Resuscitation
Volume 71, Issue 1 , Pages 29-33, October 2006

Increasing first responder CPR during resuscitation of out-of-hospital cardiac arrest using automated external defibrillators☆

  • Sachita Shah

      Affiliations

    • Department of Emergency Medicine, Brigham and Women's Hospital and Mass General, Harvard University, 75 Francis Street, Neville House, Boston (SS), MA 02115, United States
    • ,
  • Michele Garcia

      Affiliations

    • University of Washington School of Medicine, 3608 19th Street, Bellingham, WA 98229, United States
    • Corresponding Author InformationCorresponding author. Tel.: +1 206 618 7116.
    • ,
  • Thomas D. Rea

      Affiliations

    • University of Washington School of Medicine, Emergency Medical Services Division, Public Health-Seattle and King County (TDR), 999 3rd Avenue, Suite 700, Seattle, WA 98104, United States
    • Tel.: +1 206 296 4693; fax: +1 206 296 4866.

Received 21 October 2005; received in revised form 15 February 2006; accepted 15 February 2006.

Summary 

Objective

Evidence supports that increasing the balance of “hands-on” CPR may improve survival in ventricular fibrillation out-of-hospital cardiac arrest (OHCA). We assessed whether training and/or AED reconfiguration was associated with an increase in the proportion of time during which CPR was performed between first and second stacks of shocks.

Methods

The investigation was a cohort study of 291 persons who suffered ventricular fibrillation OHCA and were treated with at least two stacks of AED shocks by emergency medical services (EMS) first-tier responders. In January 2003, first-tier providers were retrained regarding the importance of CPR. In addition, a subset of AEDs was reconfigured to remove continuous fibrillation detection and its associated voice prompts as to be comparable with other AED models. The amount of time spent on CPR was assessed through review of AED electronic and audio recordings to compare the pre-intervention (n=241) and post-intervention periods (n=50).

Results

The proportion of time spent performing hands-on CPR between first and second stacks of shocks was 0.40 in the pre-intervention period compared to 0.51 in the post-intervention period (p=0.001). The difference was greatest for AEDs where EMS was retrained and the AED reconfigured (0.33 versus 0.50, p=0.01). No difference in survival was detected between the pre- and post-intervention periods (24.9% versus 28.0%, p=0.65).

Conclusions

An intervention consisting of retraining and AED reconfiguration was associated with an increase in the proportion of time spent performing CPR between first and second stacks of shocks by first-tier EMS. Whether this increase improves patient outcomes requires additional study.

Keywords: Automated external defibrillator (AED), Cardiopulmonary resuscitation (CPR), Basic life support (BLS), Ventricular fibrillation

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☆ A Spanish translated version of the summary of this article appears as Appendix in the online version at 10.1016/j.resuscitation.2006.02.021.

PII: S0300-9572(06)00130-4

doi:10.1016/j.resuscitation.2006.02.021

Resuscitation
Volume 71, Issue 1 , Pages 29-33, October 2006

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