Abstract P169: Has Implementation of the Guidelines 2005 Improved Outcome From Out-of-hospital Cardiac Arrest?
Controversy remains as to whether the 2005 CPR guidelines have improved outcome from out-of-hospital cardiac arrest. We retrospectively reviewed the cardiac arrest database of Nagoya, Japan to evaluate the effect of the new guidelines.
[Methods] In the city of Nagoya with a population of 2.2 million, data were collected by the EMS personnel in accordance with the Utstein-style reporting guidelines. We reviewed the data from Jan. 2005 through Dec. 2008, and compared the rate of return of spontaneous circulation (ROSC) and favorable neurological outcome (CPC category 1–2) at 1 month post-arrest before and after the G2005 implementation. The whole cohort of witnessed, non-traumatic cardiac arrests was divided into two cohorts according to the initial ECG (VF/VT or PEA/asystole) and was analyzed separately.
[Results] Of the 379 patients with VF/VT, 168 received CPR with the G2000 and 211 with the G2005. The rate of ROSC changed from 44.6 % to 68.7% with the G2005 implementation, and the rate of the favorable neurological outcome changed from 13.8 % to 22.4%. Of the 1955 patients with PEA/asystole, 879 received CPR with the G2000 and 1076 with the G2005. The rate of ROSC changed from 36.8 % to 46.3 % with the G2005 implementation, and the rate of the favorable neurological outcome changed from 2.4 % to 1.6 %. The adjusted odds ratios are shown in the table⇓.
[Discussion] The major changes of the CPR protocol in the G2005 include immediate resumption of chest compressions after non-stacked shocks and increasing the compression:ventilation ratio to 30:2, with the former factor concerning only with patients with VF/VT. Although we expected a greater improvement in the VF/VT cohort than in the PEA/asystole cohort, the improvement was comparable across the 2 cohorts, and was limited to the rate of ROSC. Although the failure to demonstrate improved neurological outcome may be merely due to lack of statistical power, our data may support the similar findings reported recently by the Norwegian group.