What is the role of chest compression depth during out-of-hospital cardiac arrest resuscitation?

Ian G Stiell, Siobhan P Brown, James Christenson, Sheldon Cheskes, Graham Nichol, Judy Powell, Blair Bigham, Laurie J Morrison, Jonathan Larsen, Erik Hess, Christian Vaillancourt, Daniel P Davis, Clifton W Callaway, Resuscitation Outcomes Consortium (ROC) Investigators, Ian G Stiell, Siobhan P Brown, James Christenson, Sheldon Cheskes, Graham Nichol, Judy Powell, Blair Bigham, Laurie J Morrison, Jonathan Larsen, Erik Hess, Christian Vaillancourt, Daniel P Davis, Clifton W Callaway, Resuscitation Outcomes Consortium (ROC) Investigators

Abstract

Background: The 2010 international guidelines for cardiopulmonary resuscitation recently recommended an increase in the minimum compression depth from 38 to 50 mm, although there are limited human data to support this. We sought to study patterns of cardiopulmonary resuscitation compression depth and their associations with patient outcomes in out-of-hospital cardiac arrest cases treated by the 2005 guideline standards.

Design: Prospective cohort.

Setting: Seven U.S. and Canadian urban regions.

Patients: We studied emergency medical services treated out-of-hospital cardiac arrest patients from the Resuscitation Outcomes Consortium Epistry-Cardiac Arrest for whom electronic cardiopulmonary resuscitation compression depth data were available, from May 2006 to June 2009.

Measurements: We calculated anterior chest wall depression in millimeters and the period of active cardiopulmonary resuscitation (chest compression fraction) for each minute of cardiopulmonary resuscitation. We controlled for covariates including compression rate and calculated adjusted odds ratios for any return of spontaneous circulation, 1-day survival, and hospital discharge.

Main results: We included 1029 adult patients from seven U.S. and Canadian cities with the following characteristics: Mean age 68 yrs; male 62%; bystander witnessed 40%; bystander cardiopulmonary resuscitation 37%; initial rhythms: Ventricular fibrillation/ventricular tachycardia 24%, pulseless electrical activity 16%, asystole 48%, other nonshockable 12%; outcomes: Return of spontaneous circulation 26%, 1-day survival 18%, discharge 5%. For all patients, median compression rate was 106 per minute, median compression fraction 0.65, and median compression depth 37.3 mm with 52.8% of cases having depth <38 mm and 91.6% having depth <50 mm. We found an inverse association between depth and compression rate ( p < .001). Adjusted odds ratios for all depth measures (mean values, categories, and range) showed strong trends toward better outcomes with increased depth for all three survival measures.

Conclusions: We found suboptimal compression depth in half of patients by 2005 guideline standards and almost all by 2010 standards as well as an inverse association between compression depth and rate. We found a strong association between survival outcomes and increased compression depth but no clear evidence to support or refute the 2010 recommendations of >50 mm. Although compression depth is an important component of cardiopulmonary resuscitation and should be measured routinely, the most effective depth is currently unknown.

Figures

Figure 1. Patient flow
Figure 1. Patient flow
Figure 2. Plots of Outcomes versus Average…
Figure 2. Plots of Outcomes versus Average Compression Depth

