Relationship between chest compression rates and outcomes from cardiac arrest

Abstract

Background: Guidelines for cardiopulmonary resuscitation recommend a chest compression rate of at least 100 compressions per minute. Animal and human studies have reported that blood flow is greatest with chest compression rates near 120/min, but few have reported rates used during out-of-hospital (OOH) cardiopulmonary resuscitation or the relationship between rate and outcome. The purpose of this study was to describe chest compression rates used by emergency medical services providers to resuscitate patients with OOH cardiac arrest and to determine the relationship between chest compression rate and outcome.

Methods and results: Included were patients aged ≥ 20 years with OOH cardiac arrest treated by emergency medical services providers participating in the Resuscitation Outcomes Consortium. Data were abstracted from monitor-defibrillator recordings during cardiopulmonary resuscitation. Multiple logistic regression analysis assessed the association between chest compression rate and outcome. From December 2005 to May 2007, 3098 patients with OOH cardiac arrest were included in this study. Mean age was 67 ± 16 years, and 8.6% survived to hospital discharge. Mean compression rate was 112 ± 19/min. A curvilinear association between chest compression rate and return of spontaneous circulation was found in cubic spline models after multivariable adjustment (P=0.012). Return of spontaneous circulation rates peaked at a compression rate of ≈ 125/min and then declined. Chest compression rate was not significantly associated with survival to hospital discharge in multivariable categorical or cubic spline models.

Conclusions: Chest compression rate was associated with return of spontaneous circulation but not with survival to hospital discharge in OOH cardiac arrest.

Figure 1

An example of an electronic recording from a monitor-defibrillator showing the electrical channel (black line), the bioimpedance channel (green line), and red arrows marking each chest compression.

Figure 2

Study cohort and exclusions. EMS indicates emergency medical services.

Figure 3

Adjusted cubic spline of the relationship between chest compression rates and the probability of return of spontaneous circulation (ROSC). The adjusted model includes sex, age, bystander witnessed arrest, EMS witnessed arrest, first known EMS rhythm, attempted bystander CPR, public location, and site location (y-axis). Probability of ROSC versus average chest compression rate when other covariates are equal to the population average. We used a global test, which tested the null hypothesis that the spline curve is a horizontal line (p = 0.012). A histogram of the compression rates and numbers of patients is included. Dashed lines show 95% confidence intervals.

Figure 4

Adjusted cubic spline of the relationship between chest compression rates and the probability of survival to hospital discharge. The adjusted model includes sex, age, bystander witnessed arrest, EMS witnessed arrest, first known EMS rhythm, attempted bystander CPR, public location, and site location (y-axis). Probability of survival versus average chest compression rate when other covariates are equal to the population average. We used a global test, which tested the null hypothesis that the spline curve is a horizontal line (p = 0.63). A histogram of the compression rates and numbers of patients is included. Dashed lines show 95% confidence intervals.