Quality of cardiopulmonary resuscitation before and during transport in out-of-hospital cardiac arrest.
OBJECTIVE
To evaluate quality of cardiopulmonary resuscitation (CPR) performed during transport after out-of-hospital cardiac arrest.


METHODS
Retrospective, observational study of all non-traumatic cardiac arrest patients older than 18 years who received CPR both before and during transport between May 2003 and December 2006 from the community run EMS system in Oslo. Chest compressions and ventilations were detected from impedance changes in routinely collected ECG signals, and hands-off ratio calculated as time without chest compressions divided by total CPR time.


RESULTS
Seventy-five of 787 consecutive out-of-hospital cardiac arrest patients met the inclusion criteria. Quality data were available from 36 of 66 patients receiving manual CPR and 7 of 9 receiving mechanical CPR. CPR was performed for mean 21+/-11 min before and 12+/-8 min during transport. With manual CPR hands-off ratio increased from 0.19+/-0.09 on-scene to 0.27+/-0.15 (p=0.002) during transport. Compression and ventilation rates were unchanged causing a reduction in compressions per minute from 94+/-14 min(-1) to 82+/-19 min(-1) (p=0.001). Quality was significantly better with mechanical than manual CPR. Four patients (5%) survived to hospital discharge; two with manual CPR (Cerebral performance categories (CPC) 1 and 2), and two with mechanical CPR (CPC scores 3 and 4). No discharged patients had any spontaneous circulation during transport.


CONCLUSIONS
The fraction of time without chest compressions increased during transport of out-of-hospital cardiac arrest patients. Every effort should therefore be made to stabilise patients on-scene before transport to hospital, but all transport with ongoing CPR is not futile.
Olasveengen
Theresa M
TM
Institute for Experimental Medical Research and Department of Anaesthesiology, Division Ulleval University Hospital, University of Oslo, N-0407 Oslo, Norway. t.m.olasveengen@medisin.uio.no
Wik
Lars
L
Steen
Petter A
PA
D000328:Adult; D000368:Aged; D016887:Cardiopulmonary Resuscitation / Q000592:standards*; D004632:Emergency Medical Services / Q000592:standards*; D005260:Female; D005500:Follow-Up Studies; D006323:Heart Arrest / Q000401:mortality / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009664:Norway / Q000453:epidemiology; D011785:Quality Assurance, Health Care; D012189:Retrospective Studies; D015996:Survival Rate; D014187:Transportation of Patients; D014505:Urban Population