title: A randomized trial of compression first or analyze first strategies in patients with out-of-hospital cardiac arrest: results from an Asian community.
abstract: BACKGROUND
  It is still under debate whether a period of cardiopulmonary resuscitation should be performed prior to rhythm analysis for defibrillation for out of hospital cardiac arrests (OHCA). This study compared outcomes of OHCA treated by "compression first" (CF) versus "analyze first" (AF) strategies in an Asian community with low rates of shockable rhythms.
  
  
  METHODS
  This randomized trial was conducted in Taipei City between February 2008 and December 2009. Dispatches of suspected OHCA that activated advanced life support teams were randomized into the CF and AF strategies. Patients assigned to CF strategy received 10 cycles of CPR prior to analysis by automatic external defibrillator. The primary outcome was sustained (>2 h) return of spontaneous circulation (ROSC) and secondary outcome was survival to hospital discharge.
  
  
  RESULTS
  We included 289 cases in the final analysis after exclusion by pre-specified criteria, 141 were allocated to CF strategy and 148 to AF strategy. Baseline characteristics were similar. Thirty-seven (26.2%) of those receiving CF strategy and 49 (33.1%) of the AF strategy achieved sustained ROSC (p=0.25). In a post-hoc analysis of patients who achieved ROSC, those that received CF strategy were more likely to be discharged alive from the hospital (16/37=43.2% vs. 11/49=22.4%, p=0.02).
  
  
  CONCLUSIONS
  In this study population of low rates of shockable rhythms, there was no difference in ROSC for CF or AF strategies. Considering the EMS operation situations, a period of paramedic-administered CPR for up to 10 cycles prior to rhythm analysis could be a feasible strategy in this community.
authors.affiliation: Department of Emergency Medicine, National Taiwan University Hospital, Taiwan. matthew@ntu.edu.tw
authors.forename: Matthew Huei-Ming
authors.initials: MH
authors.lastname: Ma
authors.forename: Wen-Chu
authors.initials: WC
authors.lastname: Chiang
authors.forename: Patrick Chow-In
authors.initials: PC
authors.lastname: Ko
authors.forename: Chi-Wei
authors.initials: CW
authors.lastname: Yang
authors.forename: Hui-Chi
authors.initials: HC
authors.lastname: Wang
authors.forename: Shey-Ying
authors.initials: SY
authors.lastname: Chen
authors.forename: Wei-Tien
authors.initials: WT
authors.lastname: Chang
authors.forename: Chien-Hwa
authors.initials: CH
authors.lastname: Huang
authors.forename: Hao-Chang
authors.initials: HC
authors.lastname: Chou
authors.forename: Mei-Shu
authors.initials: MS
authors.lastname: Lai
authors.forename: Kuo-Long
authors.initials: KL
authors.lastname: Chien
authors.forename: Bin-Chou
authors.initials: BC
authors.lastname: Lee
authors.forename: Chien-Hwa
authors.initials: CH
authors.lastname: Hwang
authors.forename: Yao-Cheng
authors.initials: YC
authors.lastname: Wang
authors.forename: Guan-Hwa
authors.initials: GH
authors.lastname: Hsiung
authors.forename: Ying-Wen
authors.initials: YW
authors.lastname: Hsiao
authors.forename: Anna Marie
authors.initials: AM
authors.lastname: Chang
authors.forename: Wen-Jone
authors.initials: WJ
authors.lastname: Chen
authors.forename: Shyr-Chyr
authors.initials: SC
authors.lastname: Chen
mesh_terms: D000368:Aged; D016887:Cardiopulmonary Resuscitation / Q000379:methods*; D047548:Defibrillators; D004632:Emergency Medical Services / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D058687:Out-of-Hospital Cardiac Arrest / Q000401:mortality / Q000628:therapy*; D011446:Prospective Studies; D012111:Residence Characteristics; D016019:Survival Analysis; D013624:Taiwan; D016896:Treatment Outcome; D014693:Ventricular Fibrillation / Q000628:therapy*