Abstract 130: The Effect of CPR Quality on Survival and Neurological Outcome After Out-of-Hospital Cardiac Arrest
Background: Clinical studies have demonstrated that improving CPR quality is important for successful resuscitation from out-of-hospital cardiac arrest (OHCA) but little is known about the impact of particular CPR quality metrics on survival or neurologic outcome. We assessed the relative influence of various AHA Guideline CPR quality metrics on survival and neurological outcome among adult OHCA victims.
Methods: Defibrillator records (E Series, ZOLL Medical) were prospectively collected during the treatment of consecutive adult OHCA patients in an urban EMS system in Arizona. Exclusion criteria: non-cardiac etiology, EMS-witnessed arrest. Using multivariable logistic regression, commonly used metrics of CPR quality were assessed for independent associations (α ≤ 0.05) with survival to hospital discharge and positive neurological outcome (PNO, Cerebral Performance Category Score = 1 or 2).
Results: Among 476 total cases, 334 had CPR quality data (70.2%) with 44 survivors (13.2%) and 33 PNOs (9.9%). The table compares CPR metrics between survivors/fatalities and those with/without PNO. Adjusted odds ratios for survival and PNO (adjusting for initial cardiac rhythm, witnessed arrest, age, bystander CPR, therapeutic hypothermia) were: mean chest compression (CC) depth (per 5 mm) - Survival: 1.33 (95% CI: 1.09-1.62), PNO: 1.32 (1.06-1.64); % of CCs ≥5 cm (per 10% increase) - Survival: 1.22 (1.06-1.40), PNO: 1.21 (1.04-1.40); mean CC release velocity_“recoil” (per 5 mm/sec) - Survival: 1.61 (1.15-2.25), PNO: 1.52 (1.05-2.19). The associations between survival/PNO and either CC fraction or CC rate were not significant.
Conclusion: Survival and PNO following OHCA was significantly associated with the mean depth of CCs, percent of CCs at or above the 2010 AHA Guidelines depth of 5 cm, and rate of CC recoil. While this study was observational, it is the first to identify an association between several measures of CPR quality and neurological outcomes.
- © 2012 by American Heart Association, Inc.