Abstract 256: Optimization of Cardiopulmonary Resuscitation With an Impedance Threshold Device, Automated Compression Cardiopulmonary Resuscitation and Post-Resuscitation in-the-Field Hypothermia Improves Short-term Outcomes Following Cardiac Arrest
Background: Survival after out-of-hospital cardiac arrest (OHCA) depends upon many factors, including the amount of circulation during CPR and post-resuscitation care. To increase survival rates in our large urban EMS system with a traditionally poor survival rate, circulation was optimized during CPR with an impedance threshold device (ITD) combined with automated CPR. Patients with a return of spontaneous circulation (ROSC) were then treated with in-field therapeutic hypothermia (IFTH) and transported for further post-resuscitation care. We hypothesized that this approach would increase end tidal CO2 (ETCO2) during CPR and the number of patients delivered with a stable ROSC to a cardiac receiving hospital.
Methods: A new protocol that included the ITD (ResQPOD™) + active compression (AC) CPR (LUCAS™) and IFTH was implemented in Dec 2009 for treatment of OHCA. Quality assurance data with the new protocol were compared with similar data from prior calendar year. Ambulances carried the ITD (also carried by first responders since Mar 2009) and chilled fluids and ice packs for IFTH (to goal of 34° C). The LUCAS was carried to the scene by a sprint car or supervisor. Drugs were delivered by IO (EZ-IO™) or IV route. The number of patients with a stable ROSC was compared retrospectively as a primary outcome variable (Fischer's exact test, p < 0.05 considered significant). Baseline and peak ETCO2 values (before ROSC if it occurred) were also assessed.
Results: During the implementation phase, 106 subjects were treated with mean age 65.0 ± 16.1 years (range 19–91), 54% were male, 49% were witnessed, and 93% were non-traumatic arrests. The presenting rhythm was ventricular fibrillation-13%, ventricular tachycardia-2%, asystole-59%, pulseless electrical activity-26%. Stable ROSC increased to 36% (38/106) compared with 21% (78/374) in the historical control (p = 0.002). IFTH was used in 38%. ETCO2 was measured in 84 subjects: 69% (58/84) had an increase, and the increase was > 10 mm in 30/84 patients (36%). There were no major adverse events.
Conclusions: Implementation of ITD + AC CPR with IFTH was feasible, safe and resulted in a 71% increase in stable ROSC rates. ETCO2, a surrogate for circulation, was also increased. Collection of long term survival data is underway.
- © 2010 by American Heart Association, Inc.