Compression-to-ventilation ratio and incidence of rearrest—A secondary analysis of the ROC CCC trial

Abstract

Background Previous work has demonstrated that when out-of-hospital cardiac arrest (OHCA) patients achieve return of spontaneous circulation (ROSC), but subsequently have another cardiac arrest prior to hospital arrival (rearrest), the probability of survival to hospital discharge is significantly decreased. Additionally, few modifiable factors for rearrest are known. We sought to examine the association between rearrest and compression-to-ventilation ratio during cardiopulmonary resuscitation (CPR) and to confirm the association between rearrest and outcomes. Hypothesis Rearrest incidence would be similar between cases treated with 30:2 or continuous chest compression (CCC) CPR, but inversely related to survival and good neurological outcome. Methods We conducted a secondary analysis of a large randomized-controlled trial of CCC versus 30:2 CPR for the treatment of OHCA between 2011 and 2015 among 8 sites of the Resuscitation Outcomes Consortium (ROC). Patients were randomized through an emergency medical services (EMS) agency-level cluster randomization design to receive either 30:2 or CCC CPR. Case data were derived from prehospital patient care reports, digital defibrillator files, and hospital records. The primary analysis was an as-treated comparison of the proportion of patients with a rearrest for patients who received 30:2 versus those who received CCC. In addition, we assessed the association between rearrest and both survival to hospital discharge and favorable neurological outcome (Modified Rankin Score ≤ 3) in patients with and without ROSC upon ED arrival using multivariable logistic regression adjusting for age, sex, initial rhythm and measures of CPR quality. Results There were 14,109 analyzable cases that were determined to have definitively received either CCC or 30:2 CPR. Of these, 4,713 had prehospital ROSC and 2,040 (43.2%) had at least one rearrest. Incidence of rearrest was not significantly different between patients receiving CCC and 30:2 (44.1% vs 41.8%; adjusted OR: 1.01; 95% CI: 0.88, 1.16). Rearrest was significantly associated with lower survival (23.3% vs 36.9%; adjusted OR: 0.46; 95%CI: 0.36–0.51) and worse neurological outcome (19.4% vs 30.2%; adjusted OR: 0.46; 95%CI: 0.38, 0.55). Conclusion Rearrest occurrence was not significantly different between patients receiving CCC and 30:2, and was inversely associated with survival to hospital discharge and MRS.

Effects of intra-resuscitation antiarrhythmic administration on rearrest occurrence and intra-resuscitation ECG characteristics in the ROC ALPS trial

“…Lastly, in the present study rearrest was once again found to be a strong predictor of poor resuscitation outcomes, including survival to hospital discharge and neurologic function, confirming recent findings from the ROC Continuous Chest Compressions trial. 6,26 In the prior study, no association was found between definitively classified compression-to-ventilation ratio and rearrest occurrence, an association that we had hypothesized was rooted in additional no-flow time created by regular cessation of chest compressions for delivery of ventilations.…”

“…1 In this sense, antiarrhythmic administration can be contextualized to the intermediate resuscitation outcome of rearrest , including the rhythm-specific subcategory of recurrent VF, previously associated with poor survival to hospital discharge and/or neurologic outcomes by our group and others. 2–6 The mechanism of antiarrhythmics in obviating recurrent VF or rearrest during resuscitation is conceptually complicated by the known effect of some antiarrhythmic drugs to increase the defibrillation threshold, an effect that should reduce the probability of successful defibrillation. 7–9 Even so, it was demonstrated almost two decades ago that both amiodarone and lidocaine can improve survival to hospital admission when administered for recurrent or refractory VF.…”

Effects of ‘Rescuer’ Rotating Time on the Quality of Chest Compressions: 1-Minute Vs. 2-Minute Intervals

“…Continuous chest compression CPR (CCC-CPR) is one of the protocols that has been suggested as an alternative method to conventional CPR, with emphasis on immediate chest compression and delayed respiratory ventilation (6). In the 2010 European Resuscitation Council Guideline, CCC-CPR is recommended as an alternative method to conventional resuscitation.…”