TY - JOUR
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.
N1 - Publisher Copyright:
Copyright © 2015 Massachusetts Medical Society. All rights reserved.
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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U2 - 10.1056/NEJMoa1509139
DO - 10.1056/NEJMoa1509139
M3 - Article
C2 - 26550795
AN - SCOPUS:84948799467
SN - 0028-4793
VL - 373
SP - 2203
EP - 2214
JO - New England Journal of Medicine
JF - New England Journal of Medicine
IS - 23
ER -