Abstract 14479: Association Between Chest Compressions and Ventricular Fibrillation Recurrences in Successfully Shocked Out-Of-Hospital Cardiac Arrests
Introduction: Chest compressions (CC) are unquestioned as appropriate and beneficial during rescuing attempts of out-of-hospital cardiac arrest (OOHCA). However, adverse consequences from CC are well documented and CC share many aspects with commotio cordis, a well-known cause of VF induction.
Hypothesis: To test the association between CC and VF recurrences (VFr) after a successful shock in OOHCA.
Methods: The Progetto Vita database, prospectively collecting data on all resuscitation efforts in the Piacenza province (Italy), was used for the present analysis. All data concerning the resuscitation were prospectively collected according to the Utstein recommendations. From the 461 OOHCA found in a shockable rhythm, only those with both good ECG tracings and good quality audio recordings (160) were included in the analysis. VFr was defined as related to CC when the onset of VFr occurred during the actual CC artifact or immediately after. Otherwise, it was defined as spontaneous. The conduct of CC was confirmed via auditory tapes as all rescuers speak their compression counts and can be correlated to the ECG artifacts.
Results: VFr occurred in 96 out of 160 patients (60%). In 56 out of 96 patients, the first VFr was related to CC (58%). After shock delivery, VFr incidence was higher when CC were resumed within one minute (71% vs. 48%). Early CC after a shock was significantly related to increased risk of VFr (OR 2.7; 95% CI 1.4-5.2; p=0.02). Survival to discharge without neurological impairment were higher in patients without VFr when compared to patients with VFr (52% vs 24%; p<0.001).
Conclusions: Immediate CC after a successful defibrillation is associated with VF reinduction. When a spontaneous electrical activity is present, it could be safer to wait in order to evaluate the recovery of spontaneous circulation and pulse. The potential survival benefit of early CC could be blunted by the reinduction of VF.
- Chest compression
- Chain of survival
- Ventricular defibrillation
- Ventricular fibrillation
- Ventricular arrhythmia
Author Disclosures: A. Capucci: None. D. Aschieri: None. F. Guerra: None. V. Pelizzoni: None. E. Paolini: None. G.Q. Villani: None. S. Nani: None. G.H. Bardy: None.
- © 2016 by American Heart Association, Inc.