An emergency medical service introduced a cardiocerebral resuscitation protocol and compared outcomes with a standard ACLS protocol.
Cardiocerebral resuscitation (CCR) was defined as:
- initiation of 200 immediate, uninterrupted chest compressions at a rate of 100 compressions ⁄ min
- analyzing the rhythm and delivering a single defibrillator shock, if indicated
- 200 more chest compressions before the first pulse check or rhythm reanalysis
- epinephrine (1 mg intravenous or intraosseous) as soon as possible or with each 200 compression cycle
- endotracheal intubation delayed until after three cycles of chest compressions
Data was analysed from a registry including data on 3515 patients from 62 EMS agencies, some of which instituted CCR (in a total of 1024 patients). Outcome predictors were identified using logistic regression analysis and
Individuals who received CCR had better outcomes across age groups. The increase in survival for the subgroup with a witnessed Vfib was most prominent on those <40 years of age (3.7% for standard ALS patients vs. 19% for CCR patients, odds ratio [OR] = 5.94, 95% confidence interval [CI] = 1.82 to 19.26). Neurologic outcomes were also better in the patients who received CCR (OR = 6.64, 95% CI = 1.31 to 32.8). Within the subgroup that received CCR, the factors most predictive of improved survival included witnessed arrest, initial rhythm of Vfib⁄Vtach, agonal respirations upon arrival, EMS response time, and age. Neurologic outcome was not adversely affected by age.
Cardiocerebral Resuscitation Is Associated With Improved Survival and Neurologic Outcome from Out-of-hospital Cardiac Arrest in Elders
Academic Emergency Medicine 2010;17(3):269 – 275