Limits...
Use of cardiocerebral resuscitation or AHA/ERC 2005 Guidelines is associated with improved survival from out-of-hospital cardiac arrest: a systematic review and meta-analysis.

Salmen M, Ewy GA, Sasson C - BMJ Open (2012)

Bottom Line: All the three studies using CCR demonstrated significantly improved survival compared to use of AHA 2000 Guidelines, as did five of the nine studies using AHA/ERC 2005 Guidelines.Studies using AHA/ERC 2005 Guidelines showed an overall trend towards increased survival, but significant heterogeneity existed among these studies.We demonstrate an association with improved survival from OHCA when CCR protocols or AHA/ERC 2005 Guidelines are compared to use of older guidelines.

View Article: PubMed Central - PubMed

Affiliation: Department of Emergency Medicine & Internal Medicine, Hennepin County Medical Center, Minneapolis, Minnesota, USA.

ABSTRACT

Objective: To determine whether the use of cardiocerebral resuscitation (CCR) or AHA/ERC 2005 Resuscitation Guidelines improved patient outcomes from out-of-hospital cardiac arrest (OHCA) compared to older guidelines.

Design: Systematic review and meta-analysis.

Data sources: MEDLINE, EMBASE, Web of Science and the Cochrane Library databases. We also hand-searched study references and consulted experts.

Study selection: Design: randomised controlled trials and observational studies.

Population: OHCA patients, age >17 years.

Comparators: 'Control' protocol versus 'Study' protocol. 'Control' protocol defined as AHA/ERC 2000 Guidelines for cardiopulmonary resuscitation (CPR). 'Study' protocol defined as AHA/ERC 2005 Guidelines for CPR, or a CCR protocol.

Outcome: Survival to hospital discharge.

Quality: High-quality or medium-quality studies, as measured by the Newcastle Ottawa Scale using predefined categories.

Results: Twelve observational studies met inclusion criteria. All the three studies using CCR demonstrated significantly improved survival compared to use of AHA 2000 Guidelines, as did five of the nine studies using AHA/ERC 2005 Guidelines. Pooled data demonstrate that use of a CCR protocol has an unadjusted OR of 2.26 (95% CI 1.64 to 3.12) for survival to hospital discharge among all cardiac arrest patients. Among witnessed ventricular fibrillation/ventricular tachycardia (VF/VT) patients, CCR increased survival by an OR of 2.98 (95% CI 1.92 to 4.62). Studies using AHA/ERC 2005 Guidelines showed an overall trend towards increased survival, but significant heterogeneity existed among these studies.

Conclusions: We demonstrate an association with improved survival from OHCA when CCR protocols or AHA/ERC 2005 Guidelines are compared to use of older guidelines. In the subgroup of patients with witnessed VF/VT, there was a threefold increase in OHCA survival when CCR was used. CCR appears to be a promising resuscitation protocol for Emergency Medical Services providers in increasing survival from OHCA. Future research will need to be conducted to directly compare AHA/ERC 2010 Guidelines with the CCR approach.

No MeSH data available.


Related in: MedlinePlus

Flow chart depicting the outline of study selection process.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
getmorefigures.php?uid=PMC4401819&req=5

BMJOPEN2012001273F1: Flow chart depicting the outline of study selection process.

Mentions: To be considered for inclusion, studies must have explicitly stated use of AHA 2000 Guidelines or ERC 2000 Guidelines as their EMS ‘control’ protocol. These studies had to directly compare EMS use of AHA 2000/ERC 2000 Guidelines to either AHA 2005, ERC 2005 or CCR protocols. CCR has several distinct and important differences from the AHA and ERC Guidelines for CPR, which are illustrated in figure 1. We defined an EMS study protocol to be a CCR protocol if it contained four of five critical elements 12: (1) 200 chest compressions upon initial EMS arrival; (2) if indicated, administration of a single, direct shock; (3) immediate postshock 200 chest compressions; (4) delayed intubation until after three full cycles and (5) administration of epinephrine as soon as possible.


