title: Quality of cardiopulmonary resuscitation in out-of-hospital cardiac arrest is hampered by interruptions in chest compressions--a nationwide prospective feasibility study.
abstract: OBJECTIVE
  Quality of cardiopulmonary resuscitation (CPR) is a critical determinant of outcome following out-of-hospital cardiac arrest. The aim of our study was to evaluate the quality of CPR provided by emergency medical service providers (Basic Life Support (BLS) capability) and emergency medical service providers assisted by paramedics, nurse anesthetists or physician-manned ambulances (Advanced Life Support (ALS) capability) in a nationwide, unselected cohort of out-of-hospital cardiac arrest cases.
  
  
  METHODS
  We conducted a prospective, observational study of out-of-hospital cardiac arrest with non-traumatic etiology (>18 years of age) occurring from the 1st to the 31st of January 2009 and treated by the primary Danish emergency medical service operator, covering approximately 85% of the population. One hundred and ninety-one cases were eligible for analysis. Follow-up was up to one year or death. Quality of CPR was evaluated using measurements of transthoracic impedance.
  
  
  RESULTS
  The majority of patients were treated by ambulances with ALS capability (54%). Interruptions in CPR related to loading of the patient into the emergency medical service vehicle were substantial, but independent of whether patients were managed by ALS or BLS capable units (222s versus 224s, P = 0.76) as were duration of interruptions during rhythm analysis alone (20s versus 22s, P = 0.33) and defibrillation (24s versus 26s, P = 0.07).
  
  
  CONCLUSIONS
  Nationwide, routine monitoring of transthoracic impedance is feasible. CPR is hampered by extended interruptions, particularly during loading of the patient into the emergency medical service vehicle, rhythm analysis and defibrillation.
authors.affiliation: Department of Cardiology B, Aarhus University Hospital, Skejby, Brendstrupgaardsvej 100, DK-8200 Aarhus N, Denmark. nhkrarup@gmail.com
authors.forename: Niels Henrik
authors.initials: NH
authors.lastname: Krarup
authors.forename: Christian Juhl
authors.initials: CJ
authors.lastname: Terkelsen
authors.forename: Søren Paaske
authors.initials: SP
authors.lastname: Johnsen
authors.forename: Peter
authors.initials: P
authors.lastname: Clemmensen
authors.forename: Göran K
authors.initials: GK
authors.lastname: Olivecrona
authors.forename: Troels Martin
authors.initials: TM
authors.lastname: Hansen
authors.forename: Sven
authors.initials: S
authors.lastname: Trautner
authors.forename: Jens Flensted
authors.initials: JF
authors.lastname: Lassen
mesh_terms: D000368:Aged; D016887:Cardiopulmonary Resuscitation / Q000379:methods* / Q000592:standards; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D058687:Out-of-Hospital Cardiac Arrest / Q000628:therapy*; D011446:Prospective Studies; D011787:Quality of Health Care