Trial of continuous or interrupted chest compressions during CPR

Graham Nichol, Brian Leroux, Henry Wang, Clifton W. Callaway, George Sopko, Myron Weisfeldt, Ian Stiell, Laurie J. Morrison, Tom P. Aufderheide, Sheldon Cheskes, Jim Christenson, Peter Kudenchuk, Christian Vaillancourt, Thomas D. Rea, Ahamed H. Idris, Riccardo Colella, Marshal Isaacs, Ron Straight, Shannon Stephens, Joe RichardsonJoe Condle, Robert H. Schmicker, Debra Egan, Susanne May, Joseph P. Ornato

Research output: Contribution to journalArticle

Abstract

BACKGROUND During cardiopulmonary resuscitation (CPR) in patients with out-of-hospital cardiac arrest, the interruption of manual chest compressions for rescue breathing reduces blood flow and possibly survival. We assessed whether outcomes after continuous compressions with positive-pressure ventilation differed from those after compressions that were interrupted for ventilations at a ratio of 30 compressions to two ventilations. METHODS This cluster-randomized trial with crossover included 114 emergency medical service (EMS) agencies. Adults with non-trauma-related cardiac arrest who were treated by EMS providers received continuous chest compressions (intervention group) or interrupted chest compressions (control group). The primary outcome was the rate of survival to hospital discharge. Secondary outcomes included the modified Rankin scale score (on a scale from 0 to 6, with a score of ≤3 indicating favorable neurologic function). CPR process was measured to assess compliance. RESULTS Of 23,711 patients included in the primary analysis, 12,653 were assigned to the intervention group and 11,058 to the control group. A total of 1129 of 12,613 patients with available data (9.0%) in the intervention group and 1072 of 11,035 with available data (9.7%) in the control group survived until discharge (difference, -0.7 percentage points; 95% confidence interval [CI], -1.5 to 0.1; P = 0.07); 7.0% of the patients in the intervention group and 7.7% of those in the control group survived with favorable neurologic function at discharge (difference, -0.6 percentage points; 95% CI, -1.4 to 0.1, P = 0.09). Hospital-free survival was significantly shorter in the intervention group than in the control group (mean difference, -0.2 days; 95% CI, -0.3 to -0.1; P = 0.004). CONCLUSIONS In patients with out-of-hospital cardiac arrest, continuous chest compressions during CPR performed by EMS providers did not result in significantly higher rates of survival or favorable neurologic function than did interrupted chest compressions. (Funded by the National Heart, Lung, and Blood Institute and others; ROC CCC ClinicalTrials.gov number, NCT01372748.).

Original languageEnglish (US)
Pages (from-to)2203-2214
Number of pages12
JournalNew England Journal of Medicine
Volume373
Issue number23
DOIs
StatePublished - Dec 3 2015

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Cardiopulmonary Resuscitation
Thorax
Emergency Medical Services
Control Groups
Nervous System
Out-of-Hospital Cardiac Arrest
Confidence Intervals
Ventilation
Survival Rate
National Heart, Lung, and Blood Institute (U.S.)
Survival
Positive-Pressure Respiration
Heart Arrest
Cross-Over Studies
Compliance
Respiration

ASJC Scopus subject areas

  • Medicine(all)

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Nichol, G., Leroux, B., Wang, H., Callaway, C. W., Sopko, G., Weisfeldt, M., ... Ornato, J. P. (2015). Trial of continuous or interrupted chest compressions during CPR. New England Journal of Medicine, 373(23), 2203-2214. https://doi.org/10.1056/NEJMoa1509139

Trial of continuous or interrupted chest compressions during CPR. / Nichol, Graham; Leroux, Brian; Wang, Henry; Callaway, Clifton W.; Sopko, George; Weisfeldt, Myron; Stiell, Ian; Morrison, Laurie J.; Aufderheide, Tom P.; Cheskes, Sheldon; Christenson, Jim; Kudenchuk, Peter; Vaillancourt, Christian; Rea, Thomas D.; Idris, Ahamed H.; Colella, Riccardo; Isaacs, Marshal; Straight, Ron; Stephens, Shannon; Richardson, Joe; Condle, Joe; Schmicker, Robert H.; Egan, Debra; May, Susanne; Ornato, Joseph P.

In: New England Journal of Medicine, Vol. 373, No. 23, 03.12.2015, p. 2203-2214.

