12/5/2023 0 Comments Acls chest compression fraction![]() This was the outcome for all comers, all rhythms and with ventricular fibrillation accounting for only about 22% in both groups. In the asynchronous ventilation group, overall survival was 9.7% (7.7% with most favorable neurological outcome) versus 9.0% in the continuous compression group (7% with most favorable outcome). The ROC study concluded that there was no significant difference between the two techniques with regard to survival to discharge. In the NEJM-reported trial, 8 clinical sites representing 114 EMS agencies enrolled 23,711 patients. Study centers provide high quality CPR and performance is measured through the use of recording monitor defibrillators. ROC is a well-seasoned research network that has been performing out of hospital resuscitation research for the last decade. Now, on the heels of the recommendations is an important large study conducted by the Resuscitation Outcomes Consortion (ROC) that compares continuous chest compressions with asynchronous BVM ventilation (the study intervention) against CPR with compression pauses for breaths (the study control) in patients without an advanced airway placed. These guidelines were based upon the best evidence available at the time of 2015 guideline development. For 1 and 2 rescuer CPR in adults they recommend interrupted compressions with thirty compressions followed by 2 breaths (30:2) during which chest compressions are withheld, consistent as well with the recommendations of ILCOR. ![]() The AHA guidelines endorse a strategy of continuous compressions with “asynchronous” ventilations during CPR in patients with an advanced airway, that is, breaths interposed every six seconds without interruption in CPR-OR 10 breaths/minute without stopping CPR. The 2015 AHA and ILCOR guidelines are hot off the press. But do you need to ventilate at all ? If so, how much and how frequently? We are pretty sure that pauses in CPR can be fatal, but maybe short pauses for ventilation are necessary or superior?Ģ015 CPR Guidelines already outdated by ROC? We can now unequivocally define the important parameters of “high performance CPR”: adequate depth (at least 2 inches), complete recoil of the chest, adequate rate (probably about 110/min) and a chest compression fraction or CCF (proportion of each minute chest compressions are being applied) of greater than 60% (per guidelines, but most of us have much higher goals of around 90), minimize pauses and don’t over-ventilate. And yet we are still far from sure of the best way to apply chest compressions and ventilation. We do know that of all of the drugs, tubes and mechanical devices we’ve assessed through the years, the only certain thing is that early effective CPR saves lives and that better CPR saves lives better. Since the recommendations seem to change on a frequent basis, many of us have trouble keeping up with what really is best. We have studied drugs, tools and techniques and have created an industry that brings the best and latest techniques to the medical and lay community, even though the evidence is often anecdotal or scant. The ensuing decades produced extensive research on the best treatment of sudden cardiac death. Fast forward to 2015 and it is interesting that we are still working on the details of this amazing advance in medicine. Yet resuscitation research continues to be fraught with difficulty, and physicians need to recognize its limitations.Ī few years ago, we celebrated an important 50th anniversary: the advent of closed-chest cardiopulmonary massage was published in JAMA in 1960 by Kouwenhoven, Jude and Knickerbocker. The recent AHA and ILCOR CPR guidelines and ROC trial findings codified important, current knowledge about CPR.
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