Abstract 12529: Effect of 1-Shock Protocol for Patients With Out-of-Hospital Cardiac Arrest due to Ventricular Fibrillation
Background: The 2005 guidelines for cardiopulmonary resuscitation (CPR) with electrical therapy recommended a single shock plus an immediate 2 minutes of CPR instead of 3-shock sequences recommended in the 2000 guidelines. The 2010 guidelines stressed that it is necessary to improve CPR quality. We compared the effects of electrical therapy based on the three guidelines.
METHODS: From the data of the All-Japan Utstein Registry, a prospective, nationwide, population-based registry of out-of-hospital cardiac arrest (OHCA), we included adult patients who had OHCA due to cardiac etiology and in whom shockable arrest was recorded as an initial rhythm. Study patients were divided into three groups based on the different CPR guidelines; 3-shock protocol in the 2000 guidelines (2000G), 1-shock protocol in the 2005 guidelines (2005G), and 1-shock protocol with improved CPR quality in the 2010 guidelines (2010G). The primary endpoint, favorable neurological outcome at 30 days after OHCA, was compared among the three groups with or without bystander CPR.
RESULTS: Of the 16,517 patients who met the inclusion criteria, 6,957 received CPR by bystanders, and 9,560 did not. The figure shows the comparison of favorable neurological outcome among the three groups with or without bystander CPR. Adjusted odds ratios for favorable neurological outcome were 2.7 (95% CI, 2.2 to 3.2) in the 2010G group and 1.9 (95% CI, 1.6 to 2.3) in the 2005G group (reference; the 2000G group) in patients receiving bystander CPR, and 2.4 (95% CI, 2.0 to 2.8) in the 2010G group and 1.6 (95% CI, 1.4 to 1.9) in the 2005G group (reference; the 2000G group) in patients not receiving bystander CPR.
CONCLUSION: The single-shock protocols of the 2005 and 2010 guidelines were superior to the 3-shock protocol of the 2000 guidelines in patients with shockable arrest irrespective of bystander CPR, in terms of neurological benefits.
- © 2013 by American Heart Association, Inc.