EBQ:Trial of Continuous or Interrupted Chest Compressions during CPR
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Clinical Question
Does continuous chest compressions improve outcomes vs the traditional 30:2 CPR format in patients with OHCA?
Conclusion
In patients with OHCA receiving CPR via EMS providers, continuous chest compressions did not result in improved survival to hospital discharge rates.
Major Points
Study Design
Cluster randomized trial with crossover, including 114 EMS agencies. Clusters of agencies were randomly assigned in a 1:1 ratio to perform continuous or interrupted chest compressions. Twice per year each cluster was crossed over to the other strategy. Trial ran from June 2011 to May 2015.
Population
Trial was run by the Resuscitation Outcomes Consortium (ROC), which includes 10 clinical sites in North America and their associated regional EMS agencies. 8 ROC sites and 114 EMS agencies participated in this study.
Patient Demographics
No major differences in pretreatment characteristics of patients.
| Characteristic | CCC | 30:2 |
| Age | 66.4 | 66.2 |
| Male sex | 63.5% | 64.4% |
| Obvious cause of arrest | 3.1% | 3.2% |
| Arrest in public location | 14.2% | 14.8% |
| Bystander witnessed arrest | 42.0% | 43.5% |
| Bystander CPR | 46.90% | 47.1% |
| Time from dispatch to EMS arrival | 5.9 min | 5.9 min |
Inclusion Criteria
- Adults with non-trauma related OHCA
Exclusion Criteria
- EMS witnessed arrest
- Written advanced directive DNR
- Traumatic injury, asphyxial cause of arrest, or uncontrolled bleeding/exsanguination
- Pregnancy
- Preexisting tracheostomy
- Prisoners
- Initial CPR performed by a nonparticipating EMS provider, use of mechanical CPR device, or advanced airway management prior to EMS arrival
Interventions
CCC Group (n=12,613)
- Continuous chest compressions at a rate of 100 per minute
- Asynchronous positive pressure ventilations delivered at a rate of 10 ventilations per minute
30:2 Group (n=11,035)
- Chest compressions that were interrupted for ventilations at a ratio of 30 compressions to 2 ventilations
- Ventilations were to be given with positive pressure during a pause in compressions of less than 5 seconds in duration
Common to both groups
- Ventilation strategy maintained via oral airway for initial 3 CPR cycles (2 minutes each). If not ROSC or termination of CPR, an advanced airway was inserted after this third cycle ASAP.
- Once an advanced airway was obtained, continuous chest compressions with asynchronous ventilations was the standard.
Outcomes
Primary Outcome
- Survival to Hospital Discharge: no significant difference demonstrated between groups.
| Outcome | CCC | 30:2 | P Value |
| Survival to Discharge | 9% | 9.7% | 0.07 |
Secondary Outcomes
- No statistical difference in percent of survivors with a favorable neurologic outcome (Modified Rankin >3)
- Statistical difference (of questionable clinical significance, however) in number of hospital free survival days at 30 days after arrest favoring the 30:2 Group (1.5 days) vs. CCC (1.3 days)
| Outcome | CCC | 30:2 | P Value |
| Hospital Free Days at 30 Days | 1.3 | 1.5 | 0.004 |
| Favorable Neurologic Outcome | 7.00% | 7.70% | 0.09 |
Additional Data Analysis & Outcomes
| Outcome | CCC | 30:2 | P Value |
| ROSC at ED Arrival | 24.20% | 25.30% | 0.07 |
| Compression Fraction | 0.83% | 0.77% | <0.001 |
| # pauses > 2 seconds | 3.8% | 7.0% | <0.001 |
| Bystander CPR | 46.9% | 47.1% |
Criticisms & Further Discussion
External Links
See Also
Funding
Sponsored by the National Heart, Lung, and Blood Institute, the Canadian Institutes of of Health Research, and others.