In this large city, substantial improvement occurred in overall OOHCA survival rates following the implementation of the 2005 AHA guidelines for CPR and ECC. These changes were associated with improvements in the quality of CPR.

Introduction Long pauses without chest compressions (CC) have been identified in CPR provided by EMS professionals for out-of-hospital cardiac arrest (OOHCA). The 2005 AHA ECC CPR guidelines emphasize CC. The 2005 AHA Basic Life Support (BLS) for Healthcare Professionals (HCP) course introduced a training method with more CPR skills practice during the DVD based course. The purpose of this before/after study was to determine whether CC rates increased after introduction of the 2005 course. Methods This urban EMS system has 400 cardiac etiology OOHCA events annually. A convenience sample of 49 continuous electronic ECG recordings of VF patients was analyzed with the impedance channel of the LIFEPAK 12 (Physio-Control, Redmond WA) and proprietary software. A trained researcher verified the automated analysis. Each CC during the resuscitation attempt and pauses in CC before and after the first defibrillation shock were noted. The time of return of spontaneous circulation (ROSC) was determined by medical record review and onset of regular electrical activity without CC. Medical records were reviewed for outcome to hospital discharge. The EMS patient care protocol for VF was changed on July 1, 2006 to comply with the 2005 AHA ECC guidelines. Cases were grouped by the OOHCA date: 9/2004 to 12/31/2006 (pre) and 7/1/2006 to 4/21/2007 (post). EMS personnel began taking the 2005 BLS for HCP course during spring 2006. Monthly courses over 3 years will recertify 1500 personnel. Results 29 cases were analyzed from the pre group and 20 from the post group. Compressions per minute increased from a mean (±SD) of 47 ± 16 pre to 75 ± 33 post (P < 0.01). The mean count of shocks given per victim decreased from 4.5 ± 4.0 pre to 2.8 ± 1.8 post (P < 0.04). The CC pause before the first shock was unchanged (23.6 ± 18.4 seconds to 22.1 ± 17.9). but the CC pause following that shock decreased significantly from 48.7 ± 63.2 to 11.8 ± 22.5 (p=0.008). Rates of ROSC (55% pre, 50% post) and survival to discharge (15% pre, 13% post) were similar. Conclusion Following introduction of the 2005 BLS for HCP course and the EMS protocol change, the quality of CPR delivered to victims of OOHCA improved significantly compared with pre-2006 CPR. The sample size was too small to detect differences in survival rates.

Objective: To describe changes in out-of-hospital sudden cardiac arrest (OOHCA) survival before and after the release of the 2005 AHA guidelines for CPR and ECC. Methods: Analysis of survival data from a pre-established Utstein style OOHCA registry was conducted for 1923 adult cases of OOHCA treated by EMS between April 1, 2004 and December 31, 2007. These data represented all adult cases treated by one EMS system in a large metropolitan area (population 711,432). The primary endpoint was survival to hospital discharge. A convenience sample of 69 electronic ECG recordings was also analyzed using impedence waveform analysis to assess CPR quality parameters during corresponding time periods. Intervention: Implementation of the 2005 AHA Guidelines for CPR and ECC in Spring 2006. Results: Annual OOHCA incidence rate was 72/100,000, and VF incidence rate was 15/100,000. Bystander CPR rates were 27%, and 8% of arrests occurred in a public location. PAD AED use was 2% over the entire study period and few patients received hypothermia therapy. Unadjusted OOHCA survival rates were significantly higher in the post-guidelines period 8.2% (n=1055) than in the pre-guidelines period 5.3% (n=868) despite similarities in all major predictors of outcome (OR 1.6; 95% CI 1.05–1.69). Bystander witnessed OOHCA survival for victims with VF on EMS arrival was 18 of 89 (20%) pre-guidelines vs. 31 of 110 (28%) post-guidelines (OR 1.55; 95% CI 0.8 –3.0). CPR quality measures showed significant improvement in the post-guideline period. The mean no-flow fraction (NFF) in the pre-guidelines group was 0.46 (95% CI 0.41– 0.51), while the mean NFF in the post-guidelines group was 0.34 (95% CI 0.29 – 0.40). Multivariate regression analysis controlling for significant predictors of survival showed that OOHCA in the post-guidelines time period were associated with 1.75 greater odds of survival than those in the pre-guidelines time period (95% CI 1.17–2.62). Conclusion: Substantial improvement occurred in overall OOHCA survival rates following the implementation of the 2005 AHA Guidelines for CPR and ECC. These changes are associated with improvements in the quality of CPR.

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