References

    1. Nichol G, Thomas E, Callaway CW, Hedges J, Powell JL, Aufderheide TP, et al. Regional variation in out-of-hospital cardiac arrest incidence and outcome. JAMA. 2008;300(12):1423–1431.
    1. Cummins RO, Ornato JP, Thies WH, Pepe PE. Improving survival from sudden cardiac arrest: the “chain of survival” concept. Circulation. 1991;83:1832–1847.
    1. 2005 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2005;112(24 Suppl):IV1–203.
    1. Stiell IG, Wells GA, Field BJ, Spaite DW, Nesbitt L, De Maio VJ, et al. Advanced Cardiac Life Support in Out-of-Hospital Cardiac Arrest. N Engl J Med. 2004;351:647–656.
    1. Rea TD, Cook AJ, Stiell IG, Powell J, Bigham B, Callaway CW, et al. Predicting survival after out-of-hospital cardiac arrest: role of the Utstein data elements. Ann Emerg Med. 2010;55(3):249–257.
    1. Peberdy MA, Ornato JP. Post-resuscitation care: is it the missing link in the Chain of Survival? Resuscitation. 2005;64(2):135–137.
    1. Wik L, Kramer-Johansen J, Myklebust H, Sorebo H, Svensson L, Fellows B, et al. Quality of cardiopulmonary resuscitation during out-of-hospital cardiac arrest. JAMA. 2005;293(3):299–304.
    1. Abella BS, Sandbo N, Vassilatos P, Alvarado JP, O’Hearn N, Wigder HN, et al. Chest compression rates during cardiopulmonary resuscitation are suboptimal: a prospective study during in-hospital cardiac arrest. Circulation. 2005;111(4):428–434.
    1. Kramer-Johansen J, Edelson DP, Losert H, Kohler K, Abella BS. Uniform reporting of measured quality of cardiopulmonary resuscitation (CPR) Resuscitation. 2007;74(3):406–417.
    1. Aase SO, Myklebust H. Compression depth estimation for CPR quality assessment using DSP on accelerometer signals. IEEE Trans Biomed Eng. 2002;49(3):263–268.
    1. Christenson J, Andrusiek D, Everson-Stewart S, Kudenchuk P, Hostler D, Powell J, et al. Chest Compression Fraction Determines Survival in Patients With Out-of-Hospital Ventricular Fibrillation. Circulation. 2009;120:1241–1247.
    1. Sayre MR, Koster RW, Botha M, Cave DM, Cudnik MT, Handley AJ, et al. Part 5: adult basic life support: 2010 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. Circulation. 2010;122(16 Suppl 2):S298–S324.
    1. Abella BS, Alvarado JP, Myklebust H, Edelson DP, Barry A, O’Hearn N, et al. Quality of cardiopulmonary resuscitation during in-hospital cardiac arrest. JAMA. 2005;293(3):305–310.
    1. Edelson DP, Abella BS, Kramer-Johansen J, Wik L, Myklebust H, Barry AM, et al. Effects of compression depth and pre-shock pauses predict defibrillation failure during cardiac arrest. Resuscitation. 2006;71(2):137–145.
    1. Kramer-Johansen J, Myklebust H, Wik L, Fellows B, Svensson L, Sorebo H, et al. Quality of out-of-hospital cardiopulmonary resuscitation with real time automated feedback: A prospective interventional study. Resuscitation. 2006;71(3):283–292.
    1. Ornato JP, Peberdy MA. Measuring Progress in Resuscitation: It’s Time for a Better Tool. Circulation. 2006;114(25):2754–2756.
    1. Morrison LJ, Nichol G, Rea TD, Christenson J, Callaway CW, Stephens S, et al. Rationale, development and implementation of the Resuscitation Outcomes Consortium Epistry - Cardiac Arrest. Resuscitation. 2008;78:161–169.
    1. Davis DP, Garberson LA, Andrusiek DL, Hostler D, Daya M, Pirrallo R, et al. A descriptive analysis of Emergency Medical Service Systems participating in the Resuscitation Outcomes Consortium (ROC) network. Prehosp Emerg Care. 2007;11(4):369–382.
    1. ZOLL Medical Corporation . E series operators guide. ZOLL Medical Corporation; Chelmsford, MA, USA: 2010.
    1. Li Y, Ristagno G, Bisera J, Tang W, Deng Q, Weil MH. Electrocardiogram waveforms for monitoring effectiveness of chest compression during cardiopulmonary resuscitation. Crit Care Med. 2008;36(1):211–215.
    1. Ristagno G, Tang W, Chang YT, Jorgenson DB, Russell JK, Huang L, et al. The quality of chest compressions during cardiopulmonary resuscitation overrides importance of timing of defibrillation. Chest. 2007;132(1):70–75.
    1. Wu JY, Li CS, Liu ZX, Wu CJ, Zhang GC. A comparison of 2 types of chest compressions in a porcine model of cardiac arrest. Am J Emerg Med. 2009;27(7):823–829.
    1. Babbs CF, Kemeny AE, Quan W, Freeman G. A new paradigm for human resuscitation research using intelligent devices. Resuscitation. 2008;77(3):306–315.
    1. Hostler D, Everson-Stewart S, Rea TD, Stiell IG, Callaway CW, Kudenchuk PJ, et al. Effect of real-time feedback during cardiopulmonary resuscitation outside hospital: prospective, cluster-randomised trial. BMJ. 2011;342:d512.

Source: PubMed

Patrocinadores y Colaboradores

Condiciones médicas

Intervenciones de drogas

3
Suscribir