Improved patient survival using a modified resuscitation protocol for out-of-hospital cardiac arrest

Autor: Rex Archer, Dan Lindholm, James McElroy, Joseph A. Salomone, Matthew C Gratton, Alex G. Garza
Rok vydání: 2009
Předmět:
Adult
Male
Resuscitation
medicine.medical_specialty
Emergency Medical Services
Time Factors
medicine.medical_treatment
Electric Countershock
Heart Massage
Return of spontaneous circulation
Clinical Protocols
Physiology (medical)
medicine
Emergency medical services
Intubation
Intratracheal
Humans
Cardiopulmonary resuscitation
Intensive care medicine
Aged
Retrospective Studies
business.industry
Contraindications
Oxygen Inhalation Therapy
Retrospective cohort study
Insufflation
American Heart Association
Kansas
Middle Aged
medicine.disease
Primary ventricular fibrillation
Survival Analysis
Cardiopulmonary Resuscitation
United States
Heart Arrest
Treatment Outcome
Cohort
Emergency medicine
Practice Guidelines as Topic
Ventricular Fibrillation
Brain Damage
Chronic
Female
Cardiology and Cardiovascular Medicine
business
Cohort study
Zdroj: Circulation. 119(19)
ISSN: 1524-4539
Popis: 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.
Databáze: OpenAIRE
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