Abstract 150: The Effect of Implementation of Resuscitation Guidelines 2005 on Short and Long Term Survival in Patients With Ventricular Fibrillation
Purpose: In 2005 guidelines for resuscitation were altered to improve survival. However, in studies comparing the former 2000 and current 2005 guidelines conflicting results have been reported and data on long-term survival are lacking. As patients with out-of-hospital cardiac arrest (OHCA) and ventricular fibrillation (VF) as initial rhythm might benefit most of the proposed changes we assessed short- and long-term survival for the two periods with different prevailing guidelines.
Methods: Prospective registry of OHCA patients with VF between 2006 and 2008 in a 1-tier ambulance community Gelderland-Zuid, the Netherlands. All admitted patients were treated in the University Medical Center Nijmegen, The Netherlands. The 2005 guidelines were implemented in February 2007. Chest compression fraction was calculated from defibrillator impedance. Ambulance and hospital data were collected, and 1-year survival status was assessed.
Results: In this period 106 and 132 patients were resuscitated according to guidelines 2000 and 2005 respectively. Baseline characteristics with respect to age, sex, witnessed arrest, bystander CPR and delay until ambulance arrival were comparable. The chest compression fraction was significantly higher after implementation of guidelines 2005 (median 0.43 vs 0.61, p<0.01). Hypothermia was given more often in the guidelines 2005 group (33.0% vs 45.3%, p=0.06). Return of spontaneous circulation (66.3% vs 62.8%, p=0.57) and survival to discharge did not differ between groups (33.3% vs 34.6%, p=0.84). One-year survival was also similar in patients resuscitated according to guidelines 2000 and 2005 (30.2% vs 34.6%, p=0.47).
Conclusions: In this prospective registry of unselected OHCA patients with VF only, implementation of the 2005 guidelines did neither improve short- nor long-term survival, despite significant improvement in the chest compression fraction. The unchanged survival might be explained by variation in EMS-personnel training in comparison with other studies. Another explanation is our relatively good survival before the implementation of the 2005 guidelines in comparison with previous trials. Further research is warranted on this subject.
- © 2010 by American Heart Association, Inc.