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November 11, 2015

Continuous chest compressions vs. CPR for cardiac arrest: 3 takeaways

Since Sudden Cardiac Arrest (SCA) continues to be a major cause of death in the U.S., it makes sense that research that has been ongoing for more than 60 years should remain hot and heavy. The history of resuscitation can be traced by the treatments we provided.

Most of us will not remember when closed chest compressions, proposed by Dr. James Jude and colleagues, were a novelty, a research project that mandated further study. EMS dinosaurs will remember when CPR rates were 60 compressions per minute. Then rates increases to 80 beats per minute. And two-person ratios for CPR were 5 compressions for each ventilation given to the patient.

Sadly, over the second half of the 20th century most resuscitation efforts focused on the advanced portion of resuscitation — drugs, advanced airways and invasive procedures. Hindsight being 20/20, it is likely the resuscitation profession lost real progress by not focusing on the basics of ventilation and perfusion.

In the 1990s research began validating the effectiveness of high-quality chest compressions and prompt defibrillation. A Resuscitation Outcomes Consortium study comparing continuous chest compression and standard CPR, published this week in the New England Journal of Medicine, continues the tradition of looking for the next best resuscitation mousetrap.

Here are three key points to take away from this effort:

1. The number of patients enrolled is huge. Twenty-five thousand patients spread over large areas of the country make the results much less vulnerable to simple chance findings.

2. A prospective research design was used which means the researchers attempted to control for a variety of factors that could have affected the outcomes.

3. The authors point out that they could not control for what happened to the patients after EMS transferred the patient to the next level of care. Reaffirming that EMS is just one link in the resuscitation chain of survival. It's critical that all parts of that chain function well in order to give the patient the best chance for surviving neurologically intact. EMS can have a significant impact by delivering a viable patient to the next level of care.

We are moving into an era in which increasing cardiac arrest survival rates will be based on incremental fine tuning of effective procedures and techniques. We need to continue working with our lifesaving partners, bystanders and intensivists alike, to help reverse this major killer.

What are your key takeaways? Share your thoughts with other professionals in the comments. 

About the Author

Art Hsieh, MA, NRP teaches in Northern California at the Public Safety Training Center, Santa Rosa Junior College in the Emergency Care Program. An EMS provider since 1982, Art has served as a line medic, supervisor and chief officer in the private, third service and fire-based EMS. He has directed both primary and EMS continuing education programs. Art is a textbook writer, author of "EMT Exam for Dummies," has presented at conferences nationwide and continues to provide direct patient care regularly. Art is a member of the EMS1 Editorial Advisory Board. Contact Art at Art.Hsieh@ems1.com and connect with him on Facebook or Twitter.
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