Early versus later rhythm analysis in patients with out-of-hospital cardiac arrest

Ian G. Stiell, Graham Nichol, Brian G. Leroux, Thomas D. Rea, Joseph P. Ornato, Judy Powell, James Christenson, Clifton W. Callaway, Peter J. Kudenchuk, Tom P. Aufderheide, Ahamed H. Idris, Mohamud R. Daya, Henry E. Wang, Laurie J. Morrison, Daniel Davis, Douglas Andrusiek, Shannon Stephens, Sheldon Cheskes, Robert H. Schmicker, Ray FowlerChristian Vaillancourt, David Hostler, Dana Zive, Ronald G. Pirrallo, Gary M. Vilke, George Sopko, Myron Weisfeldt

Research output: Contribution to journalArticle

161 Citations (Scopus)

Abstract

Background: In a departure from the previous strategy of immediate defibrillation, the 2005 resuscitation guidelines from the American Heart Association-International Liaison Committee on Resuscitation suggested that emergency medical service (EMS) personnel could provide 2 minutes of cardiopulmonary resuscitation (CPR) before the first analysis of cardiac rhythm. We compared the strategy of a brief period of CPR with early analysis of rhythm with the strategy of a longer period of CPR with delayed analysis of rhythm. Methods: We conducted a cluster-randomized trial involving adults with out-of-hospital cardiac arrest at 10 Resuscitation Outcomes Consortium sites in the United States and Canada. Patients in the early-analysis group were assigned to receive 30 to 60 seconds of EMS-administered CPR and those in the later-analysis group were assigned to receive 180 seconds of CPR, before the initial electrocardiographic analysis. The primary outcome was survival to hospital discharge with satisfactory functional status (a modified Rankin scale score of ≤3, on a scale of 0 to 6, with higher scores indicating greater disability). Results: We included 9933 patients, of whom 5290 were assigned to early analysis of cardiac rhythm and 4643 to later analysis. A total of 273 patients (5.9%) in the later-analysis group and 310 patients (5.9%) in the early-analysis group met the criteria for the primary outcome, with a cluster-adjusted difference of -0.2 percentage points (95% confidence interval, -1.1 to 0.7; P = 0.59). Analyses of the data with adjustment for confounding factors, as well as subgroup analyses, also showed no survival benefit for either study group. Conclusions: Among patients who had an out-of-hospital cardiac arrest, we found no difference in the outcomes with a brief period, as compared with a longer period, of EMS-administered CPR before the first analysis of cardiac rhythm. (Funded by the National Heart, Lung, and Blood Institute and others; ROC PRIMED ClinicalTrials.gov number, NCT00394706.)

Original languageEnglish (US)
Pages (from-to)787-797
Number of pages11
JournalNew England Journal of Medicine
Volume365
Issue number9
DOIs
StatePublished - Sep 1 2011

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Out-of-Hospital Cardiac Arrest
Cardiopulmonary Resuscitation
Emergency Medical Services
Resuscitation
National Heart, Lung, and Blood Institute (U.S.)
Survival
Canada
Research Design
Guidelines
Confidence Intervals

ASJC Scopus subject areas

  • Medicine(all)

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Stiell, I. G., Nichol, G., Leroux, B. G., Rea, T. D., Ornato, J. P., Powell, J., ... Weisfeldt, M. (2011). Early versus later rhythm analysis in patients with out-of-hospital cardiac arrest. New England Journal of Medicine, 365(9), 787-797. https://doi.org/10.1056/NEJMoa1010076

Early versus later rhythm analysis in patients with out-of-hospital cardiac arrest. / Stiell, Ian G.; Nichol, Graham; Leroux, Brian G.; Rea, Thomas D.; Ornato, Joseph P.; Powell, Judy; Christenson, James; Callaway, Clifton W.; Kudenchuk, Peter J.; Aufderheide, Tom P.; Idris, Ahamed H.; Daya, Mohamud R.; Wang, Henry E.; Morrison, Laurie J.; Davis, Daniel; Andrusiek, Douglas; Stephens, Shannon; Cheskes, Sheldon; Schmicker, Robert H.; Fowler, Ray; Vaillancourt, Christian; Hostler, David; Zive, Dana; Pirrallo, Ronald G.; Vilke, Gary M.; Sopko, George; Weisfeldt, Myron.

