Chest compression rates and survival following out-of-hospital cardiac arrest

Ahamed H. Idris; Danielle Guffey; Paul E. Pepe; Siobhan P. Brown; Steven C. Brooks; Clifton W. Callaway; Jim Christenson; Daniel P. Davis; Mohamud R. Daya; Randal Gray; Peter J. Kudenchuk; Jonathan Larsen; Steve Lin; James J. Menegazzi; Kellie Sheehan; George Sopko; Ian Stiell; Graham Nichol; Tom P. Aufderheide

doi:10.1097/CCM.0000000000000824

Chest compression rates and survival following out-of-hospital cardiac arrest

Ahamed H. Idris, Danielle Guffey, Paul E. Pepe, Siobhan P. Brown, Steven C. Brooks, Clifton W. Callaway, Jim Christenson, Daniel P. Davis, Mohamud R. Daya, Randal Gray, Peter J. Kudenchuk, Jonathan Larsen, Steve Lin, James J. Menegazzi, Kellie Sheehan, George Sopko, Ian Stiell, Graham Nichol, Tom P. Aufderheide

Emergency Medicine

Research output: Contribution to journal › Article › peer-review

254 Scopus citations

Abstract

Objective: Guidelines for cardiopulmonary resuscitation recommend a chest compression rate of at least 100 compressions/min. A recent clinical study reported optimal return of spontaneous circulation with rates between 100 and 120/min during cardiopulmonary resuscitation for out-of-hospital cardiac arrest. However, the relationship between compression rate and survival is still undetermined. Design: Prospective, observational study. Setting: Data is from the Resuscitation Outcomes Consortium Prehospital Resuscitation IMpedance threshold device and Early versus Delayed analysis clinical trial. Participants: Adults with out-of-hospital cardiac arrest treated by emergency medical service providers. Interventions: None. Measurements Main Results: Data were abstracted from monitor-defibrillator recordings for the first five minutes of emergency medical service cardiopulmonary resuscitation. Multiple logistic regression assessed odds ratio for survival by compression rate categories (<80, 80-99, 100-119, 120-139, ≥140), both unadjusted and adjusted for sex, age, witnessed status, attempted bystander cardiopulmonary resuscitation, location of arrest, chest compression fraction and depth, first rhythm, and study site. Compression rate data were available for 10,371 patients; 6,399 also had chest compression fraction and depth data. Age (mean ± sd) was 67 ± 16 years. Chest compression rate was 111 ± 19 per minute, compression fraction was 0.70 ± 0.17, and compression depth was 42 ± 12 mm. Circulation was restored in 34%; 9% survived to hospital discharge. After adjustment for covariates without chest compression depth and fraction (n = 10,371), a global test found no significant relationship between compression rate and survival (p = 0.19). However, after adjustment for covariates including chest compression depth and fraction (n = 6,399), the global test found a significant relationship between compression rate and survival (p = 0.02), with the reference group (100-119 compressions/min) having the greatest likelihood for survival. Conclusions: After adjustment for chest compression fraction and depth, compression rates between 100 and 120 per minute were associated with greatest survival to hospital discharge.

Original language	English (US)
Pages (from-to)	840-848
Number of pages	9
Journal	Critical care medicine
Volume	43
Issue number	4
DOIs	https://doi.org/10.1097/CCM.0000000000000824
State	Published - Apr 20 2015

Keywords

Cardiac arrest
Cardiopulmonary resuscitation
Compression rate
Guidelines
Heart arrest
Outcomes

ASJC Scopus subject areas

Critical Care and Intensive Care Medicine

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10.1097/CCM.0000000000000824

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Idris, A. H., Guffey, D., Pepe, P. E., Brown, S. P., Brooks, S. C., Callaway, C. W., Christenson, J., Davis, D. P., Daya, M. R., Gray, R., Kudenchuk, P. J., Larsen, J., Lin, S., Menegazzi, J. J., Sheehan, K., Sopko, G., Stiell, I., Nichol, G., & Aufderheide, T. P. (2015). Chest compression rates and survival following out-of-hospital cardiac arrest. Critical care medicine, 43(4), 840-848. https://doi.org/10.1097/CCM.0000000000000824

