Heart J Date: 2014-11-20 Impact factor: 4.749
Authors: Jestin N Carlson; Dana Zive; Denise Griffiths; Karen N Brown; Robert H Schmicker; Heather Herren; George Sopko; Sara DiFiore; Dixie Climer; Caroline Herdeman; Ahamed Idris; Graham Nichol; Henry E Wang Journal: Resuscitation Date: 2018-12-17 Impact factor: 5.262
Authors: Peter J Kudenchuk; Siobhan P Brown; Mohamud Daya; Laurie J Morrison; Brian E Grunau; Tom Rea; Tom Aufderheide; Judy Powell; Brian Leroux; Christian Vaillancourt; Jonathan Larsen; Lynn Wittwer; M Riccardo Colella; Shannon W Stephens; Mark Gamber; Debra Egan; Paul Dorian Journal: Am Heart J Date: 2014-03-01 Impact factor: 4.749
Authors: Guido Michels; Tobias Wengenmayer; Christian Hagl; Christian Dohmen; Bernd W Böttiger; Johann Bauersachs; Andreas Markewitz; Adrian Bauer; Jan-Thorsten Gräsner; Roman Pfister; Alexander Ghanem; Hans-Jörg Busch; Uwe Kreimeier; Andreas Beckmann; Matthias Fischer; Clemens Kill; Uwe Janssens; Stefan Kluge; Frank Born; Hans Martin Hoffmeister; Michael Preusch; Udo Boeken; Reimer Riessen; Holger Thiele Journal: Clin Res Cardiol Date: 2018-09-04 Impact factor: 5.460
Authors: G Michels; T Wengenmayer; C Hagl; C Dohmen; B W Böttiger; J Bauersachs; A Markewitz; A Bauer; J-T Gräsner; R Pfister; A Ghanem; H-J Busch; U Kreimeier; A Beckmann; M Fischer; C Kill; U Janssens; S Kluge; F Born; H M Hoffmeister; M Preusch; U Boeken; R Riessen; H Thiele Journal: Med Klin Intensivmed Notfmed Date: 2018-09 Impact factor: 0.840