title: The impact of peri-shock pause on survival from out-of-hospital shockable cardiac arrest during the Resuscitation Outcomes Consortium PRIMED trial.
abstract: BACKGROUND
  Previous research has demonstrated significant relationships between peri-shock pause and survival to discharge from out-of-hospital shockable cardiac arrest (OHCA).
  
  
  OBJECTIVE
  To determine the impact of peri-shock pause on survival from OHCA during the ROC PRIMED randomized controlled trial.
  
  
  METHODS
  We included patients in the ROC PRIMED trial who suffered OHCA between June 2007 and November 2009, presented with a shockable rhythm and had CPR process data for at least one shock. We used multivariable logistic regression to determine the association between peri-shock pause duration and survival to hospital discharge.
  
  
  RESULTS
  Among 2006 patients studied, the median (IQR) shock pause duration was: pre-shock pause 15s (8, 22); post-shock pause 6s (4, 9); and peri-shock pause 22.0 s (14, 31). After adjusting for Utstein predictors of survival as well as CPR quality measures, the odds of survival to hospital discharge were significantly higher for patients with pre-shock pause <10s (OR: 1.52, 95% CI: 1.09, 2.11) and peri-shock pause <20s (OR: 1.82, 95% CI: 1.17, 2.85) when compared to patients with pre-shock pause ≥ 20s and peri-shock pause ≥ 40s. Post-shock pause was not significantly associated with survival to hospital discharge. Results for neurologically intact survival (Modified Rankin Score ≤ 3) were similar to our primary outcome.
  
  
  CONCLUSIONS
  In patients with cardiac arrest presenting in a shockable rhythm during the ROC PRIMED trial, shorter pre- and peri-shock pauses were significantly associated with higher odds of survival. Future cardiopulmonary education and technology should focus on minimizing all peri-shock pauses.
authors: University of Toronto, Toronto, ON, Canada. Electronic address: Sheldon.Cheskes@sunnybrook.ca.
authors: Sheldon
authors: S
authors: Cheskes
authors: University of Washington, Seattle, WA, United States.
authors: Robert H
authors: RH
authors: Schmicker
authors: University of Toronto, Toronto, ON, Canada.
authors: P Richard
authors: PR
authors: Verbeek
authors: University of Pittsburgh, Pittsburgh, PA, United States.
authors: David D
authors: DD
authors: Salcido
authors: University of Washington, Seattle, WA, United States.
authors: Siobhan P
authors: SP
authors: Brown
authors: Queens University, Kingston, ON, Canada.
authors: Steven
authors: S
authors: Brooks
authors: University of Pittsburgh, Pittsburgh, PA, United States.
authors: James J
authors: JJ
authors: Menegazzi
authors: University of Ottawa, Ottawa, ON, Canada.
authors: Christian
authors: C
authors: Vaillancourt
authors: University of Washington, Seattle, WA, United States.
authors: Judy
authors: J
authors: Powell
authors: University of Washington, Seattle, WA, United States.
authors: Susanne
authors: S
authors: May
authors: Children's Hospital of Philadelphia and University of Pennsylvania, Philadelphia, PA, United States.
authors: Robert A
authors: RA
authors: Berg
authors: University of California/San Diego, San Diego, CA, United States.
authors: Rebecca
authors: R
authors: Sell
authors: University of Texas Southwestern Medical Center, Dallas, TX, United States.
authors: Ahamed
authors: A
authors: Idris
authors: Oregon Health and Science University, Portland, OR, United States.
authors: Mike
authors: M
authors: Kampp
authors: Oregon Health and Science University, Portland, OR, United States.
authors: Terri
authors: T
authors: Schmidt
authors: University of British Columbia, Vancouver, BC, Canada.
authors: Jim
authors: J
authors: Christenson
mesh_terms: D000368:Aged; D016887:Cardiopulmonary Resuscitation / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D058687:Out-of-Hospital Cardiac Arrest / Q000401:mortality* / Q000628:therapy*; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome
keywords: Cardiopulmonary resuscitation; Heart arrest; Resuscitation; Survival