The association between AHA CPR quality guideline compliance and clinical outcomes from out-of-hospital cardiac arrest

for the ROC investigators

Research output: Contribution to journalArticle

14 Citations (Scopus)

Abstract

Background Measures of chest compression fraction (CCF), compression rate, compression depth and pre-shock pause have all been independently associated with improved outcomes from out-of-hospital (OHCA) cardiac arrest. However, it is unknown whether compliance with American Heart Association (AHA) guidelines incorporating all the aforementioned metrics, is associated with improved survival from OHCA. Methods We performed a secondary analysis of prospectively collected data from the Resuscitation Outcomes Consortium Epistry-Cardiac Arrest database. As per the 2015 American Heart Association (AHA) guidelines, guideline compliant cardiopulmonary resuscitation (CPR) was defined as CCF >0.8, chest compression rate 100–120/minute, chest compression depth 50–60 mm, and pre-shock pause <10 s. Multivariable logistic regression models controlling for Utstein variables were used to assess the relationship between global guideline compliance and survival to hospital discharge and neurologically intact survival with MRS ≤3. Due to potential confounding between CPR quality metrics and cases that achieved early ROSC, we performed an a priori subgroup analysis restricted to patients who obtained ROSC after ≥10 min of EMS resuscitation. Results After allowing for study exclusions, 19,568 defibrillator records were collected over a 4-year period ending in June 2015. For all reported models, the reference standard included all cases who did not meet all CPR quality benchmarks. For the primary model (CCF, rate, depth), there was no significant difference in survival for resuscitations that met all CPR quality benchmarks (guideline compliant) compared to the reference standard (OR 1.26; 95% CI: 0.80, 1.97). When the dataset was restricted to patients obtaining ROSC after ≥10 min of EMS resuscitation (n = 4,158), survival was significantly higher for those resuscitations that were guideline compliant (OR 2.17; 95% CI: 1.11, 4.27) compared to the reference standard. Similar findings were obtained for neurologically intact survival with MRS ≤3 (OR 3.03; 95% CI: 1.12, 8.20). Conclusions In this observational study, compliance with AHA guidelines for CPR quality was not associated with improved outcomes from OHCA. Conversely, when restricting the cohort to those with late ROSC, compliance with guidelines was associated with improved clinical outcomes. Strategies to improve overall guideline compliance may have a significant impact on outcomes from OHCA.

Original languageEnglish (US)
Pages (from-to)39-45
Number of pages7
JournalResuscitation
Volume116
DOIs
StatePublished - Jul 1 2017

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American Heart Association
Out-of-Hospital Cardiac Arrest
Cardiopulmonary Resuscitation
Compliance
Guidelines
Resuscitation
Thorax
Survival
Benchmarking
Shock
Logistic Models
Defibrillators
Heart Arrest
Observational Studies
Databases

Keywords

  • Cardiopulmonary resuscitation
  • Heart arrest
  • Resuscitation
  • Survival

ASJC Scopus subject areas

  • Emergency Medicine
  • Emergency
  • Cardiology and Cardiovascular Medicine

Cite this

The association between AHA CPR quality guideline compliance and clinical outcomes from out-of-hospital cardiac arrest. / for the ROC investigators.

In: Resuscitation, Vol. 116, 01.07.2017, p. 39-45.

