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Quality of chest compressions during prehospital resuscitation phase from scene arrival to ambulance transport in out-of-hospital cardiac arrest

  • Stephen Gyung Won Lee
    Affiliations
    Department of Emergency Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Republic of Korea

    Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Republic of Korea
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  • Ki Jeong Hong
    Correspondence
    Correcponding author at: Department of Emergency Medicine, Seoul National University Hospital, Seoul, South Korea. Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, South Korea. 101 Daehak-Ro, Jongno-Gu, Seoul 03080, South Korea.
    Affiliations
    Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Republic of Korea

    Department of Emergency Medicine, Seoul National University Hospital, Seoul, Republic of Korea
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  • Tae Han Kim
    Affiliations
    Department of Emergency Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Republic of Korea

    Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Republic of Korea
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  • Seulki Choi
    Affiliations
    Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Republic of Korea

    Department of Emergency Medicine, Seoul National University Hospital, Seoul, Republic of Korea
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  • Sang Do Shin
    Affiliations
    Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Republic of Korea

    Department of Emergency Medicine, Seoul National University Hospital, Seoul, Republic of Korea
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  • Kyoung Jun Song
    Affiliations
    Department of Emergency Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Republic of Korea

    Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Republic of Korea
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  • Young Sun Ro
    Affiliations
    Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Republic of Korea

    Department of Emergency Medicine, Seoul National University Hospital, Seoul, Republic of Korea
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  • Joo Jeong
    Affiliations
    Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Republic of Korea

    Department of Emergency Medicine, Seoul National University Bundang Hospital, Seoul, Republic of Korea
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  • Yong Joo Park
    Affiliations
    Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Republic of Korea

    Department of Emergency Medicine, Seoul National University Hospital, Seoul, Republic of Korea
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  • Jeong Ho Park
    Affiliations
    Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Republic of Korea

    Department of Emergency Medicine, Seoul National University Hospital, Seoul, Republic of Korea
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      Abstract

      Aim

      Prehospital cardiopulmonary resuscitation is performed from scene arrival to hospital arrival. The diverse prehospital resuscitation phases can affect the quality of chest compressions. This study aimed to evaluate the dynamic changes in chest compression quality during prehospital resuscitation.

      Methods

      Adult out-of-hospital cardiac arrest patients treated without prehospital return of spontaneous circulation were included in Seoul between July 2020 and September 2021. The chest compressions quality was assessed using a real-time chest compression feedback device. The prehospital phase was divided by key events during the prehospital resuscitation timeline (phase 1: first 2 min after initiation of chest compression, phase 2: from the end of phase 1 to 1 min prior to ambulance departure; phase 3: from 1 min before to 1 min after ambulance departure; phase 4: from the end of phase 3 to hospital arrival). The main outcome was no-flow fraction. The no-flow fraction between prehospital phases was compared using repeated-measure analysis of variance.

      Results

      In total, 788 patients were included. Mean no-flow fraction was the highest in phase 3 (phase 1: 11.3% ± 13.8, phase 2: 19.3% ± 12.3, phase 3: 33.0% ± 34.9, phase 4: 18.7% ± 23.7, p < 0.001). The mean number of total no-flow events per minute was also the highest in phase 3. The minute-by-minute analysis showed that the no-flow fraction rapidly increased before ambulance departure and decreased during ambulance transport.

      Conclusion

      Dynamic changes in chest compression quality were observed during prehospital resuscitation phase. The no-flow fraction was the highest from 1 min before to 1 min after ambulance departure.