Research output: Contribution to journalArticle

Nichol, G, Leroux, B, Wang, H, Callaway, CW, Sopko, G, Weisfeldt, M, Stiell, I, Morrison, LJ, Aufderheide, TP, Cheskes, S, Christenson, J, Kudenchuk, P, Vaillancourt, C, Rea, TD, Idris, AH, Colella, R, Isaacs, M, Straight, R, Stephens, S, Richardson, J, Condle, J, Schmicker, RH, Egan, D, May, S & Ornato, JP 2015, 'Trial of continuous or interrupted chest compressions during CPR', New England Journal of Medicine, vol. 373, no. 23, pp. 2203-2214. https://doi.org/10.1056/NEJMoa1509139
Nichol, Graham ; Leroux, Brian ; Wang, Henry ; Callaway, Clifton W. ; Sopko, George ; Weisfeldt, Myron ; Stiell, Ian ; Morrison, Laurie J. ; Aufderheide, Tom P. ; Cheskes, Sheldon ; Christenson, Jim ; Kudenchuk, Peter ; Vaillancourt, Christian ; Rea, Thomas D. ; Idris, Ahamed H. ; Colella, Riccardo ; Isaacs, Marshal ; Straight, Ron ; Stephens, Shannon ; Richardson, Joe ; Condle, Joe ; Schmicker, Robert H. ; Egan, Debra ; May, Susanne ; Ornato, Joseph P. / Trial of continuous or interrupted chest compressions during CPR. In: New England Journal of Medicine. 2015 ; Vol. 373, No. 23. pp. 2203-2214.
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abstract = "BACKGROUND During cardiopulmonary resuscitation (CPR) in patients with out-of-hospital cardiac arrest, the interruption of manual chest compressions for rescue breathing reduces blood flow and possibly survival. We assessed whether outcomes after continuous compressions with positive-pressure ventilation differed from those after compressions that were interrupted for ventilations at a ratio of 30 compressions to two ventilations. METHODS This cluster-randomized trial with crossover included 114 emergency medical service (EMS) agencies. Adults with non-trauma-related cardiac arrest who were treated by EMS providers received continuous chest compressions (intervention group) or interrupted chest compressions (control group). The primary outcome was the rate of survival to hospital discharge. Secondary outcomes included the modified Rankin scale score (on a scale from 0 to 6, with a score of ≤3 indicating favorable neurologic function). CPR process was measured to assess compliance. RESULTS Of 23,711 patients included in the primary analysis, 12,653 were assigned to the intervention group and 11,058 to the control group. A total of 1129 of 12,613 patients with available data (9.0{\%}) in the intervention group and 1072 of 11,035 with available data (9.7{\%}) in the control group survived until discharge (difference, -0.7 percentage points; 95{\%} confidence interval [CI], -1.5 to 0.1; P = 0.07); 7.0{\%} of the patients in the intervention group and 7.7{\%} of those in the control group survived with favorable neurologic function at discharge (difference, -0.6 percentage points; 95{\%} CI, -1.4 to 0.1, P = 0.09). Hospital-free survival was significantly shorter in the intervention group than in the control group (mean difference, -0.2 days; 95{\%} CI, -0.3 to -0.1; P = 0.004). CONCLUSIONS In patients with out-of-hospital cardiac arrest, continuous chest compressions during CPR performed by EMS providers did not result in significantly higher rates of survival or favorable neurologic function than did interrupted chest compressions. (Funded by the National Heart, Lung, and Blood Institute and others; ROC CCC ClinicalTrials.gov number, NCT01372748.).",
author = "Graham Nichol and Brian Leroux and Henry Wang and Callaway, {Clifton W.} and George Sopko and Myron Weisfeldt and Ian Stiell and Morrison, {Laurie J.} and Aufderheide, {Tom P.} and Sheldon Cheskes and Jim Christenson and Peter Kudenchuk and Christian Vaillancourt and Rea, {Thomas D.} and Idris, {Ahamed H.} and Riccardo Colella and Marshal Isaacs and Ron Straight and Shannon Stephens and Joe Richardson and Joe Condle and Schmicker, {Robert H.} and Debra Egan and Susanne May and Ornato, {Joseph P.}",
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T1 - Trial of continuous or interrupted chest compressions during CPR

AU - Nichol, Graham

AU - Leroux, Brian

AU - Wang, Henry

AU - Callaway, Clifton W.

AU - Sopko, George

AU - Weisfeldt, Myron

AU - Stiell, Ian

AU - Morrison, Laurie J.