Research output: Contribution to journalArticle

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title = "The association between AHA CPR quality guideline compliance and clinical outcomes from out-of-hospital cardiac arrest",
abstract = "Background Measures of chest compression fraction (CCF), compression rate, compression depth and pre-shock pause have all been independently associated with improved outcomes from out-of-hospital (OHCA) cardiac arrest. However, it is unknown whether compliance with American Heart Association (AHA) guidelines incorporating all the aforementioned metrics, is associated with improved survival from OHCA. Methods We performed a secondary analysis of prospectively collected data from the Resuscitation Outcomes Consortium Epistry-Cardiac Arrest database. As per the 2015 American Heart Association (AHA) guidelines, guideline compliant cardiopulmonary resuscitation (CPR) was defined as CCF >0.8, chest compression rate 100–120/minute, chest compression depth 50–60 mm, and pre-shock pause <10 s. Multivariable logistic regression models controlling for Utstein variables were used to assess the relationship between global guideline compliance and survival to hospital discharge and neurologically intact survival with MRS ≤3. Due to potential confounding between CPR quality metrics and cases that achieved early ROSC, we performed an a priori subgroup analysis restricted to patients who obtained ROSC after ≥10 min of EMS resuscitation. Results After allowing for study exclusions, 19,568 defibrillator records were collected over a 4-year period ending in June 2015. For all reported models, the reference standard included all cases who did not meet all CPR quality benchmarks. For the primary model (CCF, rate, depth), there was no significant difference in survival for resuscitations that met all CPR quality benchmarks (guideline compliant) compared to the reference standard (OR 1.26; 95{\%} CI: 0.80, 1.97). When the dataset was restricted to patients obtaining ROSC after ≥10 min of EMS resuscitation (n = 4,158), survival was significantly higher for those resuscitations that were guideline compliant (OR 2.17; 95{\%} CI: 1.11, 4.27) compared to the reference standard. Similar findings were obtained for neurologically intact survival with MRS ≤3 (OR 3.03; 95{\%} CI: 1.12, 8.20). Conclusions In this observational study, compliance with AHA guidelines for CPR quality was not associated with improved outcomes from OHCA. Conversely, when restricting the cohort to those with late ROSC, compliance with guidelines was associated with improved clinical outcomes. Strategies to improve overall guideline compliance may have a significant impact on outcomes from OHCA.",
keywords = "Cardiopulmonary resuscitation, Heart arrest, Resuscitation, Survival",
author = "{for the ROC investigators} and Sheldon Cheskes and Schmicker, {Robert H.} and Tom Rea and Morrison, {Laurie J.} and Brian Grunau and Drennan, {Ian R.} and Brian Leroux and Christian Vaillancourt and Terri Schmidt and Koller, {Allison C.} and Peter Kudenchuk and Aufderheide, {Tom P.} and Heather Herren and Flickinger, {Katharyn H.} and Mark Charleston and Ron Straight and Jim Christenson",
year = "2017",
month = "7",
day = "1",
doi = "10.1016/j.resuscitation.2017.05.003",
language = "English (US)",
volume = "116",
pages = "39--45",
journal = "Resuscitation",
issn = "0300-9572",
publisher = "Elsevier Ireland Ltd",

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T1 - The association between AHA CPR quality guideline compliance and clinical outcomes from out-of-hospital cardiac arrest

AU - for the ROC investigators

AU - Cheskes, Sheldon

AU - Schmicker, Robert H.

AU - Rea, Tom

AU - Morrison, Laurie J.

AU - Grunau, Brian

AU - Drennan, Ian R.

AU - Leroux, Brian

AU - Vaillancourt, Christian

AU - Schmidt, Terri

AU - Koller, Allison C.

AU - Kudenchuk, Peter

AU - Aufderheide, Tom P.

AU - Herren, Heather

AU - Flickinger, Katharyn H.

