This Article Full Text Full Text (PDF) All Versions of this Article: 114/25/2760    most recent CIRCULATIONAHA.106.654715v1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Rea, T. D. Articles by Eisenberg, M. Search for Related Content PubMed PubMed Citation Articles by Rea, T. D. Articles by Eisenberg, M. Pubmed/NCBI databases Medline Plus Health Information CPR Related Collections CPR and emergency cardiac care

(Circulation. 2006;114:2760-2765.)
© 2006 American Heart Association, Inc.

Arrhythmia/Electrophysiology

Increasing Use of Cardiopulmonary Resuscitation During Out-of-Hospital Ventricular Fibrillation Arrest

Survival Implications of Guideline Changes

Thomas D. Rea, MD, MPH; Michael Helbock, MICP; Stephen Perry, MICP; Michele Garcia, MD; Don Cloyd, MICP; Linda Becker, MA; Mickey Eisenberg, MD, PhD

From the Department of Medicine, University of Washington (T.D.R., M.G., M.E.) and the Division of Emergency Medical Services, Public Health–Seattle & King County (T.D.R., M.H., S.P., D.C., L.B., M.E.), Seattle, Wash.

Correspondence to Thomas Rea, EMS Division, 999 3rd Ave, Suite 700, Seattle, WA 98104. E-mail rea123{at}u.washington.edu

Received July 27, 2006; revision received September 19, 2006; accepted September 28, 2006.

Background— The most recent resuscitation guidelines have sought to improve the interface between defibrillation and cardiopulmonary resuscitation; the survival impact of these changes is unknown, however. A year before issuance of the most recent guidelines, we implemented protocol changes that provided a single shock without rhythm reanalysis, stacked shocks, or postdefibrillation pulse check, and extended the period of cardiopulmonary resuscitation from 1 to 2 minutes. We hypothesized that survival would be better with the new protocol.

Methods and Results— The present study took place in a community with a 2-tiered emergency medical services response and an established system of cardiac arrest surveillance, training, and review. The investigation was a cohort study of persons who had bystander-witnessed out-of-hospital ventricular fibrillation arrest because of heart disease, comparing a prospectively defined intervention group (January 1, 2005, to January 31, 2006) with a historical control group that was treated according to previous guidelines of rhythm reanalysis, stacked shocks, and postdefibrillation pulse checks (January 1, 2002, to December 31, 2004). The primary outcome was survival to hospital discharge. The proportion of treated arrests that met inclusion criteria was similar for intervention and control periods (15.4% [134/869] versus 16.6% [374/2255]). Survival to hospital discharge was significantly greater during the intervention period compared with the control period (46% [61/134] versus 33% [122/374], P=0.008) and corresponded to a decrease in the interval from shock to start of chest compressions (28 versus 7 seconds). Adjustment for covariates did not alter the survival association.

Conclusions— These results suggest the new resuscitation guidelines will alter the interface between defibrillation and cardiopulmonary resuscitation and in turn may improve outcomes.

---

 

CLINICAL PERSPECTIVE

This article has been cited by other articles:

				D. P. Edelson, B. Litzinger, V. Arora, D. Walsh, S. Kim, D. S. Lauderdale, T. L. Vanden Hoek, L. B. Becker, and B. S. Abella Improving In-Hospital Cardiac Arrest Process and Outcomes With Performance Debriefing Arch Intern Med, May 26, 2008; 168(10): 1063 - 1069. [Abstract] [Full Text] [PDF]

				B. J. Bobrow, L. L. Clark, G. A. Ewy, V. Chikani, A. B. Sanders, R. A. Berg, P. B. Richman, and K. B. Kern Minimally Interrupted Cardiac Resuscitation by Emergency Medical Services for Out-of-Hospital Cardiac Arrest JAMA, March 12, 2008; 299(10): 1158 - 1165. [Abstract] [Full Text] [PDF]

				M. A. Peberdy and J. P. Ornato Progress in Resuscitation: An Evolution, Not a Revolution JAMA, March 12, 2008; 299(10): 1188 - 1190. [Full Text] [PDF]

				G. A. Ewy Continuous-Chest-Compression Cardiopulmonary Resuscitation for Cardiac Arrest Circulation, December 18, 2007; 116(25): 2894 - 2896. [Full Text] [PDF]

				J. A. Stewart Letter by Stewart Regarding Articles, "Increasing Use of Cardiopulmonary Resuscitation During Out-of-Hospital Ventricular Fibrillation Arrest: Survival Implications of Guideline Changes" and "Measuring Progress in Resuscitation: It's Time for a Better Tool" Circulation, July 10, 2007; 116(2): e27 - e27. [Full Text] [PDF]

				J. P. Ornato and M. A. Peberdy Measuring Progress in Resuscitation: It's Time for a Better Tool Circulation, December 19, 2006; 114(25): 2754 - 2756. [Full Text] [PDF]