title: Chest compression rates and survival following out-of-hospital cardiac arrest.
abstract: OBJECTIVE
  Guidelines for cardiopulmonary resuscitation recommend a chest compression rate of at least 100 compressions/min. A recent clinical study reported optimal return of spontaneous circulation with rates between 100 and 120/min during cardiopulmonary resuscitation for out-of-hospital cardiac arrest. However, the relationship between compression rate and survival is still undetermined.
  
  
  METHODS
  Prospective, observational study.
  
  
  METHODS
  Data is from the Resuscitation Outcomes Consortium Prehospital Resuscitation IMpedance threshold device and Early versus Delayed analysis clinical trial.
  
  
  METHODS
  Adults with out-of-hospital cardiac arrest treated by emergency medical service providers.
  
  
  METHODS
  None.
  
  
  RESULTS
  Data were abstracted from monitor-defibrillator recordings for the first five minutes of emergency medical service cardiopulmonary resuscitation. Multiple logistic regression assessed odds ratio for survival by compression rate categories (<80, 80-99, 100-119, 120-139, ≥140), both unadjusted and adjusted for sex, age, witnessed status, attempted bystander cardiopulmonary resuscitation, location of arrest, chest compression fraction and depth, first rhythm, and study site. Compression rate data were available for 10,371 patients; 6,399 also had chest compression fraction and depth data. Age (mean±SD) was 67±16 years. Chest compression rate was 111±19 per minute, compression fraction was 0.70±0.17, and compression depth was 42±12 mm. Circulation was restored in 34%; 9% survived to hospital discharge. After adjustment for covariates without chest compression depth and fraction (n=10,371), a global test found no significant relationship between compression rate and survival (p=0.19). However, after adjustment for covariates including chest compression depth and fraction (n=6,399), the global test found a significant relationship between compression rate and survival (p=0.02), with the reference group (100-119 compressions/min) having the greatest likelihood for survival.
  
  
  CONCLUSIONS
  After adjustment for chest compression fraction and depth, compression rates between 100 and 120 per minute were associated with greatest survival to hospital discharge.
authors.affiliation: 1Departments of Emergency Medicine and Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX. 2Clinical Trials Center, Department of Biostatistics, University of Washington, Seattle, WA. 3Departments of Emergency Medicine, Surgery, Internal Medicine and Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX. 4Department of Emergency Medicine, Queen's University, Toronto, Ontario, Canada. 5Department of Emergency Medicine, University of Pittsburgh, PA. 6Department of Emergency Medicine, University of British Columbia, Vancouver, British Columbia, Canada. 7Department of Emergency Medicine, University of California, San Diego Medical Center, San Diego, CA. 8Department of Emergency Medicine, Oregon Health & Science University, Portland, OR. 9Department of Emergency Medicine, University of Alabama, Birmingham, AL. 10Division of Cardiology, Department of Medicine, University of Washington, Seattle, WA. 11Seattle Fire Department, Seattle, WA. 12Division of Emergency Medicine, Department of Medicine, University of Toronto, Toronto, Ontario, Canada. 13National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD. 14Department of Emergency Medicine and Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada. 15Department of Medicine, University of Washington, Seattle, WA. 16Department of Emergency Medicine, Medical College of Wisconsin, Milwaukee, WI.
authors.forename: Ahamed H
authors.initials: AH
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mesh_terms: D000367:Age Factors; D000368:Aged; D016887:Cardiopulmonary Resuscitation; D005260:Female; D006801:Humans; D008297:Male; D016017:Odds Ratio; D058687:Out-of-Hospital Cardiac Arrest / Q000401:mortality* / Q000628:therapy*; D011446:Prospective Studies; D012044:Regression Analysis; D016896:Treatment Outcome