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Multicenter Study
. 2009 Sep 29;120(13):1241-7.
doi: 10.1161/CIRCULATIONAHA.109.852202. Epub 2009 Sep 14.

Chest compression fraction determines survival in patients with out-of-hospital ventricular fibrillation

Jim Christenson  1 , Douglas Andrusiek, Siobhan Everson-Stewart, Peter Kudenchuk, David Hostler, Judy Powell, Clifton W Callaway, Dan Bishop, Christian Vaillancourt, Dan Davis, Tom P Aufderheide, Ahamed Idris, John A Stouffer, Ian Stiell, Robert Berg; Resuscitation Outcomes Consortium Investigators
Affiliations
Multicenter Study

Chest compression fraction determines survival in patients with out-of-hospital ventricular fibrillation

Jim Christenson et al. Circulation. .

Abstract

Background: Quality cardiopulmonary resuscitation contributes to cardiac arrest survival. The proportion of time in which chest compressions are performed in each minute of cardiopulmonary resuscitation is an important modifiable aspect of quality cardiopulmonary resuscitation. We sought to estimate the effect of an increasing proportion of time spent performing chest compressions during cardiac arrest on survival to hospital discharge in patients with out-of-hospital ventricular fibrillation or pulseless ventricular tachycardia.

Methods and results: This is a prospective observational cohort study of adult patients from the Resuscitation Outcomes Consortium Cardiac Arrest Epistry with confirmed ventricular fibrillation or ventricular tachycardia, no defibrillation before emergency medical services arrival, electronically recorded cardiopulmonary resuscitation before the first shock, and a confirmed outcome. Patients were followed up to discharge from the hospital or death. Of the 506 cases, the mean age was 64 years, 80% were male, 71% were witnessed by a bystander, 51% received bystander cardiopulmonary resuscitation, 34% occurred in a public location, and 23% survived. After adjustment for age, gender, location, bystander cardiopulmonary resuscitation, bystander witness status, and response time, the odds ratios of surviving to hospital discharge in the 2 highest categories of chest compression fraction compared with the reference category were 3.01 (95% confidence interval 1.37 to 6.58) and 2.33 (95% confidence interval 0.96 to 5.63). The estimated adjusted linear effect on odds ratio of survival for a 10% change in chest compression fraction was 1.11 (95% confidence interval 1.01 to 1.21).

Conclusions: An increased chest compression fraction is independently predictive of better survival in patients who experience a prehospital ventricular fibrillation/tachycardia cardiac arrest.

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Figures

Figure 1
Figure 1
Study Cohort and Exclusions
Figure 2
Figure 2
Survival to discharge for each CCF category
Figure 3
Figure 3
Smoothing spline representing the incremental probability of survival corresponding to a linear increase in chest compression fraction
See this image and copyright information in PMC

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