Idris, AH, Guffey, D, Pepe, PE, Brown, SP, Brooks, SC, Callaway, CW, Christenson, J, Davis, DP, Daya, MR, Gray, R, Kudenchuk, PJ, Larsen, J, Lin, S, Menegazzi, JJ, Sheehan, K, Sopko, G, Stiell, I, Nichol, G & Aufderheide, TP 2015, 'Chest compression rates and survival following out-of-hospital cardiac arrest', Critical care medicine, vol. 43, no. 4, pp. 840-848. https://doi.org/10.1097/CCM.0000000000000824

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abstract = "Objective: Guidelines for cardiopulmonary resuscitation recommend a chest compression rate of at least 100 compressions/min. A recent clinical study reported optimal return of spontaneous circulation with rates between 100 and 120/min during cardiopulmonary resuscitation for out-of-hospital cardiac arrest. However, the relationship between compression rate and survival is still undetermined. Design: Prospective, observational study. Setting: Data is from the Resuscitation Outcomes Consortium Prehospital Resuscitation IMpedance threshold device and Early versus Delayed analysis clinical trial. Participants: Adults with out-of-hospital cardiac arrest treated by emergency medical service providers. Interventions: None. Measurements Main Results: Data were abstracted from monitor-defibrillator recordings for the first five minutes of emergency medical service cardiopulmonary resuscitation. Multiple logistic regression assessed odds ratio for survival by compression rate categories (<80, 80-99, 100-119, 120-139, ≥140), both unadjusted and adjusted for sex, age, witnessed status, attempted bystander cardiopulmonary resuscitation, location of arrest, chest compression fraction and depth, first rhythm, and study site. Compression rate data were available for 10,371 patients; 6,399 also had chest compression fraction and depth data. Age (mean ± sd) was 67 ± 16 years. Chest compression rate was 111 ± 19 per minute, compression fraction was 0.70 ± 0.17, and compression depth was 42 ± 12 mm. Circulation was restored in 34%; 9% survived to hospital discharge. After adjustment for covariates without chest compression depth and fraction (n = 10,371), a global test found no significant relationship between compression rate and survival (p = 0.19). However, after adjustment for covariates including chest compression depth and fraction (n = 6,399), the global test found a significant relationship between compression rate and survival (p = 0.02), with the reference group (100-119 compressions/min) having the greatest likelihood for survival. Conclusions: After adjustment for chest compression fraction and depth, compression rates between 100 and 120 per minute were associated with greatest survival to hospital discharge.",

keywords = "Cardiac arrest, Cardiopulmonary resuscitation, Compression rate, Guidelines, Heart arrest, Outcomes",

author = "Idris, {Ahamed H.} and Danielle Guffey and Pepe, {Paul E.} and Brown, {Siobhan P.} and Brooks, {Steven C.} and Callaway, {Clifton W.} and Jim Christenson and Davis, {Daniel P.} and Daya, {Mohamud R.} and Randal Gray and Kudenchuk, {Peter J.} and Jonathan Larsen and Steve Lin and Menegazzi, {James J.} and Kellie Sheehan and George Sopko and Ian Stiell and Graham Nichol and Aufderheide, {Tom P.}",

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AU - Idris, Ahamed H.

AU - Guffey, Danielle

AU - Pepe, Paul E.

AU - Brown, Siobhan P.

AU - Brooks, Steven C.

AU - Callaway, Clifton W.

AU - Christenson, Jim

AU - Davis, Daniel P.

AU - Daya, Mohamud R.

AU - Gray, Randal

AU - Kudenchuk, Peter J.

AU - Larsen, Jonathan

AU - Lin, Steve

AU - Menegazzi, James J.

AU - Sheehan, Kellie

AU - Sopko, George

AU - Stiell, Ian

AU - Nichol, Graham

AU - Aufderheide, Tom P.

