Abstract 13624: Effect of Electrical Therapy Using Biphasic Defibrillators in the 2010 CPR Guidelines for Patients With Out-of-Hospital Cardiac Arrest due to Nonshockable Rhythm

Abstract

Background: The 2005 guidelines for cardiopulmonary resuscitation (CPR) with electrical therapy recommended a single shock plus an immediate 2 minutes of CPR instead of 3-shock sequences recommended in the 2000 guidelines. The 2010 guidelines have stressed that it is necessary to improve CPR quality. Each set of guidelines recommended a timely shock when non-shockable patients were found to be in shockable rhythm. Few data are available concerning this electrical therapy. Methods: From the data of the All-Japan Utstein Registry, a prospective, nationwide, population-based registry of out-of-hospital cardiac arrest (OHCA), we included adult patients who had OHCA due to cardiac etiology, in whom non-shockable arrest were recorded as an initial rhythm, and who received shock using biphasic AEDs after conversion from non-shockable arrest to shockable arrest by emergency medical service (EMS) personnel. Study patients were divided into three groups based on the different CPR guidelines; 3-shock protocol in the 2000 guidelines (2000G), 1-shock protocol in the 2005 guidelines (2005G), and 1-shock protocol in the 2010 guidelines (2010G). The primary endpoint was favorable neurological outcome at 30 days after OHCA. Results: Of the 5066 patients who met the inclusion criteria (figure). The figure shows the comparison of favorable neurological using biphasic AEDs in the three groups. Adjusted odds ratios for favorable neurological outcome were 2.5 (95% CI, 1.3 to 4.7) after the 2005G group and the 2010G group as compared with the 2000G group, and 0.8 (95% CI, 0.6 to 1.1) after the 2010G group as compared with the 2005G group. ConclusioN: The single-shock protocol using biphasic AEDs of the 2005 and 2010 guidelines were superior to the 3-shock protocol of the 2000 guidelines, but the single-shock protocol using biphasic AEDs of the 2005 and 2010 guidelines had similar 30-day favorable neurological outcome in patients with non-shockable cardiac arrest.