Title | Minimally interrupted cardiac resuscitation by emergency medical services for out-of-hospital cardiac arrest. |
Publication Type | Journal Article |
Year of Publication | 2008 |
Authors | Bobrow BJ, Clark LL, Ewy GA, Chikani V, Sanders AB, Berg RA, Richman PB, Kern KB |
Journal | JAMA |
Volume | 299 |
Issue | 10 |
Pagination | 1158-65 |
Date Published | 2008 Mar 12 |
ISSN Number | 1538-3598 |
Keywords | Aged, Aged, 80 and over, Cardiopulmonary Resuscitation, Clinical Protocols, Emergency Medical Services, Emergency Medical Technicians, Female, Heart Arrest, Humans, Male, Middle Aged, Prospective Studies, Survival Analysis, Treatment Outcome |
Abstract | CONTEXT: Out-of-hospital cardiac arrest is a major public health problem. OBJECTIVE: To investigate whether the survival of patients with out-of-hospital cardiac arrest would improve with minimally interrupted cardiac resuscitation (MICR), an alternate emergency medical services (EMS) protocol. DESIGN, SETTING, AND PATIENTS: A prospective study of survival-to-hospital discharge between January 1, 2005, and November 22, 2007. Patients with out-of-hospital cardiac arrests in 2 metropolitan cities in Arizona before and after MICR training of fire department emergency medical personnel were assessed. In a second analysis of protocol compliance, patients from the 2 metropolitan cities and 60 additional fire departments in Arizona who actually received MICR were compared with patients who did not receive MICR but received standard advanced life support. INTERVENTION: Instruction for EMS personnel in MICR, an approach that includes an initial series of 200 uninterrupted chest compressions, rhythm analysis with a single shock, 200 immediate postshock chest compressions before pulse check or rhythm reanalysis, early administration of epinephrine, and delayed endotracheal intubation. MAIN OUTCOME MEASURE: Survival-to-hospital discharge. RESULTS: Among the 886 patients in the 2 metropolitan cities, survival-to-hospital discharge increased from 1.8% (4/218) before MICR training to 5.4% (36/668) after MICR training (odds ratio [OR], 3.0; 95% confidence interval [CI], 1.1-8.9). In the subgroup of 174 patients with witnessed cardiac arrest and ventricular fibrillation, survival increased from 4.7% (2/43) before MICR training to 17.6% (23/131) after MICR training (OR, 8.6; 95% CI, 1.8-42.0). In the analysis of MICR protocol compliance involving 2460 patients with cardiac arrest, survival was significantly better among patients who received MICR than those who did not (9.1% [60/661] vs 3.8% [69/1799]; OR, 2.7; 95% CI, 1.9-4.1), as well as patients with witnessed ventricular fibrillation (28.4% [40/141] vs 11.9% [46/387]; OR, 3.4; 95% CI, 2.0-5.8). CONCLUSIONS: Survival-to-hospital discharge of patients with out-of-hospital cardiac arrest increased after implementation of MICR as an alternate EMS protocol. These results need to be confirmed in a randomized trial. |
DOI | 10.1001/jama.299.10.1158 |
Alternate Journal | JAMA |
PubMed ID | 18334691 |