Abstract 216: How Many Shocks Should Be Given to Victims with Out-of-Hospital Cardiac Arrest with Shockable Rhythm On-site Before Transportation?
Early defibrillation and high quality cardio-pulmonary resuscitation (CPR) are the key of survival with minimal neurologic impairment (good neurological survival (GNS)) in out-of-hospital cardiac arrest (OHCA) cases. But it has not been clarified how long emergency medical service (EMS) personnel stay on site of OHCA and give CPR with defibrillation before transportation to the hospital. To clarify this, we examined the relationship between the number of defibrillation and the rate of GNS which was defined as the Glasgow-Pittsburgh cerebral performance category of 1 or 2 after one month of OHCA.
Methods and Results. From January 1, 2005, through December 31, 2009, we conducted a prospective, population-based, observational study involving the consecutive patients across Japan who had OHCA (n=547,218). Since the defibrillation protocol of one shock followed by immediate chest compression and ventilation for 2 minutes had started from January 1, 2007 in Japan, we analyzed from January 1, 2007 to December 31, 2009. We identified 13,152 EMS-treated, witnessed cardiac arrest cases, with the age >18 years old, with the initial rhythm of ventricular fibrillation or tachycardia (VF/VT). Results were shown in the figure. The intervals from witness to start CPR and the rates of by-stander CPR given by citizen were not different among each group. GNS rate was decreased as the number of defibrillation was increased, but GNS rate was still over 10% in the group of 8 shocks.
Conclusions. In conclusion, up to two shocks on site before transportation would be acceptable (because GNS was more than 20%), and CPR with defibrillation should not be stopped during transportation as long as VF/VT persists.
- © 2011 by American Heart Association, Inc.