Abstract 12371: The Effects of Cardiopulmonary Resuscitation (CPR) by Emergency Medical Services Responders Using a 30:2 Compression-Ventilation Ratio and/or a 1-Shock Protocol in Adult Victims of Cardiac Arrest
BACKGROUND The AHA 2005 and 2010 guidelines for cardiopulmonary resuscitation (CPR) recommended that emergency medical services (EMS) responders should use minimal interruptions in chest compressions using a 30:2 compression-ventilation ratio and/or a 1-shock followed immediately by 2 minutes of a 30:2 compression-ventilation ratio in adult victims of cardiac arrest. However, it is unclear whether those CPR by EMS responders can improve survival.
METHODS We compared the effects of CPR by EMS responders recommended in the 2005 CPR guidelines with those recommended in the 2000 CPR guidelines (a 15:2 compression-ventilation ratio and/or a 3-shock sequence) from the data of the All-Japan Utstein Registry, a prospective, nationwide, observational registry. The study endpoints were return of spontaneous circulation (ROSC) on hospital arrival and 30-day favorable neurological outcome after cardiac arrest.
RESULTS Of the 58,448 adult patients with bystander-witnessed out-of-hospital cardiac arrest due to presumed cardiac etiology in the year 2005, 2008 and 2009, 31,159 who did not receive bystander CPR were included; 20,746 received CPR by EMS responders recommended in the 2005 CPR guidelines, and 10,413 received CPR by EMS responders recommended in the 2000 CPR guidelines. The 2005 CPR guidelines group had significantly higher rates of ROSC and favorable neurological outcome than the 2000 CPR guidelines group in the whole cohort (ROSC; 11.2% vs. 7.2%, p<0.001, favorable neurological outcome; 4.5% vs. 2.4%, p<0.001), and in the subgroups of patients with shockable rhythm (ROSC; 26.5% vs. 18.6%, p<0.001, favorable neurological outcome; 15.3% vs. 8.4%, p<0.001) and patients with non-shockable rhythm (ROSC; 6.6% vs. 4.2%, p<0.001, favorable neurological outcome; 1.3% vs. 0.8%, p=0.003). The adjusted odds ratios after CPR by EMS responders CPR recommended in the 2005 CPR guidelines was 1.63 (95% CI, 1.49-1.78) for ROSC and 1.97 (95% CI, 1.70-2.29) for favorable neurological outcome.
CONCLUSION CPR by EMS responders using a 30:2 compression-ventilation ratio and/or a 1-shock protocol improved ROSC and favorable neurological outcome in adult patients with bystander-witnessed out-of-hospital cardiac arrest due to presumed cardiac etiology.
- © 2011 by American Heart Association, Inc.