Abstract P59: Effect Of Implementation Of The 2005 Resuscitation Guidelines On Quality Of Cardiopulmonary Resuscitation (CPR) And Survival
Background: ACLS providers have been shown to deliver inadequate CPR with long intervals without chest compressions. Several changes made to the 2005 CPR Guidelines were intended to reduce these intervals. We have evaluated if quality of CPR performed by the Oslo Emergency Medical System (EMS) improved after implementation of the 2005 CPR guidelines, and if any such improvement would result in increased survival.
Materials and methods: Retrospective, observational study of all consecutive adult cardiac arrest patients treated during a two year period before (May 2003–April 2005) and after (January 2006–December 2007) implementation of the 2005 CPR guidelines. CPR quality was assessed from continuous electronic recordings from LIFEPACK 12 defibrillators where ventilations and chest compressions were identified from typical transthoracic impedance changes. Ambulance run sheets, Utstein forms and hospital records were evaluated in order to assess outcome. Values are given as median (95% confidence intervals) or mean ± standard deviation and differences analysed using unpaired Student’s t-test or Chi square as appropriate.
Results: Resuscitation was attempted in 435 patients before and 481 patients after implementation of the 2005 Guidelines. ECGs usable for CPR quality evaluation were obtained in 64% and 76% of the cases, respectively. Pre-shock pauses decreased from median 17 (15, 20) to 5 seconds (4, 10) (p<0.001), overall hands-off ratios decreased from 0.23±0.13 to 0.14±0.09 (p<0.001), compression rates from 120±9 to 115±10 (p<0.001) and ventilation rates from 12±4 to 10±4 (p<0.001), from the first to the last period, respectively. Overall survival to hospital discharge was 10.3% and 13.1% (p=0.235).
Conclusion: Quality of CPR improved after implementation of the 2005 Guidelines with a trend towards improved survival to hospital discharge.