title: Comparison of team-focused CPR vs standard CPR in resuscitation from out-of-hospital cardiac arrest: Results from a statewide quality improvement initiative.
abstract: Team-focused CPR (TFCPR) is a choreographed approach to cardiopulmonary resuscitation (CPR) with emphasis on minimally interrupted high-quality chest compressions, early defibrillation, discourages endotracheal intubation and encourages use of the bag-valve-mask (BVM) and/or blind-insertion airway device (BIAD) with a ventilation rate of 8-10 breaths/min to minimize hyperventilation. Widespread incorporation of TFCPR in North Carolina (NC) EMS agencies began in 2011, yet its impact on outcomes is unknown.
  
  
  
  To determine whether TFCPR improves survival with good neurological outcome in out-of-hospital cardiac arrest (OHCA) patients compared to standard CPR.
  
  
  
  This retrospective cohort analysis of NC EMS agencies reporting data to the Cardiac Arrest Registry for Enhanced Survival (CARES) database from January 2010 to June 2014 included adult, non-traumatic OHCA with presumed cardiac etiology where EMS performed CPR or patient received defibrillation. Exclusions were arrest terminated per EMS policy or DNR. EMS agencies self-reported the TFCPR implementation dates. Patients were categorized as receiving either TFCPR or standard CPR. The primary outcome was good neurologic outcome at time of hospital discharge defined as Pittsburgh Cerebral Performance Category (CPC) 1-2.
  
  
  
  Of 14,994 OHCAs, 14,129 patients were included for analysis with a mean age 65 (IQR 50-81) years, 61% male, 7.3% with good neurologic outcome, 24.3% with shockable initial rhythm, and 71.5% receiving TFCPR. Of the 3427 (24.3%) with an initial shockable rhythm, 739 (71.9%) had a good neurological outcome. Good neurologic outcome was higher with TFCPR [836 (8.3%, 95%CI 7.7-8.8%)] vs. standard CPR [193 (4.8%, 95%CI 4.2-5.5%)]. Logistic regression controlling for demographic and arrest characteristics revealed TFCPR (OR 1.5), witnessed arrest (OR 4.3), initial shockable rhythm (OR 7.1), and in-hospital hypothermia (OR 3.3) were associated with good neurologic outcome. Mechanical CPR device (OR 0.68), CPR feedback device (OR 0.47), and endotracheal intubation (OR 0.44) were associated with less likelihood for a good neurologic outcome.
  
  
  
  In our statewide OHCA cohort, TFCPR was associated with improved survival with good neurological outcome.
authors.affiliation: Carolinas Medical Center, Charlotte, NC, United States. Electronic address: David.Pearson@carolinashealthcare.org.
authors.forename: David A
authors.initials: DA
authors.lastname: Pearson
authors.affiliation: Wake Forest University Health Sciences, Winston-Salem, NC, United States.
authors.forename: R
authors.initials: R
authors.lastname: Darrell Nelson
authors.affiliation: Duke Clinical Research Institute, Durham, NC, United States.
authors.forename: Lisa
authors.initials: L
authors.lastname: Monk
authors.affiliation: Duke Clinical Research Institute, Durham, NC, United States.
authors.forename: Clark
authors.initials: C
authors.lastname: Tyson
authors.affiliation: Duke Clinical Research Institute, Durham, NC, United States.
authors.forename: James G
authors.initials: JG
authors.lastname: Jollis
authors.affiliation: Duke Clinical Research Institute, Durham, NC, United States.
authors.forename: Christopher B
authors.initials: CB
authors.lastname: Granger
authors.affiliation: New Hanover Medical Center, Wilmington, NC, United States.
authors.forename: Claire
authors.initials: C
authors.lastname: Corbett
authors.affiliation: Carolinas Medical Center, Charlotte, NC, United States.
authors.forename: Lee
authors.initials: L
authors.lastname: Garvey
authors.affiliation: Carolinas Medical Center, Charlotte, NC, United States.
authors.forename: Michael S
authors.initials: MS
authors.lastname: Runyon
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016887:Cardiopulmonary Resuscitation / Q000379:methods* / Q000401:mortality; D016208:Databases, Factual; D004554:Electric Countershock; D004632:Emergency Medical Services / Q000379:methods* / Q000706:statistics & numerical data; D006801:Humans; D008875:Middle Aged; D009657:North Carolina; D058687:Out-of-Hospital Cardiac Arrest / Q000401:mortality / Q000628:therapy*; D010348:Patient Care Team / Q000706:statistics & numerical data; D015397:Program Evaluation; D058996:Quality Improvement; D012044:Regression Analysis; D012189:Retrospective Studies
keywords: CPR; Cardiac arrest; Targeted temperature management