Chest compression release velocity: Association with survival and favorable neurologic outcome after out-of-hospital cardiac arrest.
OBJECTIVE
We evaluated the association between chest compression release velocity (CCRV) and outcomes after out-of-hospital cardiac arrest (OHCA).


METHODS
CPR quality was measured using a defibrillator with accelerometer-based technology (E Series, ZOLL Medical) during OHCA resuscitations by 2 EMS agencies in Arizona between 10/2008 and 06/2013. All non-EMS-witnessed adult (≥ 18 years) arrests of presumed cardiac etiology were included. The association between mean CCRV (assessed as an appropriate measure of central tendency) and both survival to hospital discharge and neurologic outcome (Cerebral Performance Category score = 1 or 2) was analyzed using multivariable logistic regression to control for known and potential confounders and multiple imputation to account for missing data.


RESULTS
981 OHCAs (median age 68 years, 65% male, 11% survival to discharge) were analyzed with 232 (24%) missing CPR quality data. All-rhythms survival varied significantly with CCRV [fast (≥ 400 mm/s) = 18/79 (23%); moderate (300-399.9 mm/s) = 50/416 (12%); slow (<300 mm/s) 17/255 (7%); p < 0.001], as did favorable neurologic outcome [fast = 14/79 (18%); moderate = 43/415 (10%); slow = 11/255 (4%); p < 0.001]. Fast CCRV was associated with increased survival compared to slow [adjusted odds ratio (aOR) 4.17 (95% CI: 1.61, 10.82) and moderate CCRV [aOR 3.08 (1.39, 6.83)]. Fast CCRV was also associated with improved favorable neurologic outcome compared to slow [4.51 (1.57, 12.98)]. There was a 5.2% increase in the adjusted odds of survival for each 10mm/s increase in CCRV [aOR 1.052 (1.001, 1.105)].


CONCLUSIONS
CCRV was independently associated with improved survival and favorable neurologic outcome at hospital discharge after adult OHCA.
University of Arizona College of Medicine-Phoenix, 550 E Van Buren St., Phoenix, AZ 85004, United States. Electronic address: Akovacs@email.arizona.edu.
Alexander
A
Kovacs
Department of Emergency Medicine, Mayo Clinic Florida, 4500 San Pablo Road, Jacksonville, FL 32224, United States. Electronic address: Vadeboncoeur.tyler@mayo.edu.
Tyler F
TF
Vadeboncoeur
Department of Emergency Medicine, University of Arizona, PO Box 245057, 1501 N. Campbell, Tucson, AZ 85724-5057, United States. Electronic address: Ustolz@aemrc.arizona.edu.
Uwe
U
Stolz
Department of Emergency Medicine, University of Arizona, PO Box 245057, 1501 N. Campbell, Tucson, AZ 85724-5057, United States. Electronic address: Dan@aemrc.arizona.edu.
Daniel W
DW
Spaite
Department of Traumatology and Acute Critical Care, Osaka University Hospital, 2-15 Yamadaoka, Suita, Osaka 565-0871, Japan. Electronic address: Taroirisawa@yahoo.co.jp.
Taro
T
Irisawa
Zoll Medical Corporation, 269 Mill Rd, Chelmsford, MA 01824, United States. Electronic address: Asilver@zoll.com.
Annemarie
A
Silver
University of Arizona College of Medicine-Phoenix, 550 E Van Buren St., Phoenix, AZ 85004, United States; Department of Emergency Medicine, University of Arizona, PO Box 245057, 1501 N. Campbell, Tucson, AZ 85724-5057, United States; Bureau of Emergency Medical Services and Trauma System, Arizona Department of Health Services, 150 N. 18th Avenue, #540, Phoenix, AZ 85007-3248, United States. Electronic address: Bentley.Bobrow@azdhs.gov.
Bentley J
BJ
Bobrow
D000368:Aged; D001130:Arizona / Q000453:epidemiology; D016887:Cardiopulmonary Resuscitation / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D009422:Nervous System Diseases / Q000453:epidemiology* / Q000209:etiology; D058687:Out-of-Hospital Cardiac Arrest / Q000150:complications / Q000401:mortality / Q000628:therapy*; D011787:Quality of Health Care; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D013909:Thorax; D013997:Time Factors
CPR; CPR quality; Cardiac arrest; Cardiac resuscitation