Abstract 225: Impact of Cardio-Pulmonary Resuscitation by Emergency Medical Service Given Before Defibrillation on the Neurologically-Good-Survival in Cases With Out-of-Hospital Cardiac Arrest and With Ventricular Fibrillation
Nationwide public-access defibrillation in Japan has contributed to the increase in the rate of one-month survival with minimal neurologic impairment (good neurological survival (GNS)) in out-of-hospital cardiac arrest (OHCA) cases. In most OHCA cases, cardio-pulmonary resuscitation (CPR) and defibrillation were given by emergency medical services (EMS) and not by bystander. In such patients not undergoing bystander CPR, we examined whether CPR by EMS done before defibrillation can increase GNS rate, and if so, what is the optimal duration of CPR before defibrillation.
Methods and Results: From January 1, 2005, through December 31, 2008, we conducted a prospective, population-based, observational study involving the consecutive patients across Japan who had OHCA and underwent CRP by emergency responders. We identified 5,035 EMS-treated, witnessed cardiac arrest cases not receiving any bystander CPR, with the age >8 years old, with the initial rhythm of ventricular fibrillation or tachycardia (VF/VT), and with the response time <10 minutes. Among them, 149 cases were treated with DC shock firstly without prior CRP. The rate of GNS was 18.2% in the group with the response time 5 and <10 minutes (P<0.05 vs <4 minutes). The remaining 4,996 cases underwent CPR before defibrillation, and the rate of GNS was 20.0% in the group with the response time 5 and <10 minutes (P<0.05 vs <4 minutes; P<0.05 vs defibrillation without prior CRP). Of these cases with CRR prior to defibrillation, GNS rate was 14.3%, 13.5%, and 11.4%, respectively, for the cases with CPR for one-minute, 2-minute and 3-minute periods before defibrillation (p<0.05, one-minute vs 3-minute period).
Conclusions: In OHCA cases with VF/VT and without bystander CPR, when the response time is longer than 5 minutes, CPR by EMS given before defibrillation increases the one-month GNS rate. The duration of CPR before defibrillation should be less than 3 minutes.
- © 2010 by American Heart Association, Inc.