Abstract 275: The Effect of Cardiopulmonary Resuscitation Using a 30:2 Compression-Ventilation Ratio, Inclusive of 1-Shock Protocol, by Emergency Medical Services Responders
Cardiopulmonary Resuscitation (CPR) using a 30:2 compression-ventilation ratio was designed to increase the number of compressions, reduce the likelihood of hyperventilation, minimize interruptions in chest compressions for ventilation, and simplify instruction for teaching and skills retention. It is unclear whether a 30:2 ratio, inclusive of a 1-shock followed immediately by 2 minutes of CPR using a 30:2 ratio (1-shock protocol) improves survival in patients with out-of-hospital cardiac arrest.
From the All-Japan Utstein Registry, a prospective, nationwide, population-based registry of out-of-hospital cardiac arrest, 287,176 adult patients with out-of-hospital cardiac arrest were included; 199,701 received EMS-responder CPR using a 30:2 ratio and/or 1-shock protocol based on the 2005 CPR guidelines, and 87,475 received EMS-responder CPR using a 15:2 ratio and/or a 3-shock sequence followed by 1 minute of CPR using a 15:2 ratio (3-shock protocol) based on the 2000 CPR guidelines. The primary endpoint was 30-day favorable neurological outcome after cardiac arrest.
Among all study patients and the subgroups of patients who were classified in layperson CPR status, the 30:2 group had significantly higher frequency of favorable neurological outcome than the 15:2 group. The adjusted odds ratio for favorable neurological outcome after the 30:2 group (reference; the 15:2 group) was 1.97 (95% CI, 1.82 to 2.14) in the whole cohort, and 2.20 (95% CI, 1.94 to 2.50) in the subgroups of patients receiving layperson CPR and 1.81 (95% CI, 1.63 to 2.02) in patients not receiving layperson CPR. In the subanalysis, 4 subsets based on the quartiles of collapse to return of spontaneous circulation (ROSC) interval, the 30:2 ratio had no neurological benefits in quartile 1 (≤13 minutes) not receiving layperson CPR (adjusted odds ratio, 1.22; 95% CI, 0.94 to 1.60) or in quartile 4 (≥29 minutes) receiving layperson CPR (adjusted odds ratio, 1.84; 95% CI, 0.93 to 3.63).
EMS-responder CPR using a 30:2 ratio and/or 1-shock protocol improved neurologically intact survival in adults with out-of-hospital cardiac arrest. However, a 30:2 ratio was not the optimal ratio for patients having achieved ROSC after bystander-witnessed arrest.
- Cardiopulmonary resuscitation
- Cardiac arrest
- Emergency care
- Ventricular fibrillation
- Post cardiac resuscitation
- © 2012 by American Heart Association, Inc.