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Chest Compression Rates and Survival Following Out-of-Hospital Cardiac Arrest*

Idris, Ahamed H. MD1; Guffey, Danielle MS2; Pepe, Paul E. MD3; Brown, Siobhan P. PhD2; Brooks, Steven C. MD4; Callaway, Clifton W. MD, PhD5; Christenson, Jim MD6; Davis, Daniel P. MD7; Daya, Mohamud R. MD8; Gray, Randal BS, MA Ed, NREMT-P9; Kudenchuk, Peter J. MD10; Larsen, Jonathan EMT-P11; Lin, Steve MD12; Menegazzi, James J. PhD5; Sheehan, Kellie BSN2; Sopko, George MD, MPH13; Stiell, Ian MD, MSc14; Nichol, Graham MD15; Aufderheide, Tom P. MD16

doi: 10.1097/CCM.0000000000000824
Clinical Investigations

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.

Supplemental Digital Content is available in the text.

1Departments of Emergency Medicine and Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX.

2Clinical Trials Center, Department of Biostatistics, University of Washington, Seattle, WA.

3Departments of Emergency Medicine, Surgery, Internal Medicine and Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX.

4Department of Emergency Medicine, Queen’s University, Toronto, Ontario, Canada.

5Department of Emergency Medicine, University of Pittsburgh, PA.

6Department of Emergency Medicine, University of British Columbia, Vancouver, British Columbia, Canada.

7Department of Emergency Medicine, University of California, San Diego Medical Center, San Diego, CA.

8Department of Emergency Medicine, Oregon Health & Science University, Portland, OR.

9Department of Emergency Medicine, University of Alabama, Birmingham, AL.

10Division of Cardiology, Department of Medicine, University of Washington, Seattle, WA.

11Seattle Fire Department, Seattle, WA.

12Division of Emergency Medicine, Department of Medicine, University of Toronto, Toronto, Ontario, Canada.

13National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD.

14Department of Emergency Medicine and Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada.

15Department of Medicine, University of Washington, Seattle, WA.

16Department of Emergency Medicine, Medical College of Wisconsin, Milwaukee, WI.

* See also p. 922.

Resuscitation Outcomes Consortium Investigators are listed in Supplemental Digital Content 1 (http://links.lww.com/CCM/B156).

Trial registration: Resuscitation Outcomes Consortium Prehospital Resuscitation IMpedance threshold device and Early versus Delayed analysis ClinicalTrials.gov number, NCT00394706.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (http://journals.lww.com/ccmjournal).

The Resuscitation Outcomes Consortium is supported by a series of cooperative agreements to nine regional clinical centers and one Data Coordinating Center (5U01 HL077863—University of Washington Data Coordinating Center, HL077866—Medical College of Wisconsin, HL077867—University of Washington, HL077871—University of Pittsburgh, HL077872—St. Michael’s Hospital, HL077873—Oregon Health and Science University, HL077881—University of Alabama at Birmingham, HL077885—Ottawa Hospital Research Institute, HL077887—University of Texas Southwestern Medical Center, Dallas, HL077908—University of California San Diego) from the National Heart, Lung and Blood Institute in partnership with the National Institute of Neurological Disorders and Stroke, U.S. Army Medical Research & Material Command, The Canadian Institutes of Health Research–Institute of Circulatory and Respiratory Health, Defense Research and Development Canada, the Heart and Stroke Foundation of Canada, and the American Heart Association. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Heart, Lung and Blood Institute or the National Institutes of Health.

