| Improved patient survival using a modified resuscitation protocol for out-of-hospital cardiac arrest. | |
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MedLine Citation:
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PMID: 19414637 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Cardiac arrest continues to have poor survival in the United States. Recent studies have questioned current practice in resuscitation. Our emergency medical services system made significant changes to the adult cardiac arrest resuscitation protocol, including minimizing chest compression interruptions, increasing the ratio of compressions to ventilation, deemphasizing or delaying intubation, and advocating chest compressions before initial countershock. METHODS AND RESULTS: This retrospective observational cohort study reviewed all adult primary ventricular fibrillation and pulseless ventricular tachycardia cardiac arrests 36 months before and 12 months after the protocol change. Primary outcome was survival to discharge; secondary outcomes were return of spontaneous circulation and cerebral performance category. Survival of out-of-hospital arrest of presumed primary cardiac origin improved from 7.5% (82 of 1097) in the historical cohort to 13.9% (47 of 339) in the revised protocol cohort (odds ratio, 1.80; 95% confidence interval, 1.19 to 2.70). Similar increases in return of spontaneous circulation were achieved for the subset of witnessed cardiac arrest patients with initial rhythm of ventricular fibrillation from 37.8% (54 of 143) to 59.6% (34 of 57) (odds ratio, 2.44; 95% confidence interval, 1.24 to 4.80). Survival to hospital discharge also improved from an unadjusted survival rate of 22.4% (32 of 143) to 43.9% (25 of 57) (odds ratio, 2.71; 95% confidence interval, 1.34 to 1.59) with the protocol. Of the 25 survivors, 88% (n=22) had favorable cerebral performance categories on discharge. CONCLUSIONS: The changes to our prehospital protocol for adult cardiac arrest that optimized chest compressions and reduced disruptions increased the return of spontaneous circulation and survival to discharge in our patient population. These changes should be further evaluated for improving survival of out-of-hospital cardiac arrest patients. |
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Authors:
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Alex G Garza; Matthew C Gratton; Joseph A Salomone; Daniel Lindholm; James McElroy; Rex Archer |
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Publication Detail:
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Type: Comparative Study; Journal Article Date: 2009-05-04 |
Journal Detail:
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Title: Circulation Volume: 119 ISSN: 1524-4539 ISO Abbreviation: Circulation Publication Date: 2009 May |
Date Detail:
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Created Date: 2009-05-19 Completed Date: 2009-06-05 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 0147763 Medline TA: Circulation Country: United States |
Other Details:
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Languages: eng Pagination: 2597-605 Citation Subset: AIM; IM |
Affiliation:
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Washington Hospital Center, Georgetown University School of Medicine, Department of Emergency Medicine, Washington, DC, USA. alexgarza@cox.net |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adult Aged American Heart Association Brain Damage, Chronic / etiology, prevention & control Cardiopulmonary Resuscitation / methods, standards* Clinical Protocols Electric Countershock / contraindications, methods*, standards Emergency Medical Services / methods, standards* Female Heart Arrest / complications, mortality*, therapy Heart Massage* Humans Insufflation Intubation, Intratracheal / methods, standards Kansas / epidemiology Male Middle Aged Oxygen Inhalation Therapy / contraindications, methods, standards Practice Guidelines as Topic Retrospective Studies Survival Analysis Time Factors Treatment Outcome United States Ventricular Fibrillation / complications, epidemiology |
| Comments/Corrections | |
Comment In:
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Circulation. 2009 May 19;119(19):2542-4
[PMID:
19451362
]
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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