AU - Aufderheide, Tom P.

AU - Cheskes, Sheldon

AU - Christenson, Jim

AU - Kudenchuk, Peter

AU - Vaillancourt, Christian

AU - Rea, Thomas D.

AU - Idris, Ahamed H.

AU - Colella, Riccardo

AU - Isaacs, Marshal

AU - Straight, Ron

AU - Stephens, Shannon

AU - Richardson, Joe

AU - Condle, Joe

AU - Schmicker, Robert H.

AU - Egan, Debra

AU - May, Susanne

AU - Ornato, Joseph P.

PY - 2015/12/3

Y1 - 2015/12/3

N2 - BACKGROUND During cardiopulmonary resuscitation (CPR) in patients with out-of-hospital cardiac arrest, the interruption of manual chest compressions for rescue breathing reduces blood flow and possibly survival. We assessed whether outcomes after continuous compressions with positive-pressure ventilation differed from those after compressions that were interrupted for ventilations at a ratio of 30 compressions to two ventilations. METHODS This cluster-randomized trial with crossover included 114 emergency medical service (EMS) agencies. Adults with non-trauma-related cardiac arrest who were treated by EMS providers received continuous chest compressions (intervention group) or interrupted chest compressions (control group). The primary outcome was the rate of survival to hospital discharge. Secondary outcomes included the modified Rankin scale score (on a scale from 0 to 6, with a score of ≤3 indicating favorable neurologic function). CPR process was measured to assess compliance. RESULTS Of 23,711 patients included in the primary analysis, 12,653 were assigned to the intervention group and 11,058 to the control group. A total of 1129 of 12,613 patients with available data (9.0%) in the intervention group and 1072 of 11,035 with available data (9.7%) in the control group survived until discharge (difference, -0.7 percentage points; 95% confidence interval [CI], -1.5 to 0.1; P = 0.07); 7.0% of the patients in the intervention group and 7.7% of those in the control group survived with favorable neurologic function at discharge (difference, -0.6 percentage points; 95% CI, -1.4 to 0.1, P = 0.09). Hospital-free survival was significantly shorter in the intervention group than in the control group (mean difference, -0.2 days; 95% CI, -0.3 to -0.1; P = 0.004). CONCLUSIONS In patients with out-of-hospital cardiac arrest, continuous chest compressions during CPR performed by EMS providers did not result in significantly higher rates of survival or favorable neurologic function than did interrupted chest compressions. (Funded by the National Heart, Lung, and Blood Institute and others; ROC CCC ClinicalTrials.gov number, NCT01372748.).

AB - BACKGROUND During cardiopulmonary resuscitation (CPR) in patients with out-of-hospital cardiac arrest, the interruption of manual chest compressions for rescue breathing reduces blood flow and possibly survival. We assessed whether outcomes after continuous compressions with positive-pressure ventilation differed from those after compressions that were interrupted for ventilations at a ratio of 30 compressions to two ventilations. METHODS This cluster-randomized trial with crossover included 114 emergency medical service (EMS) agencies. Adults with non-trauma-related cardiac arrest who were treated by EMS providers received continuous chest compressions (intervention group) or interrupted chest compressions (control group). The primary outcome was the rate of survival to hospital discharge. Secondary outcomes included the modified Rankin scale score (on a scale from 0 to 6, with a score of ≤3 indicating favorable neurologic function). CPR process was measured to assess compliance. RESULTS Of 23,711 patients included in the primary analysis, 12,653 were assigned to the intervention group and 11,058 to the control group. A total of 1129 of 12,613 patients with available data (9.0%) in the intervention group and 1072 of 11,035 with available data (9.7%) in the control group survived until discharge (difference, -0.7 percentage points; 95% confidence interval [CI], -1.5 to 0.1; P = 0.07); 7.0% of the patients in the intervention group and 7.7% of those in the control group survived with favorable neurologic function at discharge (difference, -0.6 percentage points; 95% CI, -1.4 to 0.1, P = 0.09). Hospital-free survival was significantly shorter in the intervention group than in the control group (mean difference, -0.2 days; 95% CI, -0.3 to -0.1; P = 0.004). CONCLUSIONS In patients with out-of-hospital cardiac arrest, continuous chest compressions during CPR performed by EMS providers did not result in significantly higher rates of survival or favorable neurologic function than did interrupted chest compressions. (Funded by the National Heart, Lung, and Blood Institute and others; ROC CCC ClinicalTrials.gov number, NCT01372748.).

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