• The impact of peri-shock pause on survival from out-of-hospital shockable cardiac arrest during the Resuscitation Outcomes Consortium PRIMED trial

    by Alan Batt. Last modified: 13/03/14

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    Summary

    • Observational statistical analysis of cohort of randomized controlled trial (ROC PRIMED, n=15,794) results
    • 2006 patients included from trial who suffered OHCA, presented with a shockable rhythm and had CPR process data for at least one shock.
      • Median (IQR) shock pause duration was:
        • pre-shock pause 15 secs (8, 22)
        • post-shock pause 6 secs (4, 9)
        • peri-shock pause 22.0 secs (14, 31)
      • Odds of survival to hospital discharge were significantly higher for patients with pre-shock pause <10 secs and peri-shock pause <20 secs
      • Post-shock pause was not significantly associated with survival to hospital discharge
      • Shorter pre- and peri-shock pauses were significantly associated with higher odds of survival.

    Limitations:

    • Excluded patients include EMS witnessed arrests, non-shockable arrests, arrests with PAD intervention, traumatic arrests and those with missing data.
    • Median age in cohort was younger than overall RCT (64y v 70y)
    • Observational study can only demonstrate an association – cannot prove temporal relationship (cause and effect).
    • 56% of sites in ROC PRIMED trial did not did not collect rate of compression depth data and so this could not be controlled or accounted for.
    • Missing shock pause data during this study was 11%.
    • Study took place in regions with high performing and heavily monitored prehospital care systems with rapid response times and overall high CPR quality – results may not be applicable to systems not meeting these criteria.

     
    Cheskes S1, Schmicker RH2, Verbeek PR3, Salcido DD4, Brown SP2, Brooks S5, Menegazzi JJ4, Vaillancourt C6, Powell J2, May S2, Berg RA7, Sell R8, Idris A9, Kampp M10, Schmidt T10, Christenson J11; Resuscitation Outcomes Consortium (ROC) investigators. The impact of peri-shock pause on survival from out-of-hospital shockable cardiac arrest during the Resuscitation Outcomes Consortium PRIMED trial. Resuscitation. 2014 Mar;85(3):336-42. PMID: 24513129.

    Abstract

    Background

    Previous research has demonstrated significant relationships between peri-shock pause and survival to discharge from out-of-hospital shockable cardiac arrest (OHCA).

    Objectives

    To determine the impact of peri-shock pause on survival from OHCA during the ROC PRIMED randomized controlled trial.

    Methods

    We included patients in the ROC PRIMED trial who suffered OHCA between June 2007 and November 2009, presented with a shockable rhythm and had CPR process data for at least one shock. We used multivariable logistic regression to determine the association between peri-shock pause duration and survival to hospital discharge.

    Results

    Among 2006 patients studied, the median (IQR) shock pause duration was: pre-shock pause 15s (8, 22); post-shock pause 6s (4, 9); and peri-shock pause 22.0s (14, 31). After adjusting for Utstein predictors of survival as well as CPR quality measures, the odds of survival to hospital discharge were significantly higher for patients with pre-shock pause

    Conclusions

    In patients with cardiac arrest presenting in a shockable rhythm during the ROC PRIMED trial, shorter pre- and peri-shock pauses were significantly associated with higher odds of survival. Future cardiopulmonary education and technology should focus on minimizing all peri-shock pauses.

    References

     
    1.

    Cheskes S1, Schmicker RH2, Verbeek PR3, Salcido DD4, Brown SP2, Brooks S5, Menegazzi JJ4, Vaillancourt C6, Powell J2, May S2, Berg RA7, Sell R8, Idris A9, Kampp M10, Schmidt T10, Christenson J11; Resuscitation Outcomes Consortium (ROC) investigators. The impact of peri-shock pause on survival from out-of-hospital shockable cardiac arrest during the Resuscitation Outcomes Consortium PRIMED trial. Resuscitation. 2014 Mar;85(3):336-42. PMID: 24513129.

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    Alan Batt

    Alan Batt

    Paramedic, educator, researcher
    Alan is a critical care paramedic, paramedic educator and prehospital researcher, currently working around the world as an educator and researcher. He has previously worked and studied across Europe, North America and the Middle East. He holds a Graduate Certificate in Intensive Care Paramedic Studies, and an MSc in Critical Care. His main interests are in care of the elderly, end-of-life care, patient safety, professionalism (including role and identity), and paramedic education.

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