      Keywords

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      References

        • Virani S.S.
        • Alonso A.
        • Benjamin E.J.
        • et al.
        Heart disease and stroke statistics—2020 update: a report from the American Heart Association.
        Circulation. 2020; 141: e139-e596
        • Christenson J.
        • Andrusiek D.
        • Everson-Stewart S.
        • et al.
        Chest compression fraction determines survival in patients with out-of-hospital ventricular fibrillation.
        Circulation. 2009; 120: 1241-1247
        • Panchal A.R.
        • Bartos J.A.
        • Cabañas J.G.
        • et al.
        Part 3: adult basic and advanced life support: 2020 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care.
        Circulation. 2020; 142: S366-S468
        • Olasveengen T.M.
        • Semeraro F.
        • Ristagno G.
        • et al.
        European Resuscitation Council guidelines 2021: basic life support.
        Resuscitation. 2021; 161: 98-114
        • Zive D.
        • Koprowicz K.
        • Schmidt T.
        • et al.
        Variation in out-of-hospital cardiac arrest resuscitation and transport practices in the Resuscitation Outcomes Consortium: ROC Epistry-Cardiac Arrest.
        Resuscitation. 2011; 82: 277-284
        • Olasveengen T.M.
        • Mancini M.E.
        • Perkins G.D.
        • et al.
        Adult basic life support: 2020 international consensus on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations.
        Circulation. 2020; 142: S41-S91
        • Grunau B.
        • Kime N.
        • Leroux B.
        • et al.
        Association of intra-arrest transport vs continued on-scene resuscitation with survival to hospital discharge among patients with out-of-hospital cardiac arrest.
        JAMA. 2020; 324: 1058-1067
        • Ho A.F.W.
        • Ong M.E.H.
        Transportation during and after cardiac arrest: who, when, how and where?.
        Curr Opin Crit Care. 2021; 27: 223-231
        • Olasveengen T.M.
        • Wik L.
        • Steen P.A.
        Quality of cardiopulmonary resuscitation before and during transport in out-of-hospital cardiac arrest.
        Resuscitation. 2008; 76: 185-190
        • Roosa J.R.
        • Vadeboncoeur T.F.
        • Dommer P.B.
        • et al.
        CPR variability during ground ambulance transport of patients in cardiac arrest.
        Resuscitation. 2013; 84: 592-595
        • Ødegaard S.
        • Olasveengen T.
        • Steen P.A.
        • Kramer-Johansen J.
        The effect of transport on quality of cardiopulmonary resuscitation in out-of-hospital cardiac arrest.
        Resuscitation. 2009; 80: 843-848
        • Cheskes S.
        • Byers A.
        • Zhan C.
        • et al.
        CPR quality during out-of-hospital cardiac arrest transport.
        Resuscitation. 2017; 114: 34-39
        • Drinhaus H.
        • Nüsgen S.
        • Adams N.
        • Wetsch W.A.
        • Annecke T.
        Rescue under ongoing CPR from an upper floor: evaluation of three different evacuation routes and mechanical and manual chest compressions: a manikin trial.
        Scand J Trauma Resusc Emerg Med. 2020; 28: 1-8
        • Lyon R.M.
        • Crawford A.
        • Crookston C.
        • Short S.
        • Clegg G.R.
        The combined use of mechanical CPR and a carry sheet to maintain quality resuscitation in out-of-hospital cardiac arrest patients during extrication and transport.
        Resuscitation. 2015; 93: 102-106
        • Bekgöz B.
        • Şan İ.
        • Ergin M.
        Quality comparison of the manual chest compression and the mechanical chest compression during difficult transport conditions.
        J Emerg Med. 2020; 58: 432-438
        • Kramer-Johansen J.
        • Edelson D.P.
        • Losert H.
        • Köhler K.
        • Abella B.S.
        Uniform reporting of measured quality of cardiopulmonary resuscitation (CPR).
        Resuscitation. 2007; 74: 406-417
        • Jansen G.
        • Kipker K.
        • Latka E.
        • Borgstedt R.
        • Rehberg S.
        High-quality chest compressions are possible during intra-hospital transport, but depend on provider position: a manikin study.
        Eur J Anaesthesiol. 2020; 37: 286-293
        • Wang H.-C.
        • Chiang W.-C.
        • Chen S.-Y.
        • et al.
        Video-recording and time-motion analyses of manual versus mechanical cardiopulmonary resuscitation during ambulance transport.
        Resuscitation. 2007; 74: 453-460
        • Krarup N.H.
        • Terkelsen C.J.
        • Johnsen S.P.
        • et al.
        Quality of cardiopulmonary resuscitation in out-of-hospital cardiac arrest is hampered by interruptions in chest compressions—a nationwide prospective feasibility study.
        Resuscitation. 2011; 82: 263-269
        • Lateef F.
        • Anantharaman V.
        Delays in the EMS response to and the evacuation of patients in high-rise buildings in Singapore.
        Prehosp Emerg Care. 2000; 4: 327-332https://doi.org/10.1080/10903120090941047
        • Chew R.
        • Price C.
        • Moqadassi H.
        • et al.
        Impact of loading and transport on effectiveness of external chest compressions–a simulation study.
        Austr J Paramed. 2018; 15