Abstract 349: Effect of Electrical Therapy Using Biphasic Defibrillators in the 2010 CPR Guidelines 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 instead of 3-shock sequences recommended in the 2000 guidelines. The 2010 guidelines stressed that it is necessary to improve CPR quality. Moreover, there was insufficient evidence to recommend any specific biphasic waveform. 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 bystander-witnessed 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 in the 2010 guidelines (2010G). The primary endpoint, favorable neurological outcome at 30 days after OHCA, was compared between using biphasic AEDs and using monophasic AEDs in the three groups.
RESULTS: Of the 17,005 patients who met the inclusion criteria, 3,544 received electrical therapy in 2000G, 7,222 in 2005G, and 6,239 in 2010G. The figure shows the comparison of favorable neurological outcome between using biphasic AEDs and using monophasic AEDs in the three groups. Adjusted odds ratios for favorable neurological outcome were 1.5 (95% CI, 1.3 to 1.7) after biphasic AEDs, and 2.3 (95% CI, 2.0 to 2.6) after the 2005G group and the 2010G group as compared with the 2000G group, and 1.5 (95% CI, 1.3 to 1.8) after biphasic AEDs and 1.2 (95% CI, 1.1 to 1.3) after the 2010G group as compared with the 2005G group.
CONCLUSIONS: The single-shock protocols using biphasic AEDs of the 2010 guidelines were superior to the others in patients with shockable, in terms of neurological benefits.
- Automated external defibrillator (AED)
- Emergency medical services (EMS)
- Ventricular fibrillation
Author Disclosures: T. Yagi: None. K. Nagao: None. E. Tachibana: None. N. Yonemoto: None. S. Shirai: None. M. Takayama: None. H. Nonogi: None. T. Kimura: None. A. Hirayama: None.
- © 2014 by American Heart Association, Inc.