Vol 122, No 21
November 23, 2010
This randomized trial was conducted over one year. Nursing students (n606) completed either HeartCode™ BLS or an instructor-led course and were then randomly assigned to an experimental (6 minutes of practice/month on a voice advisory manikin) or control (no practice) group. Every 3 months, a subset of students was randomly selected from both groups for reassessment of their CPR skills. Once students were assessed at any given time point, their participation ended because the assessment, in effect, served as an additional practice session. Results: Based on compression depth and ventilation rate and volume, the intervention group performed better than the control over the 12 months and, in some parameters, showed steady improvement over time. In the control group, students lost their ability to compress with adequate depth between 9 and 12 months (p0.004) and to ventilate with an adequate volume by 3 months (p0.0001) after their initial CPR training. Conclusions: The findings of this study not only confirmed the importance of practicing CPR psychomotor skills to retain them but also revealed that short monthly practices can improve skills over baseline. The results also demonstrated that self-directed CPR skills practice on a manikin with some form of automated feedback was a viable option for delivering frequent practice sessions to nursing students and, potentially, to practicing nursing staff and other health care providers.
Author Disclosures: M.H. Oermann: Research Grant; Modest; Laerdal Medical Corp. Other Research Support; Modest; Laerdal Medical Corp. S.E. Kardong-Edgren: None. T. Odom- Maryon: None.
HT5-305 Resuscitation Outcomes Consortium ROC PRIMED Trial of Early Rhythm Analysis versus Later Analysis in Out-of-Hospital Cardiac Arrest
Ian G Stiell, Univ of Ottawa, Ottawa, ON, Canada; Graham Nichol, Univ of Washington-Harborview Ctr for Prehospital Emergency Care, Seattle, WA; Brian G. Leroux, Univ of Washington, Seattle, WA; Thomas D. Rea, Univ of Washington-Harborview Ctr for Prehospital Emergency Care, Seattle, WA; Joseph P Ornato, Virginia Commonwealth Univ, Richmond, VA; Judy Powell, Univ of Washington, Seattle, WA; James Christenson, Univ of British Columbia, Vancouver, BC, Canada; Clifton W Callaway, Univ of Pittsburgh, Pittsburgh, PA; Peter J Kudenchuk, Univ of Washington, Seattle, WA; Tom P Aufderheide, Medical Coll of Wisconsin, Milwaukee, WI; Ahamed H Idris, Univ of Texas Southwestern Med Cntr, Dallas, TX; Mohamud Daya, Oregon Health & Science Univ, Portland, OR; Henry E Wang, Univ of Alabama at Birmingham, Birmingham, AL; Laurie Morrison, Univ of Toronto, Toronto, ON, Canada; Daniel Davis, Univ of California, San Diego, CA; Dug Andrusiek, Univ of British Columbia, Vancouver, BC, Canada; Shannon Stephens, Univ of Alabama at Birmingham, Birmingham, AL; Sheldon Cheskes, Univ of Toronto, Toronto, ON, Canada; Robert H Schmicker, Univ of Washington, Seattle, WA; Ray Fowler, Univ of Texas Southwestern Med Cntr at Dallas, Dallas, TX; Christian Vaillancourt, Univ of Ottawa, Ottawa, ON, Canada;
David Hostler, Univ of Pittsburgh, Pittsburgh, PA; Dana Zive, Oregon Health & Science Univ, Portland, OR; Ronald G Pirallo, Med College of Wisconsin, Milwaukee, WI; Gary Vilke, Univ of California, San Diego, CA; George Sopko, NHLBI, NIH, Rockville, MD; Myron Weisfeldt, Johns Hopkins Med Insts, Baltimore, MD; and the Resuscitation Outcomes Consortium (ROC) Investigators
Background: In a departure from the prior immediate defibrillation paradigm, the 2005 AHA/ILCOR resuscitation guidelines recommended that Emergency Medical Service (EMS) rescuers could provide two minutes of cardiopulmonary resuscitation (CPR) before cardiac rhythm analysis. We compared brief CPR with early analysis versus longer CPR with delayed analysis. Methods: We conducted a cluster randomized crossover trial of adult out-of-hospital cardiac arrests (OOHCA) patients at 10 Resuscitation Outcomes Consortium sites in the U.S. and Canada. Patients in the Analyze Early group were allocated to receive 30–60 seconds of EMS CPR and those in the Analyze Later group were allocated to receive 180 seconds of CPR before initial ECG analysis. Results: We enrolled 9,934 patients. The primary outcome, survival to hospital discharge with satisfactory function (Modified Rankin Scale score 3), did not differ between the Analyze Early and Later groups (5.9% versus 5.9%, P0.91) with a cluster- adjusted absolute difference of 0.2% (95% CI 1.1% to 0.7%). Analyses adjusted for confounders and a priori and post-hoc subgroup analyses showed no survival benefit for either study group. Exploratory analyses suggest that with the passage of time to first ECG analysis, survival does not improve, whereas for VF/VT patients with bystander CPR, survival may even tend to decline. Conclusions: For OOHCA we found no difference in outcomes between a brief as compared with longer period of EMS CPR before the first rhythm analysis. Our findings suggest the AHA/ILCOR recommendation permitting two minutes of EMS CPR before analysis is unlikely to provide greater benefit than CPR of shorter duration.
Author Disclosures: I.G. Stiell: None. G. Nichol: Research Grant; NIH, NHLBI, Asmund S Laerdal Foundation for Acute Medicine, Medtronic Foundation. Other; Research Collaborator for Gambro Renal Inc, Sotera Wireless, Lifebridge Medizintechnik AG, Chair, AHA Executive Database Steering committee, Chair, Mission: Lifeline EMS Task Force, Cochair, AHA Resuscitation Science Symposium Planning Committee, Member, AHA Advanced Cardiac Life Support Subcommittee, Member, AHA Epidemiology and Statistics Committee, Member, AHA Pacific Mountain Affiliate Board of Directors, Received travel reimbursement, AHA. B. Leroux: None. T. Rea: None. J.P. Ornato: None. J. Powell: None. J. Christenson: None. C.W. Callaway: None. P.J. Kudenchuk: None. T.P. Aufderheide: None. A.H. Idris: None. M. Daya: None. H.E. Wang: None. L. Morrison: None. D. Davis: None. D. Andrusiek: None. S. Stephens: None. S. Cheskes: None. R.H. Schmicker: None. R. Fowler: None. C. Vaillancourt: None. D. Hostler: None. D. Zive: None. R.G. Pirallo: None. G. Vilke: None. G. Sopko: None. M. Weisfeldt: None.