Abstract 141: Defibrillation Protocol Update Neurologically Intact Survival for Patients With Out-Of-Hospital Shockable Cardiac Arrest

Abstract

Background: A series of cardiopulmonary resuscitation (CPR) maneuvers of the CoSTR has been updated since first international guidelines was published in 2000. We investigated whether CPR, especially defibrillation protocol, based on the CoSTR update improves neurologically intact survival after shockable out-of-hospital cardiac arrest (OHCA). Methods: From the All-Japan Utstein Registry between 2005 and 2015, we enrolled adult patients with witnessed shockable OHCA. Study patients were divided into 3 groups according to each CPR recommendation era (the Guidelines 2000 group in 2005; 3-stacked-shock protocol era, CoSTR 2005 group between 2006 and 2010; 1-shock protocol [1 shock immediately followed by 2 minutes of CPR] era, and the CoSTR 2010 group between 2006 and 2010; simplified dispatcher chest compressions instruction and 1-shock protocol era). Primary endpoint was favorable 30-day neurological outcome after OHCA. Results: Of the 73,578 study patients, 5,575 (7.6%) received CPR based on the Guidelines 2000, 32,749 (44.5%) the CoSTR 2005, and 35,255 (47.9%) the CoSTR 2010. Crude frequency of favorable 30-day neurological outcome increased significantly whenever the CPR maneuvers were updated (12.3% in the Guidelines 2000 group vs. 19.3% in the CoSTR 2005 group vs. 23.3% in the CoSTR 2010 group, p<0.001). Multivariable logistic-regression analysis for favorable 30-day neurological outcome showed that adjusted odds ratio (reference, the Guidelines 2000 group) was 1.89 (95% CI, 1.72-2.07) in the CoSTR 2005 group and 2.71 (95% CI, 2.47-2.97) in the CoSTR 2010 group. Other independent predictors were age, sex, collapse-to-CPR interval, call-to-scene interval, witnessed and/or bystander CPR status, and cause of cardiac arrest. On the other hand, some advanced life support maneuvers were not acceptable; adjusted odds ratio of 0.37 (95%CI, 0.35-0.39) in advanced airway management (reference, bug-mask ventilation) and 0.36 (95%CI, 0.33-0.38) in intravenous epinephrine (reference, no epinephrine). Conclusions: Defibrillation protocol update based on the CoSTR was the preferable approach to resuscitation for adult patients with witnessed shockable OHCA. However, prehospital epinephrine and advanced airway management were not helpful.