In: New England Journal of Medicine, Vol. 365, No. 9, 01.09.2011, p. 787-797.

Research output: Contribution to journalArticle

Stiell, IG, Nichol, G, Leroux, BG, Rea, TD, Ornato, JP, Powell, J, Christenson, J, Callaway, CW, Kudenchuk, PJ, Aufderheide, TP, Idris, AH, Daya, MR, Wang, HE, Morrison, LJ, Davis, D, Andrusiek, D, Stephens, S, Cheskes, S, Schmicker, RH, Fowler, R, Vaillancourt, C, Hostler, D, Zive, D, Pirrallo, RG, Vilke, GM, Sopko, G & Weisfeldt, M 2011, 'Early versus later rhythm analysis in patients with out-of-hospital cardiac arrest', New England Journal of Medicine, vol. 365, no. 9, pp. 787-797. https://doi.org/10.1056/NEJMoa1010076
Stiell, Ian G. ; Nichol, Graham ; Leroux, Brian G. ; Rea, Thomas D. ; Ornato, Joseph P. ; Powell, Judy ; Christenson, James ; Callaway, Clifton W. ; Kudenchuk, Peter J. ; Aufderheide, Tom P. ; Idris, Ahamed H. ; Daya, Mohamud R. ; Wang, Henry E. ; Morrison, Laurie J. ; Davis, Daniel ; Andrusiek, Douglas ; Stephens, Shannon ; Cheskes, Sheldon ; Schmicker, Robert H. ; Fowler, Ray ; Vaillancourt, Christian ; Hostler, David ; Zive, Dana ; Pirrallo, Ronald G. ; Vilke, Gary M. ; Sopko, George ; Weisfeldt, Myron. / Early versus later rhythm analysis in patients with out-of-hospital cardiac arrest. In: New England Journal of Medicine. 2011 ; Vol. 365, No. 9. pp. 787-797.
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abstract = "Background: In a departure from the previous strategy of immediate defibrillation, the 2005 resuscitation guidelines from the American Heart Association-International Liaison Committee on Resuscitation suggested that emergency medical service (EMS) personnel could provide 2 minutes of cardiopulmonary resuscitation (CPR) before the first analysis of cardiac rhythm. We compared the strategy of a brief period of CPR with early analysis of rhythm with the strategy of a longer period of CPR with delayed analysis of rhythm. Methods: We conducted a cluster-randomized trial involving adults with out-of-hospital cardiac arrest at 10 Resuscitation Outcomes Consortium sites in the United States and Canada. Patients in the early-analysis group were assigned to receive 30 to 60 seconds of EMS-administered CPR and those in the later-analysis group were assigned to receive 180 seconds of CPR, before the initial electrocardiographic analysis. The primary outcome was survival to hospital discharge with satisfactory functional status (a modified Rankin scale score of ≤3, on a scale of 0 to 6, with higher scores indicating greater disability). Results: We included 9933 patients, of whom 5290 were assigned to early analysis of cardiac rhythm and 4643 to later analysis. A total of 273 patients (5.9{\%}) in the later-analysis group and 310 patients (5.9{\%}) in the early-analysis group met the criteria for the primary outcome, with a cluster-adjusted difference of -0.2 percentage points (95{\%} confidence interval, -1.1 to 0.7; P = 0.59). Analyses of the data with adjustment for confounding factors, as well as subgroup analyses, also showed no survival benefit for either study group. Conclusions: Among patients who had an out-of-hospital cardiac arrest, we found no difference in the outcomes with a brief period, as compared with a longer period, of EMS-administered CPR before the first analysis of cardiac rhythm. (Funded by the National Heart, Lung, and Blood Institute and others; ROC PRIMED ClinicalTrials.gov number, NCT00394706.)",
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T1 - Early versus later rhythm analysis in patients with out-of-hospital cardiac arrest

AU - Stiell, Ian G.

AU - Nichol, Graham

AU - Leroux, Brian G.

AU - Rea, Thomas D.

AU - Ornato, Joseph P.

AU - Powell, Judy

AU - Christenson, James

AU - Callaway, Clifton W.

AU - Kudenchuk, Peter J.

AU - Aufderheide, Tom P.

AU - Idris, Ahamed H.