Use of cardiocerebral resuscitation or AHA/ERC 2005 Guidelines is associated with improved survival from out-of-hospital cardiac arrest: a systematic review and meta-analysis.

Salmen M, Ewy GA, Sasson C - BMJ Open (2012)

Flow chart depicting the outline of study selection process.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4401819&req=5

BMJOPEN2012001273F1: Flow chart depicting the outline of study selection process.
Mentions: To be considered for inclusion, studies must have explicitly stated use of AHA 2000 Guidelines or ERC 2000 Guidelines as their EMS ‘control’ protocol. These studies had to directly compare EMS use of AHA 2000/ERC 2000 Guidelines to either AHA 2005, ERC 2005 or CCR protocols. CCR has several distinct and important differences from the AHA and ERC Guidelines for CPR, which are illustrated in figure 1. We defined an EMS study protocol to be a CCR protocol if it contained four of five critical elements 12: (1) 200 chest compressions upon initial EMS arrival; (2) if indicated, administration of a single, direct shock; (3) immediate postshock 200 chest compressions; (4) delayed intubation until after three full cycles and (5) administration of epinephrine as soon as possible.

Bottom Line: All the three studies using CCR demonstrated significantly improved survival compared to use of AHA 2000 Guidelines, as did five of the nine studies using AHA/ERC 2005 Guidelines.Studies using AHA/ERC 2005 Guidelines showed an overall trend towards increased survival, but significant heterogeneity existed among these studies.We demonstrate an association with improved survival from OHCA when CCR protocols or AHA/ERC 2005 Guidelines are compared to use of older guidelines.

View Article: PubMed Central - PubMed

Affiliation: Department of Emergency Medicine & Internal Medicine, Hennepin County Medical Center, Minneapolis, Minnesota, USA.

ABSTRACT

Objective: To determine whether the use of cardiocerebral resuscitation (CCR) or AHA/ERC 2005 Resuscitation Guidelines improved patient outcomes from out-of-hospital cardiac arrest (OHCA) compared to older guidelines.

Design: Systematic review and meta-analysis.

Data sources: MEDLINE, EMBASE, Web of Science and the Cochrane Library databases. We also hand-searched study references and consulted experts.

Study selection: Design: randomised controlled trials and observational studies.

Population: OHCA patients, age >17 years.

Comparators: 'Control' protocol versus 'Study' protocol. 'Control' protocol defined as AHA/ERC 2000 Guidelines for cardiopulmonary resuscitation (CPR). 'Study' protocol defined as AHA/ERC 2005 Guidelines for CPR, or a CCR protocol.

Outcome: Survival to hospital discharge.

Quality: High-quality or medium-quality studies, as measured by the Newcastle Ottawa Scale using predefined categories.

Results: Twelve observational studies met inclusion criteria. All the three studies using CCR demonstrated significantly improved survival compared to use of AHA 2000 Guidelines, as did five of the nine studies using AHA/ERC 2005 Guidelines. Pooled data demonstrate that use of a CCR protocol has an unadjusted OR of 2.26 (95% CI 1.64 to 3.12) for survival to hospital discharge among all cardiac arrest patients. Among witnessed ventricular fibrillation/ventricular tachycardia (VF/VT) patients, CCR increased survival by an OR of 2.98 (95% CI 1.92 to 4.62). Studies using AHA/ERC 2005 Guidelines showed an overall trend towards increased survival, but significant heterogeneity existed among these studies.

Conclusions: We demonstrate an association with improved survival from OHCA when CCR protocols or AHA/ERC 2005 Guidelines are compared to use of older guidelines. In the subgroup of patients with witnessed VF/VT, there was a threefold increase in OHCA survival when CCR was used. CCR appears to be a promising resuscitation protocol for Emergency Medical Services providers in increasing survival from OHCA. Future research will need to be conducted to directly compare AHA/ERC 2010 Guidelines with the CCR approach.

No MeSH data available.


Related in: MedlinePlus