Margaret Mullins

CPR variability during ground ambulance transport of patients in cardiac arrest.

AIM OF STUDY High-quality CPR is associated with improved outcomes from out-of-hospital cardiac arrest (OHCA). The purpose of this investigation was to compare the quality of CPR provided at the prehospital scene, during ambulance transport, and during the early minutes in the emergency department (ED). METHODS A prospective observational review of consecutive adult patients with non-traumatic OHCA was conducted between September 2008 and February 2010. Patients with initiation of prehospital CPR were included as part of a statewide cardiac resuscitation quality improvement program. A monitor-defibrillator with accelerometer-based CPR measurement capability (E-series, ZOLL Medical) was utilized. CPR quality measures included variability in chest compression (CC) depth and rate, mean depth and rate, and the CC fraction. Variability of CC was defined as the mean of minute-to-minute standard deviation in CC depth or rate. CC fraction was defined as the percent of time that CPR was being performed when appropriate throughout resuscitation. RESULTS Fifty-seven adult patients with OHCA had electronic CPR data recorded at the scene, in the ambulance, and upon arrival in the ED. Across time periods, there was increased variability in CC depth (scene: 0.20 in.; transport: 0.26 in.; ED: 0.31 in., P<0.01) and rate (scene: 18.2 CC min(-1); transport: 26.1 CC min(-1); ED: 26.3 CC min(-1), P<0.01). The mean CC depth, rate, and the CC fraction did not differ significantly between groups. CONCLUSIONS There was increased CC variability from the prehospital scene to the ED though there was no difference in mean CC depth, rate, or in CC fraction. The clinical significance of CC variability remains to be determined.

Duration of Coma in Out-of-Hospital Cardiac Arrest Survivors Treated With Targeted Temperature Management.

Study objective: We evaluate the time to awakening after out‐of‐hospital cardiac arrest in patients treated with targeted temperature management and determine whether there was an association with any patient or event characteristics. Methods: This was a prospective, observational cohort study of consecutive adult survivors of out‐of‐hospital cardiac arrest of presumed cardiac cause who were treated with targeted temperature management between January 1, 2008, and March 31, 2014. Data were obtained from hospitals and emergency medical services agencies responding to approximately 90% of Arizonas population as part of a state‐sponsored out‐of‐hospital cardiac arrest quality improvement initiative. Results: Among 573 out‐of‐hospital cardiac arrest patients who completed targeted temperature management, 316 became responsive, 60 (19.0%) of whom woke up at least 48 hours after rewarming. Eight patients (2.5%) became responsive more than 7 days after rewarming, 6 of whom were discharged with a good Cerebral Performance Category score (1 or 2). There were no differences in standard Utstein variables between the early and late awakeners. The early awakeners were more likely to be discharged with a good Cerebral Performance Category score (odds ratio 2.93; 95% confidence interval 1.09 to 7.93). Conclusion: We found that a substantial proportion of adult out‐of‐hospital cardiac arrest survivors treated with targeted temperature management became responsive greater than 48 hours after rewarming, with a resultant good neurologic outcome.