AU - Daya, Mohamud R.

AU - Wang, Henry E.

AU - Morrison, Laurie J.

AU - Davis, Daniel

AU - Andrusiek, Douglas

AU - Stephens, Shannon

AU - Cheskes, Sheldon

AU - Schmicker, Robert H.

AU - Fowler, Ray

AU - Vaillancourt, Christian

AU - Hostler, David

AU - Zive, Dana

AU - Pirrallo, Ronald G.

AU - Vilke, Gary M.

AU - Sopko, George

AU - Weisfeldt, Myron

PY - 2011/9/1

Y1 - 2011/9/1

N2 - Background: In a departure from the previous strategy of immediate defibrillation, the 2005 resuscitation guidelines from the American Heart Association-International Liaison Committee on Resuscitation suggested that emergency medical service (EMS) personnel could provide 2 minutes of cardiopulmonary resuscitation (CPR) before the first analysis of cardiac rhythm. We compared the strategy of a brief period of CPR with early analysis of rhythm with the strategy of a longer period of CPR with delayed analysis of rhythm. Methods: We conducted a cluster-randomized trial involving adults with out-of-hospital cardiac arrest at 10 Resuscitation Outcomes Consortium sites in the United States and Canada. Patients in the early-analysis group were assigned to receive 30 to 60 seconds of EMS-administered CPR and those in the later-analysis group were assigned to receive 180 seconds of CPR, before the initial electrocardiographic analysis. The primary outcome was survival to hospital discharge with satisfactory functional status (a modified Rankin scale score of ≤3, on a scale of 0 to 6, with higher scores indicating greater disability). Results: We included 9933 patients, of whom 5290 were assigned to early analysis of cardiac rhythm and 4643 to later analysis. A total of 273 patients (5.9%) in the later-analysis group and 310 patients (5.9%) in the early-analysis group met the criteria for the primary outcome, with a cluster-adjusted difference of -0.2 percentage points (95% confidence interval, -1.1 to 0.7; P = 0.59). Analyses of the data with adjustment for confounding factors, as well as subgroup analyses, also showed no survival benefit for either study group. Conclusions: Among patients who had an out-of-hospital cardiac arrest, we found no difference in the outcomes with a brief period, as compared with a longer period, of EMS-administered CPR before the first analysis of cardiac rhythm. (Funded by the National Heart, Lung, and Blood Institute and others; ROC PRIMED ClinicalTrials.gov number, NCT00394706.)

AB - Background: In a departure from the previous strategy of immediate defibrillation, the 2005 resuscitation guidelines from the American Heart Association-International Liaison Committee on Resuscitation suggested that emergency medical service (EMS) personnel could provide 2 minutes of cardiopulmonary resuscitation (CPR) before the first analysis of cardiac rhythm. We compared the strategy of a brief period of CPR with early analysis of rhythm with the strategy of a longer period of CPR with delayed analysis of rhythm. Methods: We conducted a cluster-randomized trial involving adults with out-of-hospital cardiac arrest at 10 Resuscitation Outcomes Consortium sites in the United States and Canada. Patients in the early-analysis group were assigned to receive 30 to 60 seconds of EMS-administered CPR and those in the later-analysis group were assigned to receive 180 seconds of CPR, before the initial electrocardiographic analysis. The primary outcome was survival to hospital discharge with satisfactory functional status (a modified Rankin scale score of ≤3, on a scale of 0 to 6, with higher scores indicating greater disability). Results: We included 9933 patients, of whom 5290 were assigned to early analysis of cardiac rhythm and 4643 to later analysis. A total of 273 patients (5.9%) in the later-analysis group and 310 patients (5.9%) in the early-analysis group met the criteria for the primary outcome, with a cluster-adjusted difference of -0.2 percentage points (95% confidence interval, -1.1 to 0.7; P = 0.59). Analyses of the data with adjustment for confounding factors, as well as subgroup analyses, also showed no survival benefit for either study group. Conclusions: Among patients who had an out-of-hospital cardiac arrest, we found no difference in the outcomes with a brief period, as compared with a longer period, of EMS-administered CPR before the first analysis of cardiac rhythm. (Funded by the National Heart, Lung, and Blood Institute and others; ROC PRIMED ClinicalTrials.gov number, NCT00394706.)

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