Abstract 65: Improvement in Survival to Discharge of Cardiac Arrest Patients Using Novel Out of Hospital Treatment Protocol
Cardiac arrest continues to have poor survival in the U.S. despite wide distribution of AED’s to out of hospital providers. Recent studies in time dependent myocardial responsiveness to therapy, myocardial perfusion in post arrest patients, and effect of ventilation, question current practice in resuscitation. Our EMS system made significant changes in the adult cardiac arrest resuscitation protocol, including minimizing chest compression disruptions, using a 50:2 compression\ ventilation ratio, deemphasizing and delaying intubation, and performing an aggressive round of chest compressions before initial counter-shock. Treatment protocols prior to these changes were consistent with the Advanced Cardiac Life Support (ACLS) algorithm. Methods Setting: Midwest, urban, Public Utility Model, all ALS ambulance service with AED equipped BLS fire department first response. Design: Retrospective, observational, cohort study reviewing all adult primary, witnessed cardiac arrests with an initial rhythm of ventricular fibrillation 39 months pre protocol change (pre-c) and 12 months post protocol change (post-c). The outcome of interest was survival to discharge from the hospital. Analysis: Chi Square analysis was performed and Relative Risk with 95% CI were calculated. P value less than 0.05 was considered significant. Results There were 1096 primary cardiac arrest patients of which 150 met the inclusion criteria in the pre-c cohort with 32 (21.3%) patients surviving to discharge. There were 339 cardiac arrest patients of which 52 met inclusion criteria in the post-c cohort. Of these, 23 (44.2%) survived to discharge. There was a significant increase in survival to discharge in the post-c cohort (χ2 = 7.07, p < 0.01, RR, 1.82, 95% CI 1.19, 2.00). Discussion The changes to our pre-hospital protocol for adult cardiac arrest optimized chest compressions and reduced disruptions for intubation and ventilation and required compressions before a single counter-shock producing significant increases in survival to discharge in our patient population. These changes should be considered for improving survival of out of hospital cardiac arrest patients.