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Randomized Controlled Trial
. 2014 Mar;85(3):336-42.
doi: 10.1016/j.resuscitation.2013.10.014. Epub 2013 Oct 25.

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

Sheldon Cheskes  1 , Robert H Schmicker  2 , P Richard Verbeek  3 , David D Salcido  4 , Siobhan P Brown  2 , Steven Brooks  5 , James J Menegazzi  4 , Christian Vaillancourt  6 , Judy Powell  2 , Susanne May  2 , Robert A Berg  7 , Rebecca Sell  8 , Ahamed Idris  9 , Mike Kampp  10 , Terri Schmidt  10 , Jim Christenson  11 ; Resuscitation Outcomes Consortium (ROC) investigators
Affiliations
Randomized Controlled Trial

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

Sheldon Cheskes et al. Resuscitation. 2014 Mar.

Abstract

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

Objective: 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 22.0 s (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 <10s (OR: 1.52, 95% CI: 1.09, 2.11) and peri-shock pause <20s (OR: 1.82, 95% CI: 1.17, 2.85) when compared to patients with pre-shock pause ≥ 20s and peri-shock pause ≥ 40s. Post-shock pause was not significantly associated with survival to hospital discharge. Results for neurologically intact survival (Modified Rankin Score ≤ 3) were similar to our primary outcome.

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.

Keywords: Cardiopulmonary resuscitation; Heart arrest; Resuscitation; Survival.

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Conflict of interest statement

Conflict of interest statement

Drs. Cheskes, Christenson, Menegazzi, Idris as well as Susanne May and Judy Powell receive ROC grant funding. Dr. Brooks was supported by a Heart and Stroke Foundation Jumpstart Resuscitation Scholarship. Dr. Cheskes has received speaking honorarium from Zoll Medical. No other grant disclosures.

Figures

Fig. 1
Fig. 1
Consort diagram of study cohort.
Fig. 2
Fig. 2
Plot of unadjusted survival to hospital discharge versus median shock pause interval. Survival results are shown as column plots referring to the left-side axis, categorized into 5 shock pause interval ranges, and stratified by pre-shock and post-shock pause classification. Counts of available cases for each survival estimate are shown for each shock pause interval range as line plots referring to the right-side axis.
See this image and copyright information in PMC

Comment in

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