Prospective Clinical Trial, DEFI 2005: Does an AED Algorithm with More CPR Impact Out‐of‐Hospital Cardiac Arrest Prognosis? (original) (raw)
2008, Academic Emergency Medicine
Background: Level 1 evidence is lacking for the Guidelines 2005 recommended changes in CPR and automated external defibrillator (AED) protocols.Objectives: We conducted a block‐randomized controlled trial to evaluate if changes to CPR during AED use could improve return of spontaneous circulation (ROSC) and hospital admission rates.Methods: From September 2005 to March 2007, 200 biphasic LIFEPAKs, 500 AEDs, used by firefighters, were randomized every 2 months by fire station (clinicaltrials.gov NCT00139542). The 100 CONTROL AEDs conformed to Guidelines 2000. The 100 STUDY AEDs added pre‐shock CPR and removed stacked shocks and post‐shock pulse checks. In both groups, firefighters received weekly CPR training. ECG and impedance signals recorded by AEDs were reviewed to quantify CPR delivery. Median [interquartile range], *p < 0.05.Results: Informed consent was obtained for 840 defibrillated patients (420 CONTROL vs. 420 STUDY). There were no differences in patient characterist...
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Resuscitation, 2010
Immediate defibrillation is the traditional approach to resuscitation of cardiac arrest due to ventricular fibrillation or tachycardia (VF/VT). Delaying defibrillation to provide chest compressions may improve survival. We examined the effect of the duration of Emergency Medical Services (EMS) cardiopulmonary resuscitation (CPR) prior to first defibrillation on survival in patients with out-of-hospital VF/VT.From a prospective multi-center observational registry of EMS-treated out-of-hospital cardiac arrest, we identified 1638 EMS-treated cardiac arrests with first recorded rhythm VF/VT or “shockable” and complete data for analysis. Survival to hospital discharge was determined as a function of EMS CPR duration prior to first shock.Compared to the reference group of first EMS CPR duration ≤45 s, the odds of survival was greater among patients who received between 46 and 195 s of EMS CPR before first shock (46–75 s odds ratio [OR] 1.15, 95% confidence interval [CI] 0.71–1.87; 76–105 s, OR 1.37, 95% CI 0.80–2.35; 106–135 s, OR 1.53, 95% CI 0.96–2.45; 136–165 s, OR 1.24, 95% CI 0.71–2.15; 166–195 s, OR 1.47, 95% CI 0.85–2.52). The benefit of EMS CPR before defibrillation was reduced when the duration of CPR exceeded 195 s (196–225 s, OR 0.95, 95% CI 0.47–1.81; 226–255 s, OR 0.91, 95% CI 0.46–1.79; 256–285 s, OR 0.46, 95% CI 0.17–1.29; 286–315 s, OR 1.29, 95% CI 0.59–2.85). An optimal EMS CPR duration was not identified and no duration achieved statistical significance.In this observational analysis of VF/VT arrest, between 46 and 195 s of EMS CPR prior to defibrillation was weakly associated with improved survival compared to ≤45 s. Randomized trials are needed to confirm the optimal duration of EMS CPR prior to defibrillation and to assess the impact of first CPR duration on all initial rhythms.
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