Minimally interrupted cardiac resuscitation by emergency medical services for out-of-hospital cardiac arrest

Bentley J. Bobrow, Lani L. Clark, Gordon A. Ewy, Vatsal Chikani, Arthur B. Sanders, Robert A. Berg, Peter B. Richman, Karl B. Kern

Research output: Contribution to journalArticle

378 Scopus citations

Abstract

Context: Out-of-hospital cardiac arrest is a major public health problem. Objective: To investigate whether the survival of patients with out-of-hospital cardiac arrest would improve with minimally interrupted cardiac resuscitation (MICR), an alternate emergency medical services (EMS) protocol. Design, Setting, and Patients: A prospective study of survival-to-hospital discharge between January 1, 2005, and November 22, 2007. Patients with out-ofhospital cardiac arrests in 2 metropolitan cities in Arizona before and after MICR training of fire department emergency medical personnel were assessed. In a second analysis of protocol compliance, patients from the 2 metropolitan cities and 60 additional fire departments in Arizona who actually received MICR were compared with patients who did not receive MICR but received standard advanced life support. Intervention: Instruction for EMS personnel in MICR, an approach that includes an initial series of 200 uninterrupted chest compressions, rhythm analysis with a single shock, 200 immediate postshock chest compressions before pulse check or rhythm reanalysis, early administration of epinephrine, and delayed endotracheal intubation. Main Outcome Measure: Survival-to-hospital discharge. Results: Among the 886 patients in the 2 metropolitan cities, survival-to-hospital discharge increased from 1.8% (4/218) before MICR training to 5.4% (36/668) after MICR training (odds ratio [OR], 3.0; 95% confidence interval [CI], 1.1-8.9). In the subgroup of 174 patients with witnessed cardiac arrest and ventricular fibrillation, survival increased from 4.7% (2/43) before MICR training to 17.6% (23/131) after MICR training (OR, 8.6; 95% CI, 1.8-42.0). In the analysis of MICR protocol compliance involving 2460 patients with cardiac arrest, survival was significantly better among patients who received MICR than those who did not (9.1% [60/661] vs 3.8% [69/ 1799]; OR, 2.7; 95% CI, 1.9-4.1), as well as patients with witnessed ventricular fibrillation (28.4% [40/141] vs 11.9% [46/387]; OR, 3.4; 95% CI, 2.0-5.8). Conclusions: Survival-to-hospital discharge of patients with out-of-hospital cardiac arrest increased after implementation of MICR as an alternate EMS protocol. These results need to be confirmed in a randomized trial.

Original languageEnglish (US)
Pages (from-to)1158-1165
Number of pages8
JournalJAMA - Journal of the American Medical Association
Volume299
Issue number10
DOIs
StatePublished - Mar 12 2008

ASJC Scopus subject areas

  • Medicine(all)

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