AU - Charleston, Mark

AU - Straight, Ron

AU - Christenson, Jim

PY - 2017/7/1

Y1 - 2017/7/1

N2 - Background Measures of chest compression fraction (CCF), compression rate, compression depth and pre-shock pause have all been independently associated with improved outcomes from out-of-hospital (OHCA) cardiac arrest. However, it is unknown whether compliance with American Heart Association (AHA) guidelines incorporating all the aforementioned metrics, is associated with improved survival from OHCA. Methods We performed a secondary analysis of prospectively collected data from the Resuscitation Outcomes Consortium Epistry-Cardiac Arrest database. As per the 2015 American Heart Association (AHA) guidelines, guideline compliant cardiopulmonary resuscitation (CPR) was defined as CCF >0.8, chest compression rate 100–120/minute, chest compression depth 50–60 mm, and pre-shock pause <10 s. Multivariable logistic regression models controlling for Utstein variables were used to assess the relationship between global guideline compliance and survival to hospital discharge and neurologically intact survival with MRS ≤3. Due to potential confounding between CPR quality metrics and cases that achieved early ROSC, we performed an a priori subgroup analysis restricted to patients who obtained ROSC after ≥10 min of EMS resuscitation. Results After allowing for study exclusions, 19,568 defibrillator records were collected over a 4-year period ending in June 2015. For all reported models, the reference standard included all cases who did not meet all CPR quality benchmarks. For the primary model (CCF, rate, depth), there was no significant difference in survival for resuscitations that met all CPR quality benchmarks (guideline compliant) compared to the reference standard (OR 1.26; 95% CI: 0.80, 1.97). When the dataset was restricted to patients obtaining ROSC after ≥10 min of EMS resuscitation (n = 4,158), survival was significantly higher for those resuscitations that were guideline compliant (OR 2.17; 95% CI: 1.11, 4.27) compared to the reference standard. Similar findings were obtained for neurologically intact survival with MRS ≤3 (OR 3.03; 95% CI: 1.12, 8.20). Conclusions In this observational study, compliance with AHA guidelines for CPR quality was not associated with improved outcomes from OHCA. Conversely, when restricting the cohort to those with late ROSC, compliance with guidelines was associated with improved clinical outcomes. Strategies to improve overall guideline compliance may have a significant impact on outcomes from OHCA.

AB - Background Measures of chest compression fraction (CCF), compression rate, compression depth and pre-shock pause have all been independently associated with improved outcomes from out-of-hospital (OHCA) cardiac arrest. However, it is unknown whether compliance with American Heart Association (AHA) guidelines incorporating all the aforementioned metrics, is associated with improved survival from OHCA. Methods We performed a secondary analysis of prospectively collected data from the Resuscitation Outcomes Consortium Epistry-Cardiac Arrest database. As per the 2015 American Heart Association (AHA) guidelines, guideline compliant cardiopulmonary resuscitation (CPR) was defined as CCF >0.8, chest compression rate 100–120/minute, chest compression depth 50–60 mm, and pre-shock pause <10 s. Multivariable logistic regression models controlling for Utstein variables were used to assess the relationship between global guideline compliance and survival to hospital discharge and neurologically intact survival with MRS ≤3. Due to potential confounding between CPR quality metrics and cases that achieved early ROSC, we performed an a priori subgroup analysis restricted to patients who obtained ROSC after ≥10 min of EMS resuscitation. Results After allowing for study exclusions, 19,568 defibrillator records were collected over a 4-year period ending in June 2015. For all reported models, the reference standard included all cases who did not meet all CPR quality benchmarks. For the primary model (CCF, rate, depth), there was no significant difference in survival for resuscitations that met all CPR quality benchmarks (guideline compliant) compared to the reference standard (OR 1.26; 95% CI: 0.80, 1.97). When the dataset was restricted to patients obtaining ROSC after ≥10 min of EMS resuscitation (n = 4,158), survival was significantly higher for those resuscitations that were guideline compliant (OR 2.17; 95% CI: 1.11, 4.27) compared to the reference standard. Similar findings were obtained for neurologically intact survival with MRS ≤3 (OR 3.03; 95% CI: 1.12, 8.20). Conclusions In this observational study, compliance with AHA guidelines for CPR quality was not associated with improved outcomes from OHCA. Conversely, when restricting the cohort to those with late ROSC, compliance with guidelines was associated with improved clinical outcomes. Strategies to improve overall guideline compliance may have a significant impact on outcomes from OHCA.

KW - Cardiopulmonary resuscitation

KW - Heart arrest

KW - Resuscitation

KW - Survival

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