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N Engl J Med. 2011 Sep 1;365(9):787-97. doi: 10.1056/NEJMoa1010076.

Early versus later rhythm analysis in patients with out-of-hospital cardiac arrest.

Collaborators (415)

Kerby JD, Wang HE, Brown TB, Stephens SW, Williams CR, Caldwell S, Lai KR, Gray R, Acker JE, Minor ML, Reed J, Begue J, Gilford W, Idris AH, Fowler R, Miller R, Minei J, Pepe P, Ramsay M, Simonson R, Wigginton J, Beadle S, Climer D, Moffat M, Owens P, Gallegos D, O'Neill S, Smith R, Benitez F, Craft B, Detamble L, Deutsch S, Gillam T, Harvey T, Hewitt S, Isaacs M, Kayea T, LaChance R, Lehman T, Lemecha D, Malvik C, Mayer P, Metzger J, Miller D, Muse B, Pickard K, Ross B, Vinson C, Arze S, Black S, Bush M, Kelly R, Thornton E, Elder W, Marcucci J, Hum L, Gamber M, Aufderheide TP, Pirrallo RG, Brasel KJ, Winthrop AL, Klein JP, Brandt J, Bialkowski W, Noldin J, Sandoval C, Morrow K, Kitscha DJ, Burja BJ, von Briesen C, Sparks CW, Walsh P, Chianelli J, Forster R, Milbrath M, Pukansky L, Sternig K, Chin E, Frieberg N, Krueger K, Szewczuga D, Duerr T, Funk R, Jacobsen G, Spitzer J, Demien R, Martins J, Cohn J, Spahn RR, Jankowski M, James T, Wentlandt WE Jr, Berousek D, Satula BM, Behling JB, Redman DK, Hook S, Neargarder A, Singer J, Reminga T, Shepherd D, Holzhauer P, Rubin J, Skold C, Alvarez O, Harkins H, Barthell E, Haselow W, Yee A, Whitcomb J, Castro EE, Motarjeme S, Coogan P, Rader K, Glaspy J, Gerschke G, Croft H, Brin M, Wilson C, Johnson A, Kumprey W, Stiell I, Vaillancourt C, Wells G, Clement C, Da Ponti MA, Cummins J, Morrow S, Tym C, Lepage G, Banek J, Dreyer J, Munkley D, Prpic J, Maloney J, Colella P, Affleck A, Waldbillig D, Bradford P, Boyle K, Luinstra-Toohey L, Trickett J, Sykes N, Graham E, Ballah K, Hedges C, MacPhee R, DeRaad B, McCleary L, Christenson J, Andrusiek D, vanHeest R, Evans D, Hameed M, Pennington S, Connolly H, Todorova D, Christenson C, Aguirre C, Bishop D, Straight R, Twaites B, Donn S, Keetley R, Schafer N, Brannan S, Moffat G, Glinsbockel C, Anderson G, Wanger K, Balfour N, Goulding J, Callaway C, Tisherman S, Rittenberger J, Hostler D, Condle J, Kampmeyer M, Markham T, Morgan M, McMichael MR, Sabol P, Sicchitano G, Shrader A, Stull G, Groft W, McCaughan R, Rohrer R, Fuchs D, Guyette F, Jenkins W, Roth R, Walker H, Campbell T, Doshi A, MacLeod B, Daya MR, Schmidt TA, Newgard CD, Hedges JR, Griffiths DE, Zive DM, Monnig AW, Yekrang A, Tomlin B, Kampp M, Cook J, Burns J, Nelson M, Nakamura Y, Jui J, Sahni R, Warden CR, Freedman S, Shertz M, Muhr MD, Stouffer JA, Cross J, Costigan J, Gorman K, Rosteck P, Verkest M, Newton C, Beeler T, Koenig K, Lee J, Barnes R, Boyce D, Allen B, Bishop TJ, Hollingsworth M, Schult E, Sullivan S, Williams R, Dehart S, Stevens M, Pizzo R, Hawks R, Glaser A, Chin J, Blount J, Zoutendijk G, Koppenhafer C, Depuy C, Hinds K, Noble T, Wittwer L, Albrich M, Carnevale T, Schlesinger P, Schmiedeskamp K, Reiter A, Arnold K, Ramey P, McDonald R, Walsh H, Davis D, Vilke G, Dunford JV, Aker DK, Barsalou T, Haynes B, Schwartz B, Mebust D, Bei R, Skeoch G, Grad M, Grover I, Glassman J, Andree SR, Morikado L, Kramer M, Calkins T, Tamsen M, Linnik W, Glasser J, Kudenchuk PJ, Rea TD, Copass M, Eisenberg MS, Olsufka M, Solberg D, Ragsdale S, Larsen J, Helbock M, Slutsky A, Morrison LJ, Dorian P, Craig A, Baker A, Hutchison J, Rotstein O, Verbeek PR, MacDonald R, Black S, Rizoli S, Cheskes S, Brooks S, Byers A, Taher A, Turgulov A, Bigham B, Cameron B, Wenkstern C, Zhan C, Foerster C, Beers C, Beecroft J, Frank J, Mercer M, Kernen M, Grife M, Qovaizi M, Van Rooyen P, DeMaio P, Chadha R, Chung S, Perreira T, Ryan W, Bradshaw D, Whiteley J, Burgess R, Waite T, Epp M, Feldman M, Olnyk R, Sage G, Moore J, Burton T, King K, Jones V, McNenly S, Benson A, Moran P, Nemeth M, Renaud R, Shield J, Silver D, Stevens J, Verbeek R, Webb K, Suthons R, Tyukodi S, Locke J, Mokedanz D, Beckett W, Cheskes S, Craig A, Redelmeier D, Hutchison J, Spence J, Kadic M, Driscoll S, Nowicky R, Hogan S, Simonini J, Burgess G, Braga D, Molyneaux LA, McLennan M, Walker J, Back A, Chen D, Kadic E, Mueller H, Tyrwhitt J, Vardy C, Renton J, McGrath-Chong M, Allan K, Bath K, Steeves L, Lewarne L, Pagulayan M, Piette M, Shahid N, Gobin R, Tessema S, Weisfeldt M, Ornato JP, Sopko G, Egan D, Lathrop D, Mascette A, Nickens PD, Wu C, Mitchell P, Hoke T, van Belle G, Emerson S, Nichol G, Leroux B, Powell J, Van Ottingham L, Sears G, Brown S, Schmicker R, Cook A, Rudser K, Ledingham RB, Bergsten-Buret B, Moore R, Gest A, Sitlani C, Koprowicz K, Thomas L, Gabriel E, Wu K, Schroeder D, Shen C, Kirdpoo W, Berhorst J, Leonen A, Wang Y, Hallstrom A.