PY - 2015/4/20

Y1 - 2015/4/20

N2 - Objective: Guidelines for cardiopulmonary resuscitation recommend a chest compression rate of at least 100 compressions/min. A recent clinical study reported optimal return of spontaneous circulation with rates between 100 and 120/min during cardiopulmonary resuscitation for out-of-hospital cardiac arrest. However, the relationship between compression rate and survival is still undetermined. Design: Prospective, observational study. Setting: Data is from the Resuscitation Outcomes Consortium Prehospital Resuscitation IMpedance threshold device and Early versus Delayed analysis clinical trial. Participants: Adults with out-of-hospital cardiac arrest treated by emergency medical service providers. Interventions: None. Measurements Main Results: Data were abstracted from monitor-defibrillator recordings for the first five minutes of emergency medical service cardiopulmonary resuscitation. Multiple logistic regression assessed odds ratio for survival by compression rate categories (<80, 80-99, 100-119, 120-139, ≥140), both unadjusted and adjusted for sex, age, witnessed status, attempted bystander cardiopulmonary resuscitation, location of arrest, chest compression fraction and depth, first rhythm, and study site. Compression rate data were available for 10,371 patients; 6,399 also had chest compression fraction and depth data. Age (mean ± sd) was 67 ± 16 years. Chest compression rate was 111 ± 19 per minute, compression fraction was 0.70 ± 0.17, and compression depth was 42 ± 12 mm. Circulation was restored in 34%; 9% survived to hospital discharge. After adjustment for covariates without chest compression depth and fraction (n = 10,371), a global test found no significant relationship between compression rate and survival (p = 0.19). However, after adjustment for covariates including chest compression depth and fraction (n = 6,399), the global test found a significant relationship between compression rate and survival (p = 0.02), with the reference group (100-119 compressions/min) having the greatest likelihood for survival. Conclusions: After adjustment for chest compression fraction and depth, compression rates between 100 and 120 per minute were associated with greatest survival to hospital discharge.

AB - Objective: Guidelines for cardiopulmonary resuscitation recommend a chest compression rate of at least 100 compressions/min. A recent clinical study reported optimal return of spontaneous circulation with rates between 100 and 120/min during cardiopulmonary resuscitation for out-of-hospital cardiac arrest. However, the relationship between compression rate and survival is still undetermined. Design: Prospective, observational study. Setting: Data is from the Resuscitation Outcomes Consortium Prehospital Resuscitation IMpedance threshold device and Early versus Delayed analysis clinical trial. Participants: Adults with out-of-hospital cardiac arrest treated by emergency medical service providers. Interventions: None. Measurements Main Results: Data were abstracted from monitor-defibrillator recordings for the first five minutes of emergency medical service cardiopulmonary resuscitation. Multiple logistic regression assessed odds ratio for survival by compression rate categories (<80, 80-99, 100-119, 120-139, ≥140), both unadjusted and adjusted for sex, age, witnessed status, attempted bystander cardiopulmonary resuscitation, location of arrest, chest compression fraction and depth, first rhythm, and study site. Compression rate data were available for 10,371 patients; 6,399 also had chest compression fraction and depth data. Age (mean ± sd) was 67 ± 16 years. Chest compression rate was 111 ± 19 per minute, compression fraction was 0.70 ± 0.17, and compression depth was 42 ± 12 mm. Circulation was restored in 34%; 9% survived to hospital discharge. After adjustment for covariates without chest compression depth and fraction (n = 10,371), a global test found no significant relationship between compression rate and survival (p = 0.19). However, after adjustment for covariates including chest compression depth and fraction (n = 6,399), the global test found a significant relationship between compression rate and survival (p = 0.02), with the reference group (100-119 compressions/min) having the greatest likelihood for survival. Conclusions: After adjustment for chest compression fraction and depth, compression rates between 100 and 120 per minute were associated with greatest survival to hospital discharge.

KW - Cardiac arrest

KW - Cardiopulmonary resuscitation

KW - Compression rate

KW - Guidelines

KW - Heart arrest

KW - Outcomes

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Chest compression rates and survival following out-of-hospital cardiac arrest

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