CPR quality during out-of-hospital cardiac arrest transport

Abstract

Background: Previous studies have demonstrated significant associations between cardiopulmonary resuscitation (CPR) quality metrics and survival to hospital discharge. No adequately powered study has explored the relationship between location of resuscitation (scene vs. transport) and CPR quality.

Methods: We analyzed CPR quality data from treated adult OHCA occurring over a 40 month period beginning January 1, 2013 from the Rescu Epistry-cardiac arrest database. High quality CPR was defined as chest compression fraction (CCF) >0.7, compression rate >100/min and compression depth >5.0cm. Our primary objective was to compare the proportion of resuscitations for which all CPR quality benchmarks were met between scene and transport phases of resuscitation. Our secondary objectives were to compare the quality of CPR between the scene phase and transport phase of resuscitation.

Results: The proportion of patients with high quality CPR was similar on scene compared to during transport (45.8% vs. 42.5%; ∆ 3.3 %; 95% CI: -1.4, 8.1). Regarding individual CPR metrics, median compression rate was higher on scene compared to transport (105.8 compressions per minute (cpm) vs. 102.0cpm; ∆ 3.8cpm; 95% CI: 2.5, 4.0), while median compression depth (5.56cm vs. 5.33cm; ∆ 0.23cm; 95% CI: 0.12, 0.26) and median CCF (0.95 vs. 0.87; ∆ 0.08; 95% CI: 0.07, 0.08) were higher during the transport phase.

Conclusions: High quality CPR metrics were similar in both (scene and transport) locations of resuscitation. These results suggest that high quality, manual compressions can be performed by prehospital providers regardless of location.

Keywords: Cardiac arrest; Cardiopulmonary resuscitation; Emergency medical services; Paramedic; Resuscitation; Survival.