Author information

1
Department of Emergency Medicine and Ottawa Hospital Research Institute, University of Ottawa, Ottawa. istiell@ohri.ca

Abstract

BACKGROUND:

In a departure from the previous strategy of immediate defibrillation, the 2005 resuscitation guidelines from the American Heart Association-International Liaison Committee on Resuscitation suggested that emergency medical service (EMS) personnel could provide 2 minutes of cardiopulmonary resuscitation (CPR) before the first analysis of cardiac rhythm. We compared the strategy of a brief period of CPR with early analysis of rhythm with the strategy of a longer period of CPR with delayed analysis of rhythm.

METHODS:

We conducted a cluster-randomized trial involving adults with out-of-hospital cardiac arrest at 10 Resuscitation Outcomes Consortium sites in the United States and Canada. Patients in the early-analysis group were assigned to receive 30 to 60 seconds of EMS-administered CPR and those in the later-analysis group were assigned to receive 180 seconds of CPR, before the initial electrocardiographic analysis. The primary outcome was survival to hospital discharge with satisfactory functional status (a modified Rankin scale score of ≤3, on a scale of 0 to 6, with higher scores indicating greater disability).

RESULTS:

We included 9933 patients, of whom 5290 were assigned to early analysis of cardiac rhythm and 4643 to later analysis. A total of 273 patients (5.9%) in the later-analysis group and 310 patients (5.9%) in the early-analysis group met the criteria for the primary outcome, with a cluster-adjusted difference of -0.2 percentage points (95% confidence interval, -1.1 to 0.7; P=0.59). Analyses of the data with adjustment for confounding factors, as well as subgroup analyses, also showed no survival benefit for either study group.

CONCLUSIONS:

Among patients who had an out-of-hospital cardiac arrest, we found no difference in the outcomes with a brief period, as compared with a longer period, of EMS-administered CPR before the first analysis of cardiac rhythm. (Funded by the National Heart, Lung, and Blood Institute and others; ROC PRIMED ClinicalTrials.gov number, NCT00394706.).

PMID:
21879896
PMCID:
PMC3181067
DOI:
10.1056/NEJMoa1010076
[Indexed for MEDLINE]
Free PMC Article

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