Guidelines Improve Outcomes in Nonshockable Cardiac Arrest
(HealthDay News) – Implementation of the latest American Heart Association (AHA) resuscitation guidelines, which eliminate "stacked" shocks and emphasize chest compressions, results in significantly improved outcomes for patients experiencing nonshockable out-of-hospital cardiac arrest (OHCA).
To investigate the utility of the AHA guidelines in OHCA with nonshockable rhythms, Peter J. Kudenchuk, MD, of the University of Washington in Seattle, and colleagues conducted a study involving 3,960 patients with nontraumatic OHCA from nonshockable initial rhythms over a five-year historical control period (1,774 patients) and a five-year intervention period (2,186 patients).
The researchers found that 34% of patients achieved return of spontaneous circulation in the intervention period, compared with 27% in the control period. Compared with the historical control period, in the intervention group there were significantly improved outcomes: hospital discharge (6.8 vs. 4.6%); favorable neurological outcome (5.1 vs. 3.4%); one-month survival (6.2 vs. 4.1%); and one-year survival (4.9 vs. 2.7%) (all P ≤0.005). After adjustment for confounding factors, individuals treated during the intervention period had increased odds for return of spontaneous circulation (odds ratio [OR], 1.5), survival to hospital discharge (OR, 1.53), favorable neurological status (OR, 1.56), survival for one month (OR, 1.54), and survival for one year (OR, 1.85).
"Outcomes from OHCA resulting from nonshockable rhythms, although poor by comparison with shockable rhythm presentations, improved significantly after implementation of resuscitation guideline changes, suggesting their potential to benefit all presentations of OHCA," the authors write.