Improved patient survival using a modified resuscitation protocol for out-of-hospital cardiac arrest.
BACKGROUND
Cardiac arrest continues to have poor survival in the United States. Recent studies have questioned current practice in resuscitation. Our emergency medical services system made significant changes to the adult cardiac arrest resuscitation protocol, including minimizing chest compression interruptions, increasing the ratio of compressions to ventilation, deemphasizing or delaying intubation, and advocating chest compressions before initial countershock.


RESULTS
This retrospective observational cohort study reviewed all adult primary ventricular fibrillation and pulseless ventricular tachycardia cardiac arrests 36 months before and 12 months after the protocol change. Primary outcome was survival to discharge; secondary outcomes were return of spontaneous circulation and cerebral performance category. Survival of out-of-hospital arrest of presumed primary cardiac origin improved from 7.5% (82 of 1097) in the historical cohort to 13.9% (47 of 339) in the revised protocol cohort (odds ratio, 1.80; 95% confidence interval, 1.19 to 2.70). Similar increases in return of spontaneous circulation were achieved for the subset of witnessed cardiac arrest patients with initial rhythm of ventricular fibrillation from 37.8% (54 of 143) to 59.6% (34 of 57) (odds ratio, 2.44; 95% confidence interval, 1.24 to 4.80). Survival to hospital discharge also improved from an unadjusted survival rate of 22.4% (32 of 143) to 43.9% (25 of 57) (odds ratio, 2.71; 95% confidence interval, 1.34 to 1.59) with the protocol. Of the 25 survivors, 88% (n=22) had favorable cerebral performance categories on discharge.


CONCLUSIONS
The changes to our prehospital protocol for adult cardiac arrest that optimized chest compressions and reduced disruptions increased the return of spontaneous circulation and survival to discharge in our patient population. These changes should be further evaluated for improving survival of out-of-hospital cardiac arrest patients.
Garza
Alex G
AG
Washington Hospital Center, Georgetown University School of Medicine, Department of Emergency Medicine, Washington, DC, USA. alexgarza@cox.net
Gratton
Matthew C
MC
Salomone
Joseph A
JA
Lindholm
Daniel
D
McElroy
James
J
Archer
Rex
R
D000328:Adult; D000368:Aged; D000572:American Heart Association; D001925:Brain Damage, Chronic / Q000209:etiology / Q000517:prevention & control; D016887:Cardiopulmonary Resuscitation / Q000379:methods / Q000592:standards*; D002985:Clinical Protocols; D000075202:Contraindications; D004554:Electric Countershock / Q000379:methods* / Q000592:standards; D004632:Emergency Medical Services / Q000379:methods / Q000592:standards*; D005260:Female; D006323:Heart Arrest / Q000150:complications / Q000401:mortality* / Q000628:therapy; D006336:Heart Massage; D006801:Humans; D007327:Insufflation; D007442:Intubation, Intratracheal / Q000379:methods / Q000592:standards; D007615:Kansas / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D010102:Oxygen Inhalation Therapy / Q000379:methods / Q000592:standards; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States; D014693:Ventricular Fibrillation / Q000150:complications / Q000453:epidemiology