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  1. Large-Scale Study Examines Continuous vs. Interrupted CPR - Journal of Emergency Medical Services

    Subscribe | Newsletters | Advertise | Contact Us             Journal Supplements Subscribe Jobs Featured Jobs Search Jobs Post A Job Products Buyer's Guide Product Reviews Hot Products Hot Products Submissions Product Announcements Product Videos Technical Digests Webcasts White Papers Videos Ask the Expert Education & Training EMS 10 Interviews EMS Today Fitness JEMS Games Product Spotlight Home About Us Advertise Contact Us Our Team Authors Community Submit A Press Release News Patient Care Airway & Respiratory Cardiac & Resuscitation Trauma Administration & Leadership Communications & Dispatch Documentation & Patient Care Reporting Training Operations Ambulance & Vehicle Ops Equipment & Gear Rescue & Vehicle Extrication Major Incidents Mass Casualty Incidents Terrorism & Active Shooter Mobile Integrated Healthcare   Home About Us Advertise Contact Us Our Team Authors Community Submit A Press Release News Patient Care Airway & Respiratory Cardiac & Resuscitation Trauma Administration & Leadership Communications & Dispatch Documentation & Patient Care Reporting Training Operations Ambulance & Vehicle Ops Equipment & Gear Rescue & Vehicle Extrication Major Incidents Mass Casualty Incidents Terrorism & Active Shooter Mobile Integrated Healthcare Home Large-Scale Study Examines Continuous vs. Interrupted CPR Large-Scale Study Examines Continuous vs. Interrupted CPR Mon, Jan 18, 2016 By Paul Misasi, MS, NRP , John Gallagher, MD , David Page, MS, NRP COMPRESSION QUESTION Nichol G, Leroux B, Wang H, et al. Trial of continuous or interrupted chest compressions during CPR.  N Engl J Med . 2015;373(23):2203–2214. This month we look at the most recent cardiac arrest paper from the Resuscitation Outcomes Consortium (ROC). This impressive group has been making great strides in collecting data across many U.S. agencies, and their dedication to prehospital scientific research is undoubtedly the largest, longest running, and best coordinated EMS research effort to date. Background:  In this study, ROC set up a cluster-randomized trial to scientifically evaluate the effectiveness of continuous chest compressions (i.e., hands-only CPR) vs. compressions interrupted for ventilations at a ratio of 30:2 on clinical outcomes of out-of-hospital cardiac arrest (OHCA) patients. Previous studies determining the effectiveness of CPR delivery methods have demonstrated higher OHCA survival rates with continuous compressions vs. interrupted compressions. Unfortunately, this research was only correlational, showing that improved survival and continuous compressions were associated, but not necessarily causal. BOTTOM LINE What we already know:  Interruption of chest compressions has been associated with decreased survival in animal models—not humans—and continuous compressions are associated with improved neurological outcomes except in cases of hypoxic arrest. [Native Advertisement] What this study adds:  Confirmation that high-quality compressions , short interruptions, teamwork, data gathering and analysis are all markers of high-performing EMS systems with improved OHCA outcomes . Hospital care, etiology, and other variables must be controlled if we’re to make progress on identifying specific interventions. Methods:  Between June 6, 2011, and May 28, 2015, patients in the 114 participating EMS agencies were randomly assigned to either an intervention group (continuous chest compressions at 100/min with 10 ventilations/minute = 12,653 patients) or to a control group (compressions interrupted for ventilations = 11,058 patients). Outcomes were assessed using a modified Rankin scale, from 0-6, with ≤ 3 reflecting favorable neurological function. Outcome measures included: 1) rate of survival to discharge; 2) neurologic function at discharge; 3) adverse events; and 4) hospital-free survival days (number of days alive and out of the hospital during the first 30 days following arrest). Results:  The study found no statistical difference between either group’s rate of survival to discharge (9.0% of the continuous compressions group, 9.7% of the 30:2 group). Seven percent of the continuous compressions group and 7.7% of the 30:2 group survived with a modified Rankin score of 3 or less, but these results didn’t achieve a statistically significant difference (p = .09). Also important was the compression-only group was significantly less likely to be transported or admitted to the hospital, and this group also had shorter hospital-free survival. Discussion:  The results of this paper have been long awaited as we continue to question current practice and search for treatments that really matter in OHCA outcomes. It’s important to note that a large study with many contributing sites has many variables that can mask important details. OHCA is the result of several vastly different clinical conditions (e.g., coronary occlusion, pulmonary embolus, trauma, etc.). It’s a big leap of faith to study these patient groups together, looking for outcome differences from a single element, in this case CPR style. Selection of patients is an important limiting factor in this study. Excluded patient groups included EMS-witnessed arrest, traumatic arrest, hypoxic arrest, hemorrhagic exsanguination, pregnancy, prisoners, pre-existing tracheostomy, mechanical chest compressions prior to manual CPR, and many more. In-hospital care for study patients (e.g., targeted temperature management, heart catheterization), including many treatments associated with OHCA outcomes, wasn’t controlled. Interestingly, the interruptions in compression delivery were surprisingly similar for both groups. And for both groups, the compression fraction (i.e., time on chest) was higher than you’d see in other systems, making widespread generalization of the findings more difficult. Overall, this study supports the concept that chest compressions are only part of the bundle of effective care for OHCA. As the authors appropriately suggest, other factors affecting success may include process elements such as passive ventilation, team coordination, improved care systems management, and CPR performance measurement/feedback devices, to name a few. Although this paper is an excellent example of progress in EMS research, and this type of work is critical as we tease apart the subtle differences in management of complex patients, it’s important that we pause and recognize the limited conclusions we can reach. Learn more from David Page at the EMS Today Conference & Expo, Feb. 25–27, in Baltimore, Md.  EMSToday.com By Paul Misasi, MS, NRP Paul Misasi, MS, NRP, has been a paramedic for 13 years and is the clinical division manager for Sedgwick County (Kan.) EMS. He’s also the principal developer of the the Medication Administration Cross-Check protocol.  John Gallagher, MD John Gallagher, MD, is the medical director of Sedgwick County (Kan.) EMS. He served as a ski patroller and EMT prior to attending medical school at Temple University and completing his residency at Geisinger Medical Center in Danville, Pa.  David Page, MS, NRP David Page, MS, NRP, is the director of the Prehospital Care Research Forum at the University of California, Los Angeles, a field paramedic with Allina Health EMS in Minneapolis/St. Paul, Minn., and a member of the JEMS Editorial Board. Sponsored Content is made possible by our sponsor; it does not necessarily reflect the views of our editorial staff. Journal Archives Prev 2016 2015 2014 2013 2012 2011 Next Jan 2016 Volume 41 Issue 1 No Image Available Volume 41 issue-2 Prev 2016 2015 2014 2013 2012 2011 Next SUBSCRIBE DIGITAL EDITION   Featured Careers More Jobs   eNews Register for the JEMS eNewsletter, it's FREE! Sign-Up! JEMS Connect FEATURED GROUPS Disaster EMS   EMERGENCY! Lovers   Tactical Medicine   Humor In EMS     CURRENT DISCUSSIONS   JOIN JEMS CONNECT   EMS BLOGS Blogger Browser Today's Featured Posts Copyright © 2016: PennWell Corporation, Tulsa, OK. All Rights Reserved. UTILITY Home About Us Contact Us Terms of Use Subscribe Advertise Reader Service Submit a Press Release RSS Feeds Privacy Policy Topics News Patient Care Leadership Special Topics Major Incidents Operations Sections Authors Columns Community Jobs Journal Products Supplements Webcasts

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