Analysis of Bystander CPR Quality During Out-of-Hospital Cardiac Arrest Using Data Derived from Automated External Defibrillators
CCCF ePoster library. Fernando S. Oct 2, 2017; 198152
Dr. Shannon Fernando
Dr. Shannon Fernando
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Abstract
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Analysis of Bystander CPR Quality During Out-of-Hospital Cardiac Arrest Using Data Derived from Automated External Defibrillators

Fernando, Shannon M. MD, MSc1,2; Vaillancourt, Christian MD, MSc1,3; Morrow, Stanley4; Stiell, Ian G. MD, MSc1,3

 1Department of Emergency Medicine, University of Ottawa, Ottawa, ON; 2Division of Critical Care, Department of Medicine, University of Ottawa, Ottawa, ON; 3linical Epidemiology Program, Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, ON; 4Ottawa Paramedic Services, Ottawa, ON


Introduction: Out-of-hospital cardiac arrest (OHCA) is associated with high mortality, and CPR quality is one of the few modifiable factors associated with improved outcomes. Particularly, bystander CPR has been shown to improve survival and neurological outcomes. However, the quality of CPR performed by bystanders in OHCA is unknown. Automated External Defibrillators (AEDs) store CPR quality data (obtained from an accelerometer placed on the patient’s chest). and this data can be analyzed to determine bystander CPR quality.
 
Objectives: We evaluated bystander CPR quality during OHCA, utilizing data stored within AEDs, and matched with cases enrolled in the Resuscitation Outcomes Consortium (ROC) database.
 
Methods: This cohort study included adult OHCA cases from the Ottawa ROC site between 2011-2016, which were of presumed cardiac etiology, not witnessed by EMS, and where an AED was utilized by a bystander with > 1 minute of CPR process data available. We then matched AED data from Ottawa Paramedic Services to each case identified by the ROC database. AED data was analyzed using manufacturer software in order to determine overall measures of bystander CPR quality, changes in bystander CPR quality over time, and bystander adherence to existing 2010 and 2015 Heart and Stroke Foundation of Canada Resuscitation Guidelines.
 
Results: Among 148 identified cases, 100 met all inclusion criteria. 75% of patients were male, with a mean age of 62.3 years. Overall survival rate was 42.0%, with a modified Rankin Score of 3.7 (2.9-4.5). Bystanders demonstrated high-quality CPR over the course of resuscitation (mean 4.2 min. available), with a chest compression fraction (CCF) of 75.9% (95% CI: 73.6, 78.1), a compression depth of 5.26 cm (95% CI: 5.03, 5.49), and a compression rate of 111.2/min (95% CI: 107.7, 114.7). Mean peri-shock pause was 26.8 seconds (95% CI: 24.6, 29.1). Adherence rates to 2010 AHA Quality Guidelines for compression rate and depth were 66.0% (95% CI: 60.9, 71.1) and 54.9% (95% CI: 48.6, 61.3), respectively. CPR quality was lowest in the first minute of resuscitation during which rhythm analysis took place (mean 40.5 sec, 95% CI: 27.4, 53.5). In cases involving a shockable rhythm, overall latency from initiation of AED to shock delivery was 59.2 sec (95% CI: 45.5, 72.8).
 
Conclusions: In our study, we found that bystanders perform high-quality CPR, with strong adherence rates to existing AHA Quality Guidelines. Our findings provide evidence for the improved outcomes seen in cases of OHCA involving bystander CPR, and suggest further resource utilization for CPR training among laypersons.

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