Abstract 19335: Compression-to-Ventilation Ratio and Incidence of Rearrest: A Secondary Analysis of the ROC CCC Trial
Introduction: When an out-of-hospital cardiac arrest (OHCA) patient achieves return of spontaneous circulation (ROSC), but subsequently has another cardiac arrest prior to hospital arrival, the probability of survival to hospital discharge is significantly decreased. Very few modifiable factors for re-arrest are known. We examined the association between re-arrest and compression-to-ventilation ratio during cardiopulmonary resuscitation (CPR) and outcomes.
Hypothesis: Re-arrest incidence is e similar between cases treated with30:2 or continuous chest compression (CCC) CPR, but inversely related to survival and good neurological outcome.
Methods: This was a secondary analysis of a large randomized-controlled trial of CCC versus 30:2 CPR for the treatment of OHCA between 2011 and 2015 at 8 sites of the Resuscitation Outcomes Consortium (ROC). Patients were randomized through an emergency medical services (EMS) agency-level via cluster randomization design to receive either 30:2 or CCC CPR. Case data were derived from electronic prehospital patient care reports, digital defibrillator files, and hospital records. The primary comparison was the proportion of patients with a re-arrest between cases stratified by compression-to-ventilation as-treated group. We also assessed the association between re-arrest and both survival to hospital discharge and favorable neurological outcome (Modified Rankin Score ≤ 3) using multivariable logistic regression adjusting for age, sex, initial rhythm and measures of CPR quality.
Results: There were 14,109 analyzable cases who have definitively received either CCC or 30:2 CPR. Of these, 4,713 had prehospital ROSC and 2,040 (43.2%) had at least one re-arrest. Incidence of re-arrest was not significantly different between CCC and 30:2 groups (44.1% vs 42.8%; p = 0.12). After controlling for patient and treatment characteristics, re-arrest was significantly associated with lower survival (OR: 0.46; 95%CI: 0.36-0.51) and worse neurological outcome (OR: 0.46; 95%CI: 0.38, 0.55).
Conclusions: Re-arrest occurrence was not significantly different between patients receiving CCC and 30:2, and was inversely associated with survival to hospital discharge and MRS.
Author Disclosures: D. Salcido: Research Grant; Significant; NIH K12 Career Development in Emergency Care Research, Laerdal Foundation, Henry L. Hillman Foundation. R. Schmicker: None. J.E. Buick: Other; Modest; International Liaison Committee on Resuscitation Worksheet Author. S. Cheskes: Research Grant; Significant; Canadian Institutes for Health Research. Honoraria; Significant; CPR Quality Lectures for Zoll Medical and Physio Control. B. Grunau: None. P. Kudenchuk: None. B. Leroux: None. S. Zellner: None. D. Zive: None. T.P. Aufderheide: Research Grant; Significant; NHLBI: ROC and NIH Director’s Transformative Research Award, NINDS: NETT. Other; Modest; AHA Science Subcommittee, Board of Directors Citizen CPR Foundation, Institute of Medicine Report on Cardiac Arrest. A.C. Koller: None. H. Herren: None. J. Nuttall: None. M.L. Sundermann: None.
- © 2016 by American Heart Association, Inc.