Alexander Kovacs1, Tyler F Vadeboncoeur2, Uwe Stolz3, Daniel W Spaite4, Taro Irisawa5, Annemarie Silver6, Bentley J Bobrow7. 1. University of Arizona College of Medicine-Phoenix, 550 E Van Buren St., Phoenix, AZ 85004, United States. Electronic address: Akovacs@email.arizona.edu. 2. Department of Emergency Medicine, Mayo Clinic Florida, 4500 San Pablo Road, Jacksonville, FL 32224, United States. Electronic address: Vadeboncoeur.tyler@mayo.edu. 3. Department of Emergency Medicine, University of Arizona, PO Box 245057, 1501 N. Campbell, Tucson, AZ 85724-5057, United States. Electronic address: Ustolz@aemrc.arizona.edu. 4. Department of Emergency Medicine, University of Arizona, PO Box 245057, 1501 N. Campbell, Tucson, AZ 85724-5057, United States. Electronic address: Dan@aemrc.arizona.edu. 5. Department of Traumatology and Acute Critical Care, Osaka University Hospital, 2-15 Yamadaoka, Suita, Osaka 565-0871, Japan. Electronic address: Taroirisawa@yahoo.co.jp. 6. Zoll Medical Corporation, 269 Mill Rd, Chelmsford, MA 01824, United States. Electronic address: Asilver@zoll.com. 7. University of Arizona College of Medicine-Phoenix, 550 E Van Buren St., Phoenix, AZ 85004, United States; Department of Emergency Medicine, University of Arizona, PO Box 245057, 1501 N. Campbell, Tucson, AZ 85724-5057, United States; Bureau of Emergency Medical Services and Trauma System, Arizona Department of Health Services, 150 N. 18th Avenue, #540, Phoenix, AZ 85007-3248, United States. Electronic address: Bentley.Bobrow@azdhs.gov.
Abstract
PURPOSE: We evaluated the association between chest compression release velocity (CCRV) and outcomes after out-of-hospital cardiac arrest (OHCA). MATERIALS AND METHODS: CPR quality was measured using a defibrillator with accelerometer-based technology (E Series, ZOLL Medical) during OHCA resuscitations by 2 EMS agencies in Arizona between 10/2008 and 06/2013. All non-EMS-witnessed adult (≥ 18 years) arrests of presumed cardiac etiology were included. The association between mean CCRV (assessed as an appropriate measure of central tendency) and both survival to hospital discharge and neurologic outcome (Cerebral Performance Category score = 1 or 2) was analyzed using multivariable logistic regression to control for known and potential confounders and multiple imputation to account for missing data. RESULTS: 981 OHCAs (median age 68 years, 65% male, 11% survival to discharge) were analyzed with 232 (24%) missing CPR quality data. All-rhythms survival varied significantly with CCRV [fast (≥ 400 mm/s) = 18/79 (23%); moderate (300-399.9 mm/s) = 50/416 (12%); slow (<300 mm/s) 17/255 (7%); p < 0.001], as did favorable neurologic outcome [fast = 14/79 (18%); moderate = 43/415 (10%); slow = 11/255 (4%); p < 0.001]. Fast CCRV was associated with increased survival compared to slow [adjusted odds ratio (aOR) 4.17 (95% CI: 1.61, 10.82) and moderate CCRV [aOR 3.08 (1.39, 6.83)]. Fast CCRV was also associated with improved favorable neurologic outcome compared to slow [4.51 (1.57, 12.98)]. There was a 5.2% increase in the adjusted odds of survival for each 10mm/s increase in CCRV [aOR 1.052 (1.001, 1.105)]. CONCLUSION: CCRV was independently associated with improved survival and favorable neurologic outcome at hospital discharge after adult OHCA.
PURPOSE: We evaluated the association between chest compression release velocity (CCRV) and outcomes after out-of-hospital cardiac arrest (OHCA). MATERIALS AND METHODS: CPR quality was measured using a defibrillator with accelerometer-based technology (E Series, ZOLL Medical) during OHCA resuscitations by 2 EMS agencies in Arizona between 10/2008 and 06/2013. All non-EMS-witnessed adult (≥ 18 years) arrests of presumed cardiac etiology were included. The association between mean CCRV (assessed as an appropriate measure of central tendency) and both survival to hospital discharge and neurologic outcome (Cerebral Performance Category score = 1 or 2) was analyzed using multivariable logistic regression to control for known and potential confounders and multiple imputation to account for missing data. RESULTS: 981 OHCAs (median age 68 years, 65% male, 11% survival to discharge) were analyzed with 232 (24%) missing CPR quality data. All-rhythms survival varied significantly with CCRV [fast (≥ 400 mm/s) = 18/79 (23%); moderate (300-399.9 mm/s) = 50/416 (12%); slow (<300 mm/s) 17/255 (7%); p < 0.001], as did favorable neurologic outcome [fast = 14/79 (18%); moderate = 43/415 (10%); slow = 11/255 (4%); p < 0.001]. Fast CCRV was associated with increased survival compared to slow [adjusted odds ratio (aOR) 4.17 (95% CI: 1.61, 10.82) and moderate CCRV [aOR 3.08 (1.39, 6.83)]. Fast CCRV was also associated with improved favorable neurologic outcome compared to slow [4.51 (1.57, 12.98)]. There was a 5.2% increase in the adjusted odds of survival for each 10mm/s increase in CCRV [aOR 1.052 (1.001, 1.105)]. CONCLUSION: CCRV was independently associated with improved survival and favorable neurologic outcome at hospital discharge after adult OHCA.
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