The effect of transport on quality of cardiopulmonary resuscitation in out-of-hospital cardiac arrest |
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| Authors: | Silje Ødegaard Theresa Olasveengen Petter Andreas Steen Jo Kramer-Johansen |
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| Institution: | 1. Institute for Experimental Medical Research, Ulleval University Hospital, N-0407 Oslo, Norway;2. University of Oslo, Faculty Division Ulleval University Hospital, N-0407 Oslo, Norway;4. Prehospital Division, Ulleval University Hospital, N-0407 Oslo, Norway;1. Department of Communications Engineering, University of the Basque Country, UPV/EHU, 48013 Bilbao, Spain;2. Oregon Health & Science University, 97239-3098 Portland, OR, USA;3. Norwegian National Advisory Unit on Prehospital Emergency Medicine, Oslo University Hospital, Oslo, Norway;4. Russell Biomedical Research Consulting, Seattle, USA;5. Norwegian Centre for Prehospital Emergency Care (NAKOS), Oslo University Hospital and University of Oslo, 0424 Oslo, Norway;6. Department of Electrical Engineering and Computer Science, Faculty of Science and Technology, University of Stavanger, 4036 Stavanger, Norway;1. Department of Emergency Medicine, University of Alabama School of Medicine, Birmingham, AL, USA;2. The Clinical Trials Center, Department of Biostatistics, University of Washington, Seattle, WA, USA;3. Department of Emergency Medicine, University of British Columbia, Faculty of Medicine, Vancouver, British Columbia, Canada;4. Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, PA, USA;5. Department of Emergency Medicine, Allegheny Health Network, Saint Vincent Hospital, Erie, PA, USA;6. Alfred Hospital and Baker IDI Heart and Diabetes Institute, Melbourne Australia;7. Sunnybrook Center for Prehospital Medicine, Department of Family and Community Medicine, Divison of Emergency Medicine, University of Toronto, Toronto, Ontario, Canada;8. Rescu, Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael''s Hospital, Toronto, Ontario, Canada;9. Division of Emergency Medicine, Department of Medicine, University of Toronto, Toronto, ON, Canada;10. Department of Anesthesiology & Perioperative Medicine, Oregon Health & Science University, Portland, OR, USA;11. The Ottawa Hospital, Department of Emergency Medicine, University of Ottawa Ottawa, ON, Canada;12. Clackamas Fire District #1, Milwaukie, OR, USA;1. Rescu, Keenan Research Centre, Li Ka Shing Knowledge Institute at St. Michael''s Hospital, University of Toronto, Toronto, Ontario, Canada;2. Division of Emergency, Department of Medicine, University of Toronto, Toronto, Ontario, Canada;3. Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada;4. Southwest Ontario Regional Base Hospital Program, London Health Sciences Centre, Owen Sound Site, Ontario, Canada;5. Division of Emergency, Department of Medicine, Western University, London, Ontario, Canada;6. Department of Research Design & Biostatistics, Sunnybrook Health Sciences Centre, Institute for Clinical and Evaluative Sciences, Toronto, Ontario, Canada;7. Peterborough Regional Health Centre, Peterborough, Ontario, Canada;8. Sunnybrook Centre for Prehospital Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada;9. Northeastern Ontario Prehospital Care Program, Health Sciences North, Timmins Site, Ontario, Canada;10. Centre for Paramedic Education and Research, Hamilton Health Sciences Centre, Hamilton, Ontario, Canada;11. Division of Emergency Medicine, Department of Medicine, McMaster University, Hamilton, Ontario, Canada;12. Northeastern Ontario Prehospital Care Program, Health Sciences North, Sault Ste. Marie Site, Ontario, Canada;13. Regional Paramedic Program for Eastern Ontario, Ottawa, Ontario, Canada;14. Medavie EMS Ontario (MEMSO Muskoka), Muskoka, Ontario, Canada;1. Communications Engineering Department, University of the Basque Country UPV/EHU, Alameda Urquijo S/N, 48013 Bilbao, Spain;2. Department of Emergency Medicine, Oregon Health & Science University, 97239-3098 Portland, OR, United States;3. Knight Cardiovascular Institute, Oregon Health & Science University, 97239-3098 Portland, OR, United States;1. Communications Engineering Department, University of the Basque Country UPV/EHU, Alameda Urquijo S/N, 48013 Bilbao, Spain;2. Institute for Experimental Medical Research, Oslo University Hospital and University of Oslo, N-0424 Oslo, Norway;3. Department of Electrical Engineering and Computer Science, University of Stavanger, 4036 Stavanger, Norway;1. Communications Engineering Department, University of the Basque Country UPV/EHU, Alameda Urquijo S/N, 48013 Bilbao, Spain;2. Philips Healthcare, Bothell, WA 98021, United States;3. Department of Emergency Medicine, Oregon Health & Science University, Portland, OR 97239-3098, United States |
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| Abstract: | IntroductionMost manikin and clinical studies have found decreased quality of CPR during transport to hospital. We wanted to study quality of CPR before and during transport for out-of-hospital cardiac arrest patients and also whether quality of CPR before initiation of transport was different from the quality in patients only receiving CPR on scene.Materials and methodsQuality of CPR was prospectively registered with a modified defibrillator for consecutive cases of out-of-hospital cardiac arrest in three ambulance services during 2002–2005. Ventilations were registered via changes in transthoracic impedance and chest compressions were measured with an extra chest compression pad placed on the patients’ sternum. Paired t-tests were used to analyse quality of CPR before vs. during transport with ongoing CPR. Unpaired t-tests were used to compare CPR quality prior to transport to CPR quality in patients with CPR terminated on site.ResultsQuality of CPR did not deteriorate during transport, but as previously reported overall quality of CPR was substandard. Quality of CPR performed on site was significantly better when transport was not initiated with ongoing CPR compared to episodes with initiation of transport during CPR: fraction of time without chest compressions was 0.45 and 0.53 (p < 0.001), compression depth 37 mm and 34 mm (p = 0.04), and number of chest compressions per minute 61 and 56 (p = 0.01), respectively.ConclusionCPR quality was sub-standard both before and during transport. Early decision to transport might have negatively affected CPR quality from the early stages of resuscitation. |
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