Abstract 111: Efficacy of the Single Shocks Plus Immediate Cardiopulmonary Resuscitation by Emergency Medical Service Personnel After Out-of-Hospital Ventricular Fibrillation Cardiac Arrest
Background: The AHA 2005 guidelines for electrical therapies of cardiopulmonary resuscitation (CPR) led to the recommendation of single shocks plus immediate 2 minutes of CPR instead of 3-shock sequences in victims of sudden cardiac arrest (Class 2a). Emergency medical service (EMS) personnel who arrive at the patient's side may provide 2 minutes of CPR before checking the cardiac arrest rhythm and attempting defibrillation (Class 2b). It is not known whether the neurologically intact survival rate will increase if EMS personnel perform the CPR according to the new recommendations of electrical therapies.
Methods: The JCS-ReSS investigated the effect of the change in electrical therapies (2 minutes of CPR before checking the cardiac arrest rhythm, and 1 shock followed immediately by 2 minutes of CPR). Data of patients with out-of-hospital cardiac arrest from the all-Japan Utstein Registry of the Fire and Disaster Management Agency were analyzed.
Results: Of the 95,503 patients with witnessed out-of-hospital cardiac arrest due to cardiac etiology, 10,599 patients with an age of 8 years and over, with no bystander CPR, and with shockable cardiac arrest rhythm on EMS arrival at patients side were included; 5,312 received defibrillation procedures according to the 2000 guidelines (the 3-shock group), 5,287 received defibrillation procedures according to the 2005 guidelines (the 1-shock group). The 1-shock group had higher proportions of 30-day neurologically intact survival than the 3-shock group in among all patients in the study (19.2 % vs. 13.3 %; p<0.0001), and in the subgroups of patients with call access-to-EMS-arrival interval in three of four quartiles (quartile 1 with 5 minutes or shorter; 25.7% vs.17.6%, p<0.0001, quartile 2 with 6 to 7 minutes; 18.2% vs.11.4%, p<0.0001, quartile 3 with 8 to 9 minutes; 16.7% vs.10.9%, p<0.0001, respectively). A multiple logistic-regression analysis showed that the adjusted odds ratio for 30-day neurologically intact survival after 1-shock procedures was 1.57 (95% CI, 1. 41 to 1.74, p<0.0001).
Conclusions: The defibrillation procedures of the 2005 AHA guidelines are superior to those of the 2000 guidelines in terms of neurological benefit.
- © 2010 by American Heart Association, Inc.