Dr. Idris is employed by the University of Texas Southwestern Medical Center, lectured for Cedars Sinai Medical Center (Honorarium for a lecture), and received support for article research from the National Institutes of Health (NIH). His institution received grant support and support for travel from the National Heart, Lung, and Blood Institute (NHLBI, NIH). He receives grant funding from the NHLBI and the National Institute of Neurological Disorders and Stroke (NINDS) and is a volunteer board member for Take Heart America and for the Citizen CPR Foundation. Drs. Idris and Daya are unpaid consultants for Philips Medical Systems. Drs. Idris, Brooks, Daya, Kudenchuk, Nichol, and Aufderheide are volunteers for the American Heart Association National Emergency Cardiovascular Care Committee. Dr. Guffey received support for article research from the NIH. Her institution received grant support from the NIH. Dr. Pepe is employed by the U.S. Food and Drug Administration (FDA) (travel and time for FDA advisory), provided expert testimony for the U.S. FDA (travel reimbursement for FDA testimony), and received support for article research from the NIH. His institution received grant support (large NIH study center grant), support for travel, and support for participation in review activities from the NIH. Dr. Brown’s institution received grant support from the NHLBI in partnership with the NINDS; U.S. Army Medical Research & Material Command; The Canadian Institutes of Health Research (CIHR)–Institute of Circulatory and Respiratory Health; Defense Research and Development Canada; the Heart and the Stroke Foundation of Canada; and the American Heart Association (AHA). Dr. Brooks’ institution received grant support from the Heart and Stroke Foundation of Canada (grant-in-aid for the study of a novel smartphone application that crowd-sources bystanders to provide resuscitation). Dr. Brooks is a volunteer with the Canadian Heart and Stroke Foundation. Dr. Callaway received royalties from Up-to-Date (royalties for chapter in online medical textbook), received support for travel from the AHA (travel to meetings for development of Emergency Cardiovascular Care guidelines as an AHA volunteer), and received support for article research from the NIH. His institution received grant support from the NHLBI (ROC grant) and NINDS (grants to conduct clinical trials in resuscitation and in neurological emergencies). Dr. Christenson consulted for Dr. James M. Christenson (honorarium to manage trial as part of University of British Columbia (UBC) salary to support headship); received support for travel from Dr. Christenson (expenses only); is employed by UBC Faculty of Medicine; and received support for article research from the NIH, the Institute of Cardiovascular and Respiratory Health, and the Heart and Stroke Foundation of Canada. Dr. Christenson and his institution received grant support from the ROC Grant. Dr. Davis consulted for Masimo Corporation, is employed by Air Methods Corporation, provided expert testimony for various entities, received support for travel from Zoll Medical, and received support for article research from the NIH. His institution has patent with and received royalties from Masimo Corporation. Dr. Daya consulted for Philips Health Care (unpaid consultant) and Washington Heart Rescue (consultant on project whose aim is to create a statewide registry of out-of-hospital cardiac arrest and double survival); is employed by Tualatin Valley Fire & Rescue (EMS Medical Director), Forest Grove Fire & Rescue (EMS Medical Director), and Washington County Consolidated Communications Agency (Medical Director for 911 Center); and received support for article research from the NIH. His institution received grant support from the NIH (ROC). Dr. Gray received support for article research from the NIH. Dr. Kudenchuk received support for article research from the NIH. His institution received grant support from the NHLBI and support for travel from the NHLBI (Investigator Steering Committee Meetings for NHLBI). Dr. Larsen received support for article research from the NIH. Dr. Lin received support from the CIHR (Fellowship award). He disclosed serving as a worksheet author on the C2010 International Liaison Committee on Resuscitation (ILCOR) acute coronary syndrome taskforce and as an evidence reviewer on the C2015 ILCOR advanced life support taskforce. His institution received grant support from the Canadian Association of Emergency Physicians and Physicians’ Services Incorporated Foundation (research grants). Dr. Menegazzi received support for article research from the NIH. His institution received grant support (Dr. Menegazzi is supported, in part, by a grant from the NHLBI) and received grant support (Dr. Menegazzi has several grants pending with NIH). Dr. Sheehan received support for article research from the NIH. Her institution received grant support from the ROC Clinical Trial Center University of Washington (cooperative agreement funded through the NIH). Dr. Sopko received support for article research from the NIH and disclosed government work. Dr. Stiell received support for article research from the NIH. His institution received grant support (grant from the Ottawa Hospital Research Institute (OHRI), NIH, Heart and Stroke Foundation of Canada paid to the institution [OHRI]). Dr. Nichol served as a board member for Medic One Foundation (Seattle, WA—Member, Board of Directors), the Western States Affiliate, and the AHA (Dallas, TX—Member, Board of Directors); consulted for Velomedix (Menlo Park, CA—National co-principal investigator [PI], Pilot Study of Ultrafast Hypothermia in Patients with ST-elevation Myocardial Infarction); and received support for article research from the NIH. His institution received grant support from the ROC (NIH U01 HL077863-06, co-PI, Coordinating Center) and support from the Dynamic AED Registry (Food and Drug Administration [Silver Spring, MD], Philips Healthcare [Andover, MA], Physio-Control [Redmond, WA], ZOLL [Chelmsford, MA], Cardiac Science [Wakeusha, WI], and HeartSine [Newton, PA] PI) and Washington Study of Ultrasound in Resuscitation (Philips Healthcare; PI). Dr. Aufderheide received support for travel (ROC, Neurological Emergencies Treatment Trial, Director’s Transformative Research travel reimbursement); served as a board member for the Institute of Medicine (Committee on Treatment of Cardiac Arrest member), Heart America (Volunteer Secretary), Citizen CPR Foundation (Volunteer President), and the National American Heart Association (Volunteer; Science Subcommittee and Volunteer Co-Chair; Resuscitation Science Symposium); and received support for article research from the NIH. His institution received grant support from the NIH/NHLBI/NINDS (ROC, Neurological Emergencies Treatment Trials, Director’s Transformative Research Award).

Address requests for reprints to: Ahamed H. Idris, MD, Department of Emergency Medicine, University of Texas Southwestern Medical Center at Dallas, 5323 Harry Hines Boulevard, Dallas, TX 75390–8579. E-mail: aidris@sbcglobal.net

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