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

Matthew Huei Ming Ma, Wen Chu Chiang, Patrick Chow In Ko, Chi Wei Yang, Hui Chi Wang, Shey Ying Chen, Wei Tien Chang, Chien Hwa Huang, Hao Chang Chou, Mei Shu Lai, Kuo Long Chien, Bin Chou Lee, Chien Hwa Hwang, Yao Cheng Wang, Guan Hwa Hsiung, Ying Wen Hsiao, Anna Marie Chang, Wen Jone Chen, Shyr Chyr Chen

Research output: Contribution to journalArticle

20 Citations (Scopus)

Abstract

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 " compression first" (CF) versus " analyze first" (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.

Original languageEnglish (US)
Pages (from-to)806-812
Number of pages7
JournalResuscitation
Volume83
Issue number7
DOIs
StatePublished - Jul 2012
Externally publishedYes

Fingerprint

Out-of-Hospital Cardiac Arrest
Cardiopulmonary Resuscitation
Allied Health Personnel
Defibrillators
Outcome Assessment (Health Care)
Survival
Population

Keywords

  • Automatic external defibrillator
  • Cardiac arrest
  • Cardiopulmonary resuscitation
  • Emergency medical services systems
  • Shockable rhythm
  • Ventricular fibrillation

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Emergency
  • Emergency Medicine

Cite this

A randomized trial of compression first or analyze first strategies in patients with out-of-hospital cardiac arrest : Results from an Asian community. / Ma, Matthew Huei Ming; Chiang, Wen Chu; Ko, Patrick Chow In; Yang, Chi Wei; Wang, Hui Chi; Chen, Shey Ying; Chang, Wei Tien; Huang, Chien Hwa; Chou, Hao Chang; Lai, Mei Shu; Chien, Kuo Long; Lee, Bin Chou; Hwang, Chien Hwa; Wang, Yao Cheng; Hsiung, Guan Hwa; Hsiao, Ying Wen; Chang, Anna Marie; Chen, Wen Jone; Chen, Shyr Chyr.

In: Resuscitation, Vol. 83, No. 7, 07.2012, p. 806-812.

Research output: Contribution to journalArticle

Ma, MHM, Chiang, WC, Ko, PCI, Yang, CW, Wang, HC, Chen, SY, Chang, WT, Huang, CH, Chou, HC, Lai, MS, Chien, KL, Lee, BC, Hwang, CH, Wang, YC, Hsiung, GH, Hsiao, YW, Chang, AM, Chen, WJ & Chen, SC 2012, 'A randomized trial of compression first or analyze first strategies in patients with out-of-hospital cardiac arrest: Results from an Asian community', Resuscitation, vol. 83, no. 7, pp. 806-812. https://doi.org/10.1016/j.resuscitation.2012.01.009
Ma, Matthew Huei Ming ; Chiang, Wen Chu ; Ko, Patrick Chow In ; Yang, Chi Wei ; Wang, Hui Chi ; Chen, Shey Ying ; Chang, Wei Tien ; Huang, Chien Hwa ; Chou, Hao Chang ; Lai, Mei Shu ; Chien, Kuo Long ; Lee, Bin Chou ; Hwang, Chien Hwa ; Wang, Yao Cheng ; Hsiung, Guan Hwa ; Hsiao, Ying Wen ; Chang, Anna Marie ; Chen, Wen Jone ; Chen, Shyr Chyr. / A randomized trial of compression first or analyze first strategies in patients with out-of-hospital cardiac arrest : Results from an Asian community. In: Resuscitation. 2012 ; Vol. 83, No. 7. pp. 806-812.
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abstract = "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 {"} compression first{"} (CF) versus {"} analyze first{"} (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.",
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T1 - A randomized trial of compression first or analyze first strategies in patients with out-of-hospital cardiac arrest

T2 - Results from an Asian community

AU - Ma, Matthew Huei Ming

AU - Chiang, Wen Chu

AU - Ko, Patrick Chow In

AU - Yang, Chi Wei

AU - Wang, Hui Chi

AU - Chen, Shey Ying

AU - Chang, Wei Tien

AU - Huang, Chien Hwa

AU - Chou, Hao Chang

AU - Lai, Mei Shu

AU - Chien, Kuo Long

AU - Lee, Bin Chou

AU - Hwang, Chien Hwa

AU - Wang, Yao Cheng

AU - Hsiung, Guan Hwa

AU - Hsiao, Ying Wen

AU - Chang, Anna Marie

AU - Chen, Wen Jone

AU - Chen, Shyr Chyr

PY - 2012/7

Y1 - 2012/7

N2 - 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 " compression first" (CF) versus " analyze first" (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.

AB - 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 " compression first" (CF) versus " analyze first" (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.

KW - Automatic external defibrillator

KW - Cardiac arrest

KW - Cardiopulmonary resuscitation

KW - Emergency medical services systems

KW - Shockable rhythm

KW - Ventricular fibrillation

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