Association between chest compression rates and clinical outcomes following in-hospital cardiac arrest at an academic tertiary hospital.
Recent guidelines for management of cardiac arrest recommend chest compression rates of 100-120 compressions/min. However, animal studies have found cardiac output to increase with rates up to 150 compressions/min. The objective of this study was to test the association between chest compression rates during cardiopulmonary resuscitation for in-hospital cardiac arrest (IHCA) and outcome.



We conducted a prospective observational study at a single academic medical center.



age≥18, IHCA, cardiopulmonary resuscitation performed. We analyzed chest compression rates measured by defibrillation electrodes, which recorded changes in thoracic impedance. The primary outcome was return of spontaneous circulation (ROSC). We used multivariable logistic regression to determine odds ratios for ROSC by chest compression rate categories (100-120, 121-140, >140 compressions/min), adjusted for chest compression fraction (proportion of time chest compressions provided) and other known predictors of outcome. We set 100-120 compressions/min as the reference category for the multivariable model.



We enrolled 222 consecutive patients and found a mean chest compression rate of 139±15. Overall 53% achieved ROSC; among 100-120, 121-140, and >140 compressions/min, ROSC was 29%, 64%, and 49% respectively. A chest compression rate of 121-140 compressions/min had the greatest likelihood of ROSC, odds ratio 4.48 (95% CI 1.42-14.14).



In this sample of adult IHCA patients, a chest compression rate of 121-140 compressions/min had the highest odds ratio of ROSC. Rates above the currently recommended 100-120 compressions/min may improve the chances of ROSC among IHCA patients.
The Department of Emergency Medicine, Cooper University Hospital, Cooper Medical School of Rowan University, Camden, NJ, United States.
J Hope
JH
Kilgannon
The Department of Emergency Medicine, Cooper University Hospital, Cooper Medical School of Rowan University, Camden, NJ, United States.
Michael
M
Kirchhoff
The Department of Medicine, Division of Critical Care Medicine, Cooper University Hospital, Cooper Medical School of Rowan University, Camden, NJ, United States.
Lisa
L
Pierce
The Department of Emergency Medicine, Cooper University Hospital, Cooper Medical School of Rowan University, Camden, NJ, United States.
Nicholas
N
Aunchman
The Department of Emergency Medicine, Cooper University Hospital, Cooper Medical School of Rowan University, Camden, NJ, United States; The Department of Medicine, Division of Critical Care Medicine, Cooper University Hospital, Cooper Medical School of Rowan University, Camden, NJ, United States.
Stephen
S
Trzeciak
The Department of Emergency Medicine, Cooper University Hospital, Cooper Medical School of Rowan University, Camden, NJ, United States. Electronic address: roberts-brian-w@cooperhealth.edu.
Brian W
BW
Roberts
D000368:Aged; D001775:Blood Circulation; D002302:Cardiac Output; D016887:Cardiopulmonary Resuscitation / Q000379:methods / Q000592:standards; D005260:Female; D006323:Heart Arrest / Q000401:mortality / Q000503:physiopathology / Q000628:therapy; D006336:Heart Massage / Q000379:methods / Q000592:standards; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D011446:Prospective Studies; D058996:Quality Improvement; D014481:United States / Q000453:epidemiology
Cardiac arrest; Cardiopulmonary resuscitation; Heart arrest; Resuscitation
Resuscitation. 2003 Mar;56(3):247-63
12628556
Resuscitation. 2010 Oct;81(10):1277-92
20956051
Emerg Med J. 2013 Aug;30(8):623-7
22851670
J Biomed Inform. 2009 Apr;42(2):377-81
18929686
JAMA. 2006 Jan 4;295(1):50-7
16391216
BMJ. 2014 May 20;348:g3028
24846323
Resuscitation. 1996 Oct;32(3):169-76
8923577
Resuscitation. 2015 Oct;95:e43-69
26477428
Circulation. 1988 Jan;77(1):240-50
3335070
Circulation. 2015 Nov 3;132(18 Suppl 2):S444-64
26472995
Resuscitation. 2008 Dec;79(3):432-7
19061785
J Thorac Cardiovasc Surg. 1988 Mar;95(3):523-32
3343860
Resuscitation. 2009 Jun;80(6):617-23
19386408
JAMA. 1960 Jul 9;173:1064-7
14411374
Circulation. 2011 Nov 8;124(19):2158-77
21969010
Resuscitation. 2003 Sep;58(3):297-308
12969608
Resuscitation. 2006 Nov;71(2):161-70
16989937
Crit Care Med. 2015 Apr;43(4):840-8
25565457
Resuscitation. 2005 Sep;66(3):271-83
16129543
Circulation. 2010 Nov 2;122(18 Suppl 3):S685-705
20956221
Circ Cardiovasc Qual Outcomes. 2010 Jan;3(1):63-81
20123673
Resuscitation. 2011 Mar;82(3):263-9
21146913
J Clin Epidemiol. 1995 Dec;48(12):1503-10
8543964
Resuscitation. 2012 Nov;83(11):1319-23
22828356
Med Care. 2016 Jan;54(1):74-80
26783858
Resuscitation. 2013 May;84(5):596-601
23000361
Circulation. 1984 Jul;70(1):86-101
6723014
Anesthesiology. 1967 Sep-Oct;28(5):806-13
6035010
Resuscitation. 2005 Sep;66(3):317-21
16081201
Acad Emerg Med. 2006 May;13(5):530-6
16551775
Circulation. 2004 Nov 23;110(21):3385-97
15557386
Circulation. 2015 Jan 27;131(4):e29-322
25520374
JAMA. 2005 Jan 19;293(3):305-10
15657323
Arch Intern Med. 1992 Jan;152(1):145-9
1728910
Circulation. 2012 Jun 19;125(24):3004-12
22623717
Resuscitation. 2009 May;80(5):546-52
19409300
J Clin Epidemiol. 1996 Dec;49(12):1373-9
8970487
Circulation. 2015 Nov 3;132(18 Suppl 2):S414-35
26472993
Resuscitation. 2014 Feb;85(2):182-8
24125742
Resuscitation. 2009 Jan;80(1):79-82
18952361