Improved neurological outcome with continuous chest compressions compared with 30: 2 compressions-to-ventilations cardiopulmonary resuscitation in a realistic swine model of out-of-hospital cardiac arrest

Gordon A. Ewy, Mathias Zuercher, Ronald W. Hilwig, Arthur B Sanders, Robert A. Berg, Charles W Otto, Melinda M. Hayes, Karl B Kern

Research output: Contribution to journalArticle

151 Citations (Scopus)

Abstract

BACKGROUND - The 2005 Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care changed the previous ventilations-to-chest- compression algorithm for bystander cardiopulmonary resuscitation (CPR) from 2 ventilations before each 15 chest compressions (2:15 CPR) to 30 chest compressions before 2 ventilations (30:2 CPR). It was acknowledged in the guidelines that the change was based on a consensus rather than clear evidence. This study was designed to compare 24-hour neurologically normal survival between the initial applications of continuous chest compressions without assisted ventilations with 30:2 CPR in a swine model of witnessed out-of-hospital ventricular fibrillation cardiac arrest. METHODS AND RESULTS - Sixty-four animals underwent 12 minutes of ventricular fibrillation before defibrillation attempts. They were divided into 4 groups, each with increasing durations (3, 4, 5, and 6 minutes, respectively) of untreated ventricular fibrillation before the initiation of bystander resuscitation consisting of either continuous chest compression or 30:2 CPR. After the various untreated ventricular durations plus bystander resuscitation durations, all animals were given the first defibrillation attempt 12 minutes after the induction of ventricular fibrillation, followed by the 2005 guideline-recommended advanced cardiac life support. Neurologically normal survival at 24 hours after resuscitation was observed in 23 of 33 (70%) of the animals in the continuous chest compression groups but in only 13 of 31 (42%) of the 30:2 CPR groups (P=0.025). CONCLUSIONS - In a realistic model of out-of-hospital ventricular fibrillation cardiac arrest, initial bystander administration of continuous chest compressions without assisted ventilations resulted in significantly better 24-hour postresuscitation neurologically normal survival than did the initial bystander administration of 2005 guideline-recommended 30:2 CPR.

Original languageEnglish (US)
Pages (from-to)2525-2530
Number of pages6
JournalCirculation
Volume116
Issue number22
DOIs
StatePublished - Nov 2007

Fingerprint

Out-of-Hospital Cardiac Arrest
Cardiopulmonary Resuscitation
Ventilation
Swine
Thorax
Ventricular Fibrillation
Resuscitation
Guidelines
Heart Arrest
Advanced Cardiac Life Support
Emergency Medical Services

Keywords

  • Cardiopulmonary resuscitation
  • Heart arrest
  • Resuscitation
  • Ventricular fibrillation

ASJC Scopus subject areas

  • Physiology
  • Cardiology and Cardiovascular Medicine

Cite this

Improved neurological outcome with continuous chest compressions compared with 30 : 2 compressions-to-ventilations cardiopulmonary resuscitation in a realistic swine model of out-of-hospital cardiac arrest. / Ewy, Gordon A.; Zuercher, Mathias; Hilwig, Ronald W.; Sanders, Arthur B; Berg, Robert A.; Otto, Charles W; Hayes, Melinda M.; Kern, Karl B.

In: Circulation, Vol. 116, No. 22, 11.2007, p. 2525-2530.

Research output: Contribution to journalArticle

@article{41131ea181614ba59ae0e3cc6866f460,
title = "Improved neurological outcome with continuous chest compressions compared with 30: 2 compressions-to-ventilations cardiopulmonary resuscitation in a realistic swine model of out-of-hospital cardiac arrest",
abstract = "BACKGROUND - The 2005 Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care changed the previous ventilations-to-chest- compression algorithm for bystander cardiopulmonary resuscitation (CPR) from 2 ventilations before each 15 chest compressions (2:15 CPR) to 30 chest compressions before 2 ventilations (30:2 CPR). It was acknowledged in the guidelines that the change was based on a consensus rather than clear evidence. This study was designed to compare 24-hour neurologically normal survival between the initial applications of continuous chest compressions without assisted ventilations with 30:2 CPR in a swine model of witnessed out-of-hospital ventricular fibrillation cardiac arrest. METHODS AND RESULTS - Sixty-four animals underwent 12 minutes of ventricular fibrillation before defibrillation attempts. They were divided into 4 groups, each with increasing durations (3, 4, 5, and 6 minutes, respectively) of untreated ventricular fibrillation before the initiation of bystander resuscitation consisting of either continuous chest compression or 30:2 CPR. After the various untreated ventricular durations plus bystander resuscitation durations, all animals were given the first defibrillation attempt 12 minutes after the induction of ventricular fibrillation, followed by the 2005 guideline-recommended advanced cardiac life support. Neurologically normal survival at 24 hours after resuscitation was observed in 23 of 33 (70{\%}) of the animals in the continuous chest compression groups but in only 13 of 31 (42{\%}) of the 30:2 CPR groups (P=0.025). CONCLUSIONS - In a realistic model of out-of-hospital ventricular fibrillation cardiac arrest, initial bystander administration of continuous chest compressions without assisted ventilations resulted in significantly better 24-hour postresuscitation neurologically normal survival than did the initial bystander administration of 2005 guideline-recommended 30:2 CPR.",
keywords = "Cardiopulmonary resuscitation, Heart arrest, Resuscitation, Ventricular fibrillation",
author = "Ewy, {Gordon A.} and Mathias Zuercher and Hilwig, {Ronald W.} and Sanders, {Arthur B} and Berg, {Robert A.} and Otto, {Charles W} and Hayes, {Melinda M.} and Kern, {Karl B}",
year = "2007",
month = "11",
doi = "10.1161/CIRCULATIONAHA.107.711820",
language = "English (US)",
volume = "116",
pages = "2525--2530",
journal = "Circulation",
issn = "0009-7322",
publisher = "Lippincott Williams and Wilkins",
number = "22",

