Abstract 99: Efficacy of the AHA 2005 Guidelines for Cardiopulmonary Resuscitation After Out-of-Hospital Cardiac Arrest
Background: The AHA 2005 guidelines for cardiopulmonary resuscitation (CPR) and emergency cardiovascular care (ECC) based on the evidence evaluated at the 2005 International Consensus Conference on CPR and ECC superseded the international guidelines of 2000 for CPR and ECC. It is not known whether the neurologically intact survival rate will increase if lay rescuers and/or emergency medical service (EMS) personnel perform the CPR procedures according to the AHA 2005 guidelines.
Methods: The JCS-ReSS investigated the effect of the change in CPR procedures (minimization of interruptions in chest compressions, and/or 2 minutes of CPR before attempting defibrillation plus 1 shock followed immediately by 2 minutes of CPR) to the 2005 AHA guidelines. Data of patients with out-of-hospital cardiac arrest from the all-Japan Utstein Registry of the Fire and Disaster Management Agency were analyzed. The primary end point was a 30-day neurologically intact survival.
Results: Of the 95,503 patients with witnessed out-of-hospital cardiac arrest due to cardiac etiology, 19,480 patients with an age of 8 and over and with shockable cardiac arrest rhythm on EMS arrival at patients side were included; 9,291 received CPR procedures according to the 2000 guidelines (the 2000 guidelines group), 10,189 received CPR procedures according to the 2005 guidelines (the 2005 guidelines group). The 2005 guidelines group had higher proportions of 30-day neurologically intact survival than the 2000 guidelines group among all patients in the study (20.8% vs. 14.1%; p<0.0001), and in the subgroups of patients with no bystander CPR (19.2% vs. 13.3%; p<0.0001), and with bystander CPR (22.5% vs. 15.2%; p<0.0001). A multiple logistic-regression analysis showed that the adjusted odds ratio for 30-day neurologically intact survival after CPR procedures according to the 2005 guidelines was 1.63 (95% CI, 1. 51 to 1.76, p<0.0001).
Conclusions: We conclude that the CPR procedures of the 2005 AHA guidelines are superior to those of the 2000 guidelines in terms of neurological benefit. With the 2010 guidelines for CPR and ECC, we are hoping for still more improvement of neurologically intact survival.
- © 2010 by American Heart Association, Inc.