Defibrillation or cardiopulmonary resuscitation first for patients with out-of-hospital cardiac arrests found by paramedics to be in ventricular fibrillation? A randomised control trial

Baker, Paul; Conway, Jane; Cotton, C. Randy; Ashby, Dale T.; Smyth, James; Woodman, Richard; Grantham, Hugh

doi:10.1016/j.resuscitation.2008.07.017

Cited by 103 publications

(90 citation statements)

References 6 publications

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“…who received CPR prior to defibrillation. For the total response interval, our results are consistent with the studies of Wik et al, 5 Jacobs et al, 6 and Baker et al 7 In a subgroup analysis, the lack of difference in subgroups was not consistent with Cobb et al 4 and Wik et al, 5 who found a better outcome with CPR before defibrillation with response intervals of ≥4 minutes and ≥5 minutes, respectively. Jacobs et al 6 pointed out that the study by Cobb et al 4 had changes in clinical protocol and guidelines that might have influenced their results, and the nonrandomized study design might have overestimated the treatment effect.…”

Section: Cardiopulmonary Resuscitation First Versus Shock Firstsupporting

confidence: 81%

“…18 Jacobs et al 6 also found that the subgroup analysis by Cobb et al 4 had wide confidence intervals and no adjustment for three interim analyses. Baker et al 7 mentioned that in the studies of Cobb et al 4 and Wik et al, 5 an extended period of CPR before subsequent defibrillation had the greatest impact on survival. These factors discussed above may have affected the results of our study.…”

Section: Cardiopulmonary Resuscitation First Versus Shock Firstmentioning

confidence: 99%

“…In other randomized trials, Jacobs et al 6 showed that 90 seconds of CPR before defibrillation does not improve overall survival, and Baker et al 7 showed that 3 minutes of CPR before defibrillation also does not improve overall survival. The optimal CPR duration prior to defibrillation is unknown.…”

mentioning

confidence: 99%

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Immediate Defibrillation or Defibrillation After Cardiopulmonary Resuscitation

Koike¹,

Tanabe²,

Ogawa³

et al. 2011

Prehospital Emergency Care

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Objectives. This study aimed to determine whether short cardiopulmonary resuscitation (CPR) by emergency medical services before defibrillation (CPR first) has a better outcome than immediate defibrillation followed by CPR (shock first) in patients with ventricular fibrillation/pulseless ventricular tachycardia (VF/pulseless VT) out-of-hospital cardiac arrest. Methods. We analyzed a national database between 2006 and 2008, and included patients aged 18 years or more who had witnessed cardiac arrests and whose first recorded rhythm was VF/pulseless VT. Those study subjects were divided into five groups in accordance with the CPR/defibrillation intervention sequence. Each group was subdivided into call-to-response intervals of <5 minutes and ≥5 minutes. We identified 267 patients in the shockfirst group and 6,407 patients in the CPR-first group. Onemonth survival and neurologically favorable one-month survival rates were used for outcome measures. The association of intervention type on outcomes (one-month survival or neurologically favorable one-month survival) was analyzed using multivariate logistic regression analyses by adjusting potential confounding factors such as survey year, gender, age (years), bystander CPR, intubation, and call-toresponse interval (min). Results. The overall one-month survival rate was 26.2% (3,125/11,941) and the neurologically favorable one-month survival rate was 16.6% (1,983/11,934). The CPR-first group had a one-month survival rate of 27.8% (1,780/6,407) and a neurologically favorable onemonth survival rate of 17.8% (1,140/6,404), and the shockfirst group had survival rates of 24.7% (66/267) and 18.4% (49/267), respectively. There were no significant differences in one-month survival and neurologically favorable onemonth survival in these two primary comparison groups (odds ratio [95% confidence interval], 0.85 [0.64-1.13] and 1.04 [0.76-1.42], respectively). Logistic regression analysis showed that neither CPR first nor shock first was associated with the rate of one-month survival or neurologically favorable one-month survival, after adjusting for potential confounders. Conclusions. In our study, CPR prior to attempted defibrillation did not present a better outcome compared with shock first as measured by either one-month survival or neurologically favorable one-month survival, after adjusting for potential confounders. Further studies are required to determine whether CPR first has an advantage over shock first.

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Section: Cardiopulmonary Resuscitation First Versus Shock Firstsupporting

confidence: 81%

Section: Cardiopulmonary Resuscitation First Versus Shock Firstmentioning

confidence: 99%

See 1 more Smart Citation

Immediate Defibrillation or Defibrillation After Cardiopulmonary Resuscitation

Koike¹,

Tanabe²,

Ogawa³

et al. 2011

Prehospital Emergency Care

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show abstract

“…It is controversial whether OHCA victims should be treated with CPR before defibrillation when the AED pads are attached to the OHCA patients [27][28][29][30]. It is generally recommended that single bystander should going for AED after witnessing patient collapse only when they can see an AED at the scene [9].…”

Section: Discussionmentioning

confidence: 99%

Advantage of CPR-first over call-first actions for out-of-hospital cardiac arrests in nonelderly patients and of noncardiac aetiology

et al. 2015

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Aim: To assess the benefit of immediate call or cardiopulmonary resuscitation (CPR) for survival from outof-hospital cardiac arrests (OHCAs). Results: The overall survival rates in immediate Call + CPR, Call-First, and CPR-First groups were 11.5, 12.4, and 11.5%, respectively without significant differences (p = 0.543). Subgroup analyses by multivariate logistic regression following univariate analysis disclosed that CPR-first group is more likely to survive in subgroups of noncardiac aetiology (adjusted odds ratio; 95% confidence interval, 2.01; 1.39-2.98) and of nonelderly OHCAs (1.38; 1.09-1.76). MethodsConclusions: Immediate CPR-first action followed by an emergency call without a large delay may be recommended when a bystander with sufficient skills to perform CPR witnesses OHCAs in nonelderly people and of noncardiac aetiology.Word count: 250

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“…In practice, the exact duration of cardiac arrest for most SCD patients will be difficult to ascertain; therefore, defibrillation should not be delayed for the sole purpose of providing chest compressions, nor should chest compressions be delayed while obtaining a defibrillator. 12,[71][72][73] There is direct evidence concerning 1 shock versus a series of 2 or 3 stacked shocks. Rea et al 74 investigated this question and found that the initial defibrillation attempt terminated ventricular fibrillation in 83.6% of 481 patients overall and in 92% when biphasic defibrillators were used.…”

Section: Defibrillator Sequence Technique and The Use Of Pacingmentioning

confidence: 99%