}

TY - JOUR

T1 - Improved neurological outcome with continuous chest compressions compared with 30

T2 - 2 compressions-to-ventilations cardiopulmonary resuscitation in a realistic swine model of out-of-hospital cardiac arrest

AU - Ewy, Gordon A.

AU - Zuercher, Mathias

AU - Hilwig, Ronald W.

AU - Sanders, Arthur B

AU - Berg, Robert A.

AU - Otto, Charles W

AU - Hayes, Melinda M.

AU - Kern, Karl B

PY - 2007/11

Y1 - 2007/11

N2 - BACKGROUND - The 2005 Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care changed the previous ventilations-to-chest- compression algorithm for bystander cardiopulmonary resuscitation (CPR) from 2 ventilations before each 15 chest compressions (2:15 CPR) to 30 chest compressions before 2 ventilations (30:2 CPR). It was acknowledged in the guidelines that the change was based on a consensus rather than clear evidence. This study was designed to compare 24-hour neurologically normal survival between the initial applications of continuous chest compressions without assisted ventilations with 30:2 CPR in a swine model of witnessed out-of-hospital ventricular fibrillation cardiac arrest. METHODS AND RESULTS - Sixty-four animals underwent 12 minutes of ventricular fibrillation before defibrillation attempts. They were divided into 4 groups, each with increasing durations (3, 4, 5, and 6 minutes, respectively) of untreated ventricular fibrillation before the initiation of bystander resuscitation consisting of either continuous chest compression or 30:2 CPR. After the various untreated ventricular durations plus bystander resuscitation durations, all animals were given the first defibrillation attempt 12 minutes after the induction of ventricular fibrillation, followed by the 2005 guideline-recommended advanced cardiac life support. Neurologically normal survival at 24 hours after resuscitation was observed in 23 of 33 (70%) of the animals in the continuous chest compression groups but in only 13 of 31 (42%) of the 30:2 CPR groups (P=0.025). CONCLUSIONS - In a realistic model of out-of-hospital ventricular fibrillation cardiac arrest, initial bystander administration of continuous chest compressions without assisted ventilations resulted in significantly better 24-hour postresuscitation neurologically normal survival than did the initial bystander administration of 2005 guideline-recommended 30:2 CPR.

AB - BACKGROUND - The 2005 Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care changed the previous ventilations-to-chest- compression algorithm for bystander cardiopulmonary resuscitation (CPR) from 2 ventilations before each 15 chest compressions (2:15 CPR) to 30 chest compressions before 2 ventilations (30:2 CPR). It was acknowledged in the guidelines that the change was based on a consensus rather than clear evidence. This study was designed to compare 24-hour neurologically normal survival between the initial applications of continuous chest compressions without assisted ventilations with 30:2 CPR in a swine model of witnessed out-of-hospital ventricular fibrillation cardiac arrest. METHODS AND RESULTS - Sixty-four animals underwent 12 minutes of ventricular fibrillation before defibrillation attempts. They were divided into 4 groups, each with increasing durations (3, 4, 5, and 6 minutes, respectively) of untreated ventricular fibrillation before the initiation of bystander resuscitation consisting of either continuous chest compression or 30:2 CPR. After the various untreated ventricular durations plus bystander resuscitation durations, all animals were given the first defibrillation attempt 12 minutes after the induction of ventricular fibrillation, followed by the 2005 guideline-recommended advanced cardiac life support. Neurologically normal survival at 24 hours after resuscitation was observed in 23 of 33 (70%) of the animals in the continuous chest compression groups but in only 13 of 31 (42%) of the 30:2 CPR groups (P=0.025). CONCLUSIONS - In a realistic model of out-of-hospital ventricular fibrillation cardiac arrest, initial bystander administration of continuous chest compressions without assisted ventilations resulted in significantly better 24-hour postresuscitation neurologically normal survival than did the initial bystander administration of 2005 guideline-recommended 30:2 CPR.

KW - Cardiopulmonary resuscitation

KW - Heart arrest

KW - Resuscitation

KW - Ventricular fibrillation

UR - http://www.scopus.com/inward/record.url?scp=36549000290&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=36549000290&partnerID=8YFLogxK

U2 - 10.1161/CIRCULATIONAHA.107.711820

DO - 10.1161/CIRCULATIONAHA.107.711820

M3 - Article

C2 - 17998457

AN - SCOPUS:36549000290

VL - 116

SP - 2525

EP - 2530

JO - Circulation

JF - Circulation

SN - 0009-7322

IS - 22

ER -