Implementing the 2005 American Heart Association Guidelines improves outcomes after out-of-hospital cardiac arrest

Aufderheide, Tom P.; Yannopoulos, Demetris; Lick, Charles; Myers, Brent; Romig, Laurie; Stothert, Joseph C.; Barnard, Jeffrey J.; Vartanian, Levon; Pilgrim, Ashley J.; Benditt, David G.

doi:10.1016/j.hrthm.2010.04.022

Cited by 85 publications

(57 citation statements)

References 26 publications

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“…10,11,27 Overall, we observed a ϳ2% absolute increase (representing an 81% relative improvement) in 1-year survival after OHCA caused by a nonshockable rhythm. Although seemingly modest, with a number needed to treat of Ϸ50 for every additional life saved, this survival difference translates to a measurable improvement in public health from a widely applicable and comparatively low-cost intervention.…”

Section: Discussionmentioning

confidence: 53%

“…3,14,15 At present, OHCA is largely attributable to nonshockable arrhythmias-asystole and pulseless electric activity-from which survival is especially poor and for which few if any interventions are effective. 10,16,17 In particular, the impact of community-wide treatment strategies incorporating changes in CPR guidelines for what is now a majority of patients with nonshockable OHCA is uncertain. 10,11 Also at issue is whether treatments that benefit ventricular fibrillation/ tachycardia might be less beneficial for nonshockable arrests.…”

Section: Clinical Perspective On P 1794mentioning

confidence: 99%

“…10,16,17 In particular, the impact of community-wide treatment strategies incorporating changes in CPR guidelines for what is now a majority of patients with nonshockable OHCA is uncertain. 10,11 Also at issue is whether treatments that benefit ventricular fibrillation/ tachycardia might be less beneficial for nonshockable arrests. For example, chest compressions are believed to have greater importance than ventilations in ventricular fibrillation/ tachycardia, 18 but the converse could be true during resuscitation of nonshockable arrest if caused by respiratory failure.…”

Section: Clinical Perspective On P 1794mentioning

confidence: 99%

“…5,6 Some communities have reported a significant increase in survival from OHCA after implementation of this protocol among patients presenting with shockable cardiac arrest caused by ventricular fibrillation/ tachycardia and described an association between fewer interruptions in chest compressions and outcome. [7][8][9][10][11][12][13] …”

mentioning

confidence: 99%

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Impact of Changes in Resuscitation Practice on Survival and Neurological Outcome After Out-of-Hospital Cardiac Arrest Resulting From Nonshockable Arrhythmias

et al. 2012

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Background-Out-of-hospital cardiac arrest (OHCA) claims millions of lives worldwide each year. OHCA survival from shockable arrhythmias (ventricular fibrillation/tachycardia) improved in several communities after implementation of American Heart Association resuscitation guidelines that eliminated "stacked" shocks and emphasized chest compressions. "Nonshockable" rhythms are now the predominant presentation of OHCA; the benefit of such treatments on nonshockable rhythms is uncertain. Methods and Results-We studied 3960 patients with nontraumatic OHCA from nonshockable initial rhythms treated by prehospital providers in King County, Washington, over a 10-year period. Outcomes during a 5-year intervention period after adoption of new resuscitation guidelines were compared with the previous 5-year historical control period. The primary outcome was 1-year survival. Patient demographics and resuscitation characteristics were similar between the control (nϭ1774) and intervention (nϭ2186) groups, among whom 471 of 1774 patients (27%) versus 742 of 2186 patients (34%), respectively, achieved return of spontaneous circulation; 82 (4.6%) versus 149 (6.8%) were discharged from hospital, 60 (3.4%) versus 112 (5.1%) with favorable neurological outcome; 73 (4.1%) versus 135 (6.2%) survived 1 month; and 48 (2.7%) versus 106 patients (4.9%) survived 1 year (all PՅ0.005). After adjustment for potential confounders, the intervention period was associated with an improved odds of 1.50 (95% confidence interval, 1.29 -1.74) for return of spontaneous circulation, 1.53 (95% confidence interval, 1.14 -2.05) for hospital survival, 1.56 (95% confidence interval, 1.11-2.18) for favorable neurological status, 1.54 (95% confidence interval, 1.14 -2.10) for 1-month survival, and 1.85 (95% confidence interval, 1.29 -2.66) for 1-year survival. Conclusion-Outcomes from OHCA resulting from nonshockable rhythms, although poor by comparison with shockable rhythm presentations, improved significantly after implementation of resuscitation guideline changes, suggesting their potential to benefit all presentations of OHCA. (Circulation. 2012;125:1787-1794.)

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Section: Discussionmentioning

confidence: 53%

Section: Clinical Perspective On P 1794mentioning

confidence: 99%

Section: Clinical Perspective On P 1794mentioning

confidence: 99%

mentioning

confidence: 99%

See 2 more Smart Citations

Impact of Changes in Resuscitation Practice on Survival and Neurological Outcome After Out-of-Hospital Cardiac Arrest Resulting From Nonshockable Arrhythmias

et al. 2012

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“…[1][2][3][4] In the in-hospital setting, quality improvement efforts have included the use of routine mock codes, post-resuscitation debriefing, defibrillation by non-medical personnel, and participation in quality improvement registries, such as Get with the Guidelines-Resuscitation (GWTGResuscitation). [5][6][7][8][9] Whether overall survival for patients with in-hospital cardiac arrest has improved with these efforts remains unknown.…”

Section: Introductionmentioning

confidence: 99%