Abstract P55: Survival From Out-of-Hospital Cardiac Arrest Among Patients Receiving AHA 2000 ACLS Guidelines, AHA 2005 ACLS Guidelines, or Cardiocerebral Resuscitation: A Statewide Analysis
Objective: Survival of patients with out-of-hospital cardiac arrest (OHCA) receiving standard ACLS before and after the transition from AHA 2000 to 2005 guidelines in EMS systems across Arizona was compared to patients receiving Cardiocerebral Resuscitation (CCR). CCR includes 1) 200 preshock chest compressions 2) a single defibrillator shock, when indicated, followed immediately by 200 postshock compressions 3) early epinephrine administration and 4) delayed endotracheal intubation.
Methods: Utstein style data were prospectively collected (1/1/05–12/31/07) from 66 fire departments (FDs) serving approximately 80% of Arizona’s population. A total of 3896 consecutive OHCAs of which 2805 were adult, of presumed cardiac etiology, and occurred prior to EMS arrival. CCR was implemented in 20 FDs while 46 FDs utilized standard ACLS. FDs not adopting CCR transitioned from 2000 to 2005 guidelines in late 2005 and early 2006. While the timing of implementation of new ACLS varied among FDs, the majority of patients receiving ACLS during calendar year 05 received 2000 guidelines while those treated in 06/07 received 2005 guidelines. The primary end-point was survival to hospital discharge. Outcomes were compared using Fisher’s Exact Test or Chi Square as appropriate; α = 0.05.
Results: Standard ACLS FDs treated 1730 OHCAs: 672 of these occurred during the intention to treat with 2000 guidelines (assumed during calendar year 05) while 1058 cases occurred during the intention to treat with 2005 guidelines (assumed during 06/07). CCR FDs treated 767 OHCAs during the 3 years.
Conclusion: In Arizona survival from OHCA improved during the transition from 2000 to 2005 ACLS guidelines. However, the best survival in all cohorts was among patients receiving protocol-compliant CCR.