Abstract P134: A Building Block Strategy for Optimizing Outcomes From Out of Hospital Cardiac Arrest
Background Outcome studies in cardiac arrest focus on the impact of single therapy interventions.
Hypothesis Optimization of outcomes for OOH-CA requires incorporating multiple interventions into a building block strategy. There is larger outcome benefit from a combination strategy than single interventions alone.
Methods We evaluated a case series of 1,598 consecutive, adult, out-of-hospital, non-traumatic cardiac arrest events in Richmond, VA from 1/1/01–12/31/08. Serial standard of care changes were made in the EMS system over time. Administration of vasopressin and epinephrine alternating every 5 minutes was implemented in 2001 on top of standard manual CPR, endotracheal tube and IV insertion. A mechanical load distributing band CC device used early after EMS arrival was added in 2004 to permit fewer interruptions in CCs. Optional IO drug administration was added in 2005 with a protocol change in 2008 to encourage IO placement after one failed IV attempt or as initial access. The King airway was introduced and encouraged after one failed ET attempt or as a rescue airway in 2007. IO and King airway devices were added to minimize CC interruptions and shorten the time to drug administration. Infusion of 2L IV or IO saline at 4 °C during resuscitation in patients with initial VF or witnessed asystole/PEA was introduced in 2008. Primary outcome measure was sustained ROSC by year.
Results See graphic.
Conclusion A building block strategy including alternating vasoconstrictor administration, minimally interrupted mechanical CC, less use of ETT airway management, IO route of drug administration, and cold saline given during resuscitation improved OOH-CA outcome.