Abstract
Improved Patient Survival Using a Modified Resuscitation Protocol for Out-of-Hospital Cardiac Arrest
(Circulation. 2009;119:2597–2605) AG Garza, MC Gratton, JA Salomone, et al
Prepared by Anil Menon, MD, Stanford Wilderness Fellow, Stanford, CA, USA
This retrospective observation cohort study evaluated the introduction of a modified pre-hospital resuscitation protocol. Data spanned 36 months before and 12 months after the implementation of a new protocol by the Kansas City, Missouri Emergency Medical Services System. A total of 492 primary cardiac arrests were analyzed in this study.
The new protocol differed in several areas from the previous protocol modeled on the American Heart Association 2000 cardiac arrest guidelines. Chest compressions increased from a 5:1 ratio to a 50:2 ratio and were a mandatory initial action, before defibrillation, in any arrest that was not reliably witnessed within 5 minutes. A manual defibrillator was used if the paramedics identified a shockable rhythm after 200 compressions. Only after 3 cycles of 200 compressions was intubation attempted.
Outcome measures included survival to discharge and return of spontaneous circulation, both of which improved with the new protocol. Survival to discharge increased from 22% to 44%. Return of spontaneous circulation improved with the new protocol and was most noticeable in the group of patients with witnessed ventricular fibrillation rising from 38% to 60%. This study showed a benefit of this alternate approach to pre-hospital arrest.