Thomas Rea1, Michele Olsufka2, Lihua Yin2, Charles Maynard2, Leonard Cobb2. 1. Harborview Medical Center and the University of Washington, United States. Electronic address: rea123@u.washington.edu. 2. Harborview Medical Center and the University of Washington, United States.
Abstract
BACKGROUND: Guidelines direct rescuers to minimize CPR interruptions during resuscitation. There is little evidence that evaluates the relationship of increasing CPR fraction among patients with relatively high fractions or prolonged resuscitation. METHODS: We conducted an observational study of persons who suffered out-of-hospital ventricular fibrillation arrest and required >5 min of emergency medical services (EMS) CPR for persistent pulselessness. We determined the association between hands-on CPR fraction and outcomes of spontaneous circulation, survival to hospital discharge, and neurologically favorable survival. Analyses were stratified by median hands-on CPR and were conducted for those who required 5, 10, and 20 min of EMS CPR for persistent pulselessness. RESULTS: Of 414 potentially eligible patients, 323 (78%) required >5 min of EMS CPR, 234 (56%) required >10 min of EMS CPR, and 153 (37%) required EMS CPR for >20 min. The median CPR fraction was 81%. We did not observe a significant association for the outcomes of hospital survival and neurologically favorable survival for the 5-min and 10-min groups. When restricted to patients who required >20 min of EMS CPR, the half who received a higher hands-on CPR fraction were more likely to achieve spontaneous circulation (40% versus 18%, p=0.004), survival to hospital discharge (20% versus 8%, p=0.03), and neurologically favorable survival (20% versus 7%, p=0.02). CONCLUSION: Over one-third required 20 min of persistent EMS CPR. The EMS was able to achieve a high hands-on CPR fraction in the context of advanced therapies. Those who required the most prolonged EMS CPR appeared to benefit from greater hands-on CPR fraction.
BACKGROUND: Guidelines direct rescuers to minimize CPR interruptions during resuscitation. There is little evidence that evaluates the relationship of increasing CPR fraction among patients with relatively high fractions or prolonged resuscitation. METHODS: We conducted an observational study of persons who suffered out-of-hospital ventricular fibrillation arrest and required >5 min of emergency medical services (EMS) CPR for persistent pulselessness. We determined the association between hands-on CPR fraction and outcomes of spontaneous circulation, survival to hospital discharge, and neurologically favorable survival. Analyses were stratified by median hands-on CPR and were conducted for those who required 5, 10, and 20 min of EMS CPR for persistent pulselessness. RESULTS: Of 414 potentially eligible patients, 323 (78%) required >5 min of EMS CPR, 234 (56%) required >10 min of EMS CPR, and 153 (37%) required EMS CPR for >20 min. The median CPR fraction was 81%. We did not observe a significant association for the outcomes of hospital survival and neurologically favorable survival for the 5-min and 10-min groups. When restricted to patients who required >20 min of EMS CPR, the half who received a higher hands-on CPR fraction were more likely to achieve spontaneous circulation (40% versus 18%, p=0.004), survival to hospital discharge (20% versus 8%, p=0.03), and neurologically favorable survival (20% versus 7%, p=0.02). CONCLUSION: Over one-third required 20 min of persistent EMS CPR. The EMS was able to achieve a high hands-on CPR fraction in the context of advanced therapies. Those who required the most prolonged EMS CPR appeared to benefit from greater hands-on CPR fraction.
Authors: Christian Vaillancourt; Ashley Petersen; Eric N Meier; Jim Christenson; James J Menegazzi; Tom P Aufderheide; Graham Nichol; Robert Berg; Clifton W Callaway; Ahamed H Idris; Daniel Davis; Raymond Fowler; Debra Egan; Douglas Andrusiek; Jason E Buick; T J Bishop; M Riccardo Colella; Ritu Sahni; Ian G Stiell; Sheldon Cheskes Journal: Resuscitation Date: 2020-06-20 Impact factor: 5.262
Authors: Rainer Nitzschke; Christoph Doehn; Jan F Kersten; Julian Blanz; Tobias J Kalwa; Norman A Scotti; Jens C Kubitz Journal: Scand J Trauma Resusc Emerg Med Date: 2017-04-04 Impact factor: 2.953