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Resuscitation. 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.

Author information

1
University of Toronto, Toronto, ON, Canada. Electronic address: Sheldon.Cheskes@sunnybrook.ca.
2
University of Washington, Seattle, WA, United States.
3
University of Toronto, Toronto, ON, Canada.
4
University of Pittsburgh, Pittsburgh, PA, United States.
5
Queens University, Kingston, ON, Canada.
6
University of Ottawa, Ottawa, ON, Canada.
7
Children's Hospital of Philadelphia and University of Pennsylvania, Philadelphia, PA, United States.
8
University of California/San Diego, San Diego, CA, United States.
9
University of Texas Southwestern Medical Center, Dallas, TX, United States.
10
Oregon Health and Science University, Portland, OR, United States.
11
University of British Columbia, Vancouver, BC, Canada.

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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