Influence of Cardiopulmonary Resuscitation Prior to Defibrillation in Patients With Out-of-Hospital Ventricular Fibrillation

CONTEXT Use of automated external defibrillators (AEDs) by first arriving emergency medical technicians (EMTs) is advocated to improve the outcome for out-of-hospital ventricular fibrillation (VF). However, adding AEDs to the emergency medical system in Seattle, Wash, did not improve survival. Studi...

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Bibliographic Details
Published in:JAMA : the journal of the American Medical Association 1999-04, Vol.281 (13), p.1182-1188
Main Authors: Cobb, Leonard A, Fahrenbruch, Carol E, Walsh, Thomas R, Copass, Michael K, Olsufka, Michele, Breskin, Maryann, Hallstrom, Alfred P
Format: Article
Language:English
Subjects:
Aged
Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy
Biological and medical sciences
Cardiopulmonary Resuscitation
Cardiovascular disease
CPR
Electric Countershock
Emergency and intensive cardiocirculatory care. Cardiogenic shock. Coronary intensive care
Emergency Medical Services
Emergency Medical Technicians
Evaluation Studies as Topic
Female
Humans
Intensive care medicine
Lifesaving
Logistic Models
Male
Medical sciences
Middle Aged
Prospective Studies
Statistics, Nonparametric
Survival Analysis
Treatment Outcome
Ventricular Fibrillation - mortality
Ventricular Fibrillation - therapy
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Summary:CONTEXT Use of automated external defibrillators (AEDs) by first arriving emergency medical technicians (EMTs) is advocated to improve the outcome for out-of-hospital ventricular fibrillation (VF). However, adding AEDs to the emergency medical system in Seattle, Wash, did not improve survival. Studies in animals have shown improved outcomes when cardiopulmonary resuscitation (CPR) was administered prior to an initial shock for VF of several minutes' duration. OBJECTIVE To evaluate the effects of providing 90 seconds of CPR to persons with out-of-hospital VF prior to delivery of a shock by first-arriving EMTs. DESIGN Observational, prospectively defined, population-based study with 42 months of preintervention analysis (July 1, 1990-December 31, 1993) and 36 months of postintervention analysis (January 1, 1994-December 31, 1996). SETTING Seattle fire department–based, 2-tiered emergency medical system. PARTICIPANTS A total of 639 patients treated for out-of-hospital VF before the intervention and 478 after the intervention. INTERVENTION Modification of the protocol for use of AEDs, emphasizing approximately 90 seconds of CPR prior to delivery of a shock. MAIN OUTCOME MEASURES Survival and neurologic status at hospital discharge determined by retrospective chart review as a function of early (
ISSN:0098-7484
1538-3598
DOI:10.1001/jama.281.13.1182