A randomized trial of compression first or analyze first strategies in patients with out-of-hospital cardiac arrest: Results from an Asian community

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• 作者：Matthew Huei-Ming Ma^a ; ^{matthew@ntu.edu.tw} ; ^{mattma.tw@gmail.com} ; Wen-Chu Chiang^a ; ^b ; Patrick Chow-In Ko^a ; ^b ; Chi-Wei Yang^a ; ^b ; ^c ; Hui-Chi Wang^a ; Shey-Ying Chen^a ; ^b ; Wei-Tien Chang^a ; Chien-Hwa Huang^a ; Hao-Chang Chou^a ; Mei-Shu Lai^b ; Kuo-Long Chien^b ; Bin-Chou Lee^d ; Chien-Hwa Hwang^e ; Yao-Cheng Wang^e ; Guan-Hwa Hsiung^e ; Ying-Wen Hsiao^e ; Anna Marie Chang^f ; Wen-Jone Chen^a ; Shyr-Chyr Chen^a
• 关键词：Cardiac arrest ; Cardiopulmonary resuscitation ; Automatic external defibrillator ; Ventricular fibrillation ; Shockable rhythm ; Emergency medical services systems
• 刊名：Resuscitation
• 出版年：2012
• 期刊代码：236_03009572
• 类别：med
• 出版时间：July, 2012
• 卷：83
• 期：7
• 页码：806-812
• 文件大小：483 K

摘要

Background

It is still under debate whether a period of cardiopulmonary resuscitation should be performed prior to rhythm analysis for defibrillation for out of hospital cardiac arrests (OHCA). This study compared outcomes of OHCA treated by 鈥渃ompression first鈥?(CF) versus 鈥渁nalyze first鈥?(AF) strategies in an Asian community with low rates of shockable rhythms.

Methods

This randomized trial was conducted in Taipei City between February 2008 and December 2009. Dispatches of suspected OHCA that activated advanced life support teams were randomized into the CF and AF strategies. Patients assigned to CF strategy received 10 cycles of CPR prior to analysis by automatic external defibrillator. The primary outcome was sustained (>2 h) return of spontaneous circulation (ROSC) and secondary outcome was survival to hospital discharge.

Results

We included 289 cases in the final analysis after exclusion by pre-specified criteria, 141 were allocated to CF strategy and 148 to AF strategy. Baseline characteristics were similar. Thirty-seven (26.2%) of those receiving CF strategy and 49 (33.1%) of the AF strategy achieved sustained ROSC (p = 0.25). In a post-hoc analysis of patients who achieved ROSC, those that received CF strategy were more likely to be discharged alive from the hospital (16/37 = 43.2%vs. 11/49 = 22.4%, p = 0.02).

Conclusion

In this study population of low rates of shockable rhythms, there was no difference in ROSC for CF or AF strategies. Considering the EMS operation situations, a period of paramedic-administered CPR for up to 10 cycles prior to rhythm analysis could be a feasible strategy in this community.