![]() ![]() For our secondary outcome, we used multivariable logistic regression to estimate the adjusted odds ratio of any out-of-hospital ROSC for each CCF category (0-40%, 41-60%, and 61-80%) relative to a CCF of 81-100%. For our primary outcome, we used multivariable logistic regression to estimate the adjusted odds ratio of survival to hospital discharge for each CCF category (0-40%, 41-60%, and 61-80%) relative to a CCF of 81-100%. We combined the 0-20% and the 20-40% groups for analyses because there were too few subjects in the 0-20% group. For our study population, we used descriptive statistics to compare the patient and system characteristics across categories of CCF (0-40%, 41-60%, 61-80%, and 81-100%). We used descriptive statistics to compare the patient and system characteristics for our study population to those excluded due to missing CPR process data or having less than one minute of analysable CPR time. The ROC PRIMED study and the ROC Epistry both received approval from all the US Institutional Review Boards, Canadian Research Ethics Boards, and EMS Services Institutional Review Boards at each of the participating sites. Patients were also excluded if they had less than one minute of analysable CPR process data available over the first five minutes, period during which CPR process data was most reliably available. We excluded patients for whom the statuses of out-of-hospital ROSC or survival to hospital discharge were missing. We excluded patients who received a shock from an AED prior to EMS arrival or preceding EMS CPR. All rhythm diagnoses were later confirmed by research staff. The initial rhythm was determined to be non-shockable if the initial automated external defibrillator (AED) did not recommend a shock, or if the EMS provider interpreted the initial rhythm to be other than VF/VT. In addition to collecting the elements suggested by Utstein, 21 ten of the eleven ROC regional centres also collected digitally recorded CPR process data (for example chest compression rate, depth, and pauses in compressions).Įligible patients for this study were adults (18 years of age and older) experiencing OHCA of presumed cardiac aetiology prior to EMS arrival for whom resuscitation was attempted, and initial rhythm was other than VF/VT (i.e. 20 Information collected by the ROC is subject to standardized operational definitions, and all data are managed by a central data coordinating centre. 19 The ROC Epistry has been collecting population-based prospective data on OHCA from more than 260 emergency medical service (EMS) agencies since December, 2005. 18 The ROC PRIMED study used a cluster-randomized design to study the impact of early (after no more than 30 to 60 seconds of CPR) or delayed (after 180 seconds of CPR) first rhythm analysis on OHCA survival outcomes. ROC is a clinical network of 11 regional centres distributed across North America conducting research in the fields of OHCA and life-threatening traumatic injury. This is a retrospective analysis (completed in 2016) of a cohort of OHCA patients prospectively enrolled either in the Resuscitation Outcomes Consortium (ROC) PRIMED study (from June 2007-November 2009) or in the ROC Epistry following the completion of the ROC PRIMED study (January 2010-April 2011). 17 This study, however, was relatively small (2,103 patients including 42 survivors) and was under-powered to robustly evaluate the impact of CCF on ROSC or clinical outcomes such as survival to hospital discharge. 16 A single prior study of this rhythm group suggested that higher CCF could possibly be associated with a higher incidence of return of spontaneous circulation (ROSC) among non-shockable OHCA victims. 1 Importantly, cardiac arrest aetiology and physiology may differ in the non-shockable group such that optimal CPR, including CCF, may also differ. This group now represents almost 75% of all OHCA victims, and has a substantially poorer prognosis compared to patients with an initial shockable rhythm. Very little is known about the impact of CCF in a population of OHCA patients with initial non-shockable rhythms (asystole and pulseless electrical activity). However, most studies have involved patients with an initial shockable rhythm (ventricular fibrillation or tachycardia, VF/VT). Higher CCF has been associated with both higher 11- 13 and lower 14, 15 survival to hospital discharge for OHCA patients. There currently exists conflicting evidence supporting efforts to achieve a greater CCF. ![]()
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