The impact of increased chest compression fraction on survival for out-of-hospital cardiac arrest patients with a non-shockable initial rhythm

the Resuscitation Outcomes Consortium Investigators.

Research output: Contribution to journalArticlepeer-review

1 Scopus citations

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%.

Original languageEnglish (US)
Pages (from-to)93-100
Number of pages8
JournalResuscitation
Volume154
DOIs
StatePublished - Sep 2020

Bibliographical note

Funding Information:
The Resuscitation Outcomes Consortium (ROC) is supported by a series of cooperative agreements with 10 regional clinical centres and one data Coordinating Centre ( 5U01HL077863 , HL077881 , HL077871 , HL077872 , HL077866 , HL077908 , HL077867 , HL077885 , HL077887 , HL077873 , HL077865 ) from the National Heart, Lung, and Blood Institute in partnership with the National Institute of Neurological Disorders and Stroke , U.S. Army, Medical Research & Material Command, the Canadian Institutes of Health Research – Institute of Circulatory and Respiratory Health, Defence Research and Development Canada, the Heart and Stroke Foundation of Canada, and the American Heart Association.

Funding Information:
The Resuscitation Outcomes Consortium (ROC) is supported by a series of cooperative agreements with 10 regional clinical centres and one data Coordinating Centre (5U01HL077863, HL077881, HL077871, HL077872, HL077866, HL077908, HL077867, HL077885, HL077887, HL077873, HL077865) from the National Heart, Lung, and Blood Institute in partnership with the National Institute of Neurological Disorders and Stroke, U.S. Army, Medical Research & Material Command, the Canadian Institutes of Health Research ? Institute of Circulatory and Respiratory Health, Defence Research and Development Canada, the Heart and Stroke Foundation of Canada, and the American Heart Association.

Publisher Copyright:
© 2020 Elsevier B.V.

Keywords

  • Cardiopulmonary resuscitation
  • Heart arrest
  • Resuscitation

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