Abstract 224: Modified Minimally Interrupted Cardiac Resuscitation Protocol and Outcomes After Out-of-Hospital Cardiac Arrest in a Metropolitan City
Introduction: Prompt and minimal interruption of cardiac resuscitation (MICR) protocol includs more strict and continuous chest compression, delayed airway procedures, and team approach cardiopulmonary resuscitation (CPR) for minimal interruption of chest compression. However, it is unclear whether MICR is effective in an Asian EMS system with intermediate service level or not.
Objective: This study aimed to determine whether the MICR protocol is associated with improved out-of-hospital cardiac arrest (OHCA) outcomes in a metropolitan city.
Methods: This is a before- and after- EMS intervention trial. Data on patients with adult OHCA (18 years old and older) of cardiac etiology were from January 2011 to December 2012. The MICR protocol was implemented as a standardized field protocol in January 2011 and followed by a series of education and training for EMS providers. Education and training session composed of knowledge and skill sessions (four hours) was held in February and June 2012 for 50 and 70 EMS teams each. Outcome was prehospital return of spontaneous circulation and survival to discharge. Intervention group was defined as patients treated by 120 teams after training of the protocol and control group was patients treated by same EMS providers before training. A multivariable logistic regression analysis was used to compare outcomes between two groups adjusting for potential risks.
Results: Total 622 cases in intervention group and 868 cases in control group were enrolled. Prehospital return of spontaneous circulation (ROSC) was 3.0% in control group and 6.1% in intervention group (p=0.004). Survival to discharge rate was 9.33% in control group and 11.3% in intervention group (p=0.225) . Adjusted odds ratio (95% confidence interval) of intervention compared with control group for prehospital ROSC and survival to discharge was not significant.
Conclusions: The MICR protocol showed higher prehopital ROSC and survival to discharge rate than conventional CPR protocol in a metropolitan city but the adjusted model did not show better outcome. More intensive training to disseminate protocol among EMS providers is needed.
- © 2013 by American Heart Association, Inc.