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Study Report - CPR before DEFIB found to not make a difference!
Interesting report straight from FireRescue1.com that a recent study showed no advantage...
Study finds CPR before defibrillation insignificantContrary to traditional practice, some responders now delay defibrillation to allow for a short period of CPR based on 2005 recommendations
It doesn't matter whether or not EMTs do a few minutes' CPR before defibrillation of cardiac-arrest patients, researchers conclude in a meta-analysis that challenge international guidelines.
"The summary estimate of effect from this meta-analysis demonstrated not only a statistically non-significant result, but also a clinically nonsignificant result," Paul M. Simpson of the Ambulance Research Institute in Sydney, Australia, and colleagues noted online May 19 in Resuscitation.
Contrary to traditional practice, some EMTs now delay defibrillation to allow for a short period of CPR based on 2005 recommendations from the International Liaison Committee on Resuscitation. The guidelines followed findings from animals and two observational studies that suggested it would be easier to restore circulation after initial CPR.
"The prudent stance to take for many larger EMS organizations," the researchers add, "may be to maintain current resuscitation practices whether that is immediate or delayed defibrillation, and instead direct what are usually finite training resources and funding into ensuring the awareness and performance of effective CPR with uninterrupted chest compressions."
In a systematic review, Simpson and colleagues identified three randomized controlled trials that compared CPR before and after defibrillation. Each study was required to include between 90 to 180 seconds of initial CPR and to report survival discharge as the primary outcome.
Two studies were Australian and one was Norwegian; none of them found overall differences in survival regardless of whether patients received CPR first or immediate defibrillation. When pooling data from all 658 patients, the odds ratio was 0.94.
Replies to This Discussion
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Permalink Reply by Spanner 122 on
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I was under the impression the study (here it was called the ROC study, I'm assuming it was the same across North America) was to show whether defib should be done immediately or after the initial three minutes of CPR. By that, if we were early defib, we still did CPR while setting up the defib and the analyze button was pressed. We did not simply hook up the defib without compressions.
Has it been done in some areas without compressions at all? How does the blood move? I would think that while leads and pads are being put on compressions are being done (just like we do here).
All of that being said, they have found that it makes little difference, so basically start compressions either way.
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Permalink Reply by Norm Tindell on
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We'll check with our Medical Director to see what he has learned. Last we heard AHA guidelines were still the latest and best practice for first responders. Thanks for bringing this research to our attention.
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Permalink Reply by Mike Ward on
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The devil is in the details of the studies.
The Resuscitations Outcome Consortium (ROC) found a different outcome.
From a June 3, 2008 "The Seattle Secret" blog post:
Two years ago the National Institutes of Health joined other agencies to fund a $50 million Resuscitation Outcomes Consortium (ROC) that established ten research centers. The goal of the two-to-three year study is to oversee innovational clinical trials to determine the effectiveness of selected life-saving interventions.
http://www.utsouthwestern.edu/utsw/cda/dept37389/files/303192.html
ROC planned to enroll 15,000 cardiac arrest and 5,000 major trauma patients. At last week’s Society for Academic Emergency Medicine [ http://www.saem.org ] annual meeting some of the findings were shared in the presentation Bringing Back the Dead: From Down-Time to Doctor, What We Think We Know About Resuscitation, and What We Don’t Know That’s Killing Our Patients.
Some of the clinical interventions used equipment that measured the real-time activities during a cardiac arrest scenario, showing when ventilations, chest compressions and defibrillation occurred. One of the principal investigators (PI) noted that Seattle had some of the best spontaneous return of circulation rates within the study.
Looking at the data recorded during the resuscitation indicated that certain tasks were done in a different order in Seattle than in the PI’s hometown urban ems service. To get a better perspective, the PI rode with the paramedics in Seattle.
TEN MINUTES OF UNINTERRUPTED CHEST COMPRESSIONS
When Seattle Medic 1 paramedics arrive, the first medic immediately starts chest compressions at the rate of 120 compressions per minute. The second medic sets up the bag-valve-mask, defibrillator and starts the IV line. Intubation is not even considered until after ten minutes of compression are delivered.
The PI compared that procedure to his hometown urban paramedics, who traditionally place intubation as an initial clinical task. The recordings showed that while the paramedics were ventilating the patient with a bag-valve-mask while setting up the tube, no chest compressions were going on.
The cardiac arrest patient would have no chest compressions performed until six to ten minutes after the arrival of the paramedics. This was demonstrated in thousands of patients enrolled in the ROC study. The patients that received immediate chest compressions had a higher survival rate than those who were intubated first.
The PI, who has a day job as a medical director for an urban EMS agency, implemented the Seattle procedure based on his research. He has already documented an improvement in cardiac arrest patients in his hometown.
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Mike
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