Guidelines changes for cardiopulmonary resuscitation and emergency cardiovascular care have improved neurologically intact survival for patients suffering out-of-hospital cardiac arrest, according to research presented during Saturday’s Resuscitation Science Symposium at Scientific Sessions.
The guidelines changes, which were recommended in 2005 and 2010 by the International Consensus on CPR and ECC Science with Treatment Recommendations (CoSTR), have improved the odds ratio of neurologically intact survival by 1.6 and 2.3, respectively, compared to baseline recommendations published in 2000.
“The most significant changes in the CoSTR2005 and CoSTR2010 recommendations were to increase the chest compressions delivered per minute and to reduce interruptions in chest compressions during CPR,” said Ken Nagao, MD, PhD, from the cardiovascular center at Nihon University Hospital, Tokyo, Japan. “Early access to CPR, early chest compressions and early defibrillation are the most important changes in these guidelines.”
Nagao is lead author of the study, which was one of the “Best of the Best” oral abstract presentations at the 2016 Resuscitation Science Symposium.
The AHA and the International Liaison Committee on Resuscitation (ILCOR) published an initial set of joint guidelines for CPR and ECC in 2000.
Nagao’s research team used the All-Japan Utstein Registry, a prospective, nationwide, population-based observational registry, to identify adults treated with CPR following out-of-hospital cardiac arrest between 2005 and 2014. The 1,136,283 identified cases were divided into three groups based on the guidelines in place at the time of the cardiac arrest.
In the study, 100,509 patients (8.8 percent) were treated under the 2000 guidelines. Another 549,147 patients (48.3 percent) were treated under the CoSTR2005 guidelines that were in place from 2006 to 2010, and 486,627 patients (42.8 percent) were treated under the CoSTR2010 guidelines. The primary endpoint was a favorable 30-day neurological outcome.
Each guideline change placed increased emphasis on early access, early CPR, early defibrillation and early advanced life support, Nagao said.
“The greatest single advance was the change from the older protocol of three stacked defibrillation shocks put in place in 2000 to a one-shock scenario followed by two minutes of additional CPR,” Nagao said. “When it comes to CPR, the most important changes emphasized early chest compressions with minimal interruptions to compressions, to push hard, push fast and allow for complete chest recoil between compressions.”
In the study, CoSTR2005 and CoSTR2010 were independent predictors of favorable 30-day neurological outcomes for both witnessed and unwitnessed out-of-hospital cardiac arrest compared to the original 2000 guidelines. For individuals with a witnessed out-of-hospital cardiac arrest, CoSTR2005 guidelines had an odds ratio of 1.9 compared to the 2000 guidelines, and the CoSTR2010 guidelines had an odds ratio of 2.8. Individuals with an unwitnessed cardiac arrest showed similar odds ratios of 1.3 under CoSTR2005 and 1.6 under CoSTR2010.
“These changes to CPR maneuvers and protocols were helpful to save lives and improve neurological outcomes,” Nagao said. “We are conducting a new study to assess the quality of CPR using new, simpler CPR methods that have been developed in recent years. Resuscitation programs must establish processes for continuous quality improvement to reduce the time to CPR and shock delivery and to improve the quality of CPR delivered.”