Abstract P78: Does Longer Chest Compression Prior to Rhythm Analysis Improve the Outcomes of Out-of-Hospital Cardiac Arrest? A Randomized Control Trial
Introduction For out-of-hospital cardiac arrest (OHCA), best sequence and duration of chest compression relative to automatic external defibrillator (AED) analysis and shock remain controversial, especially among population with low rates (<10%) of initial shockable rhythms. A randomized controlled trial was conducted to examine whether longer chest compression prior to AED analysis and shocks improves outcomes.
Methods All adult (>15 years) non-traumatic OHCA responded by advanced life support teams in Taipei (population 2.27 million) were enrolled and randomized into two groups: Compression First (CF) with 10 cycles of standard 30:2 cardiopulmonary resuscitation prior to AED analysis and rescue shocks, if needed; and Analyzing First (AF) with immediate AED analysis and shocks. Cases with asphyxia, obvious sign of death, and do-not-resuscitation (DNR) order were excluded. The primary endpoint was sustained (>2 hours) return of spontaneous circulation (ROSC), and the secondary endpoints were survival at admission, and at discharge.
Results From Feb 2008 to Apr 2009, 232 (118 in CF and 114 in AF) patients were included, 7.8% with initial shockable rhythms and 9.9% received any prehospital shocks. There were no differences in gender, age, comorbidity, initial rhythms, bystander CPR, and response time between 2 groups. There were no differences in primary and secondary outcomes between 2 groups.
Conclusion In an Asian population with low rates of shockable rhythms, longer (10 cycles) chest compression prior to AED analysis compared to current practice of immediate AED analysis didn’t provide outcomes benefits. Caution should be exercised to revise sequence or duration of CPR in the community.