Christian Vaillancourt1, Ashley Petersen2, Eric N Meier3, Jim Christenson4, James J Menegazzi5, Tom P Aufderheide6, Graham Nichol7, Robert Berg8, Clifton W Callaway5, Ahamed H Idris9, Daniel Davis10, Raymond Fowler9, Debra Egan11, Douglas Andrusiek12, Jason E Buick13, T J Bishop14, M Riccardo Colella15, Ritu Sahni16, Ian G Stiell17, Sheldon Cheskes18. 1. Department of Emergency Medicine and Ottawa Hospital Research Institute, University of Ottawa, ON, Canada. Electronic address: cvaillancourt@ohri.ca. 2. Division of Biostatistics, University of Minnesota, Minneapolis, MN, US. 3. Department of Biostatistics, University of Washington, Seattle, WA, US. 4. University of British Columbia, Vancouver, BC, Canada. 5. University of Pittsburgh, Pittsburgh, PA, US. 6. Medical College of Wisconsin, Milwaukee, WI, US. 7. University of Washington, Seattle, WA, US. 8. University of Pennsylvania, The Children's Hospital of Philadelphia, PA, US. 9. Department of Emergency Medicine, University of Texas Southwestern Medical Center, Dallas, TX, US. 10. Air Methods Corporation, Greenwood Village, CO, US. 11. National Center for Complementary and Integrative Health, National Institutes of Health, Bethesda, MD, US. 12. Doctors Without Borders, Toronto, ON, Canada. 13. Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada. 14. Lake Chelan Community Hospital EMS, Chelan, WA, US. 15. Departments of Emergency Medicine, Pediatrics and the Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, WI, US. 16. Clackamas County EMS, Oregon City, OR, US. 17. Department of Emergency Medicine and Ottawa Hospital Research Institute, University of Ottawa, ON, Canada. 18. Department of Family and Community Medicine, Division of Emergency Medicine, University of Toronto, Toronto, ON, Canada.
Abstract
OBJECTIVE: We evaluated the effect of chest compression fraction (CCF) on survival to hospital discharge and return of spontaneous circulation (ROSC) in out-of-hospital cardiac arrest (OHCA) patients with non-shockable rhythms. METHODS: This is a retrospective analysis (completed in 2016) of a prospective cohort study which included OHCA patients from ten U.S. and Canadian sites (Resuscitation Outcomes Consortium Epistry and PRIMED study (2007-2011)). We included all OHCA victims of presumed cardiac aetiology, not witnessed by emergency medical services (EMS), without automated external defibrillator shock prior to EMS arrival, receiving > 1 min of CPR with CPR process measures available, and initial non-shockable rhythm. We measured CCF using the first 5 min of electronic CPR records. RESULTS: Demographics of 12,928 adult patients were: mean age 68; male 59.9%; public location 8.5%; bystander witnessed 35.2%; bystander CPR 39.3%; median interval from 911 to defibrillator turned on 10 min:04 s; initial rhythm asystole 64.8%, PEA 26.0%, other non-shockable 9.2%; compression rate 80-120/min (69.1%); median CCF 74%; ROSC 25.6%; survival to hospital discharge 2.4%. Adjusted odds ratio (OR); 95% confidence intervals (95%CI) of survival for each CCF category were: 0-40% (2.00; 1.16, 3.32); 41-60% (0.83; 0.54, 1.24); 61-80% (1.02; 0.77, 1.35); and 81-100% (reference group). Adjusted (OR; 95%CI) of ROSC for each CCF category were: 0-40% (1.02; 0.79, 1.30); 41-60% (0.83; 0.72, 0.95); 61-80% (0.85; 0.77, 0.94); and 81-100% (reference group). CONCLUSIONS: We observed an incremental benefit from higher CCF on the incidence of ROSC, but not survival, among non-shockable OHCA patients with CCF higher than 40%.
OBJECTIVE: We evaluated the effect of chest compression fraction (CCF) on survival to hospital discharge and return of spontaneous circulation (ROSC) in out-of-hospital cardiac arrest (OHCA) patients with non-shockable rhythms. METHODS: This is a retrospective analysis (completed in 2016) of a prospective cohort study which included OHCA patients from ten U.S. and Canadian sites (Resuscitation Outcomes Consortium Epistry and PRIMED study (2007-2011)). We included all OHCA victims of presumed cardiac aetiology, not witnessed by emergency medical services (EMS), without automated external defibrillator shock prior to EMS arrival, receiving > 1 min of CPR with CPR process measures available, and initial non-shockable rhythm. We measured CCF using the first 5 min of electronic CPR records. RESULTS: Demographics of 12,928 adult patients were: mean age 68; male 59.9%; public location 8.5%; bystander witnessed 35.2%; bystander CPR 39.3%; median interval from 911 to defibrillator turned on 10 min:04 s; initial rhythm asystole 64.8%, PEA 26.0%, other non-shockable 9.2%; compression rate 80-120/min (69.1%); median CCF 74%; ROSC 25.6%; survival to hospital discharge 2.4%. Adjusted odds ratio (OR); 95% confidence intervals (95%CI) of survival for each CCF category were: 0-40% (2.00; 1.16, 3.32); 41-60% (0.83; 0.54, 1.24); 61-80% (1.02; 0.77, 1.35); and 81-100% (reference group). Adjusted (OR; 95%CI) of ROSC for each CCF category were: 0-40% (1.02; 0.79, 1.30); 41-60% (0.83; 0.72, 0.95); 61-80% (0.85; 0.77, 0.94); and 81-100% (reference group). CONCLUSIONS: We observed an incremental benefit from higher CCF on the incidence of ROSC, but not survival, among non-shockable OHCA patients with CCF higher than 40%.
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