Abstract 209: The Triple CPR 16 study: Does rhythm truly needed to be checked every 2 minutes in Cardiopulmonary Arrest Patients?

Abstract

Purpose: Current guidelines recommend rhythm checks every 2 minutes during cardiopulmonary resuscitation (CPR), but evidence for this recommendation is insufficient. Recent reports identified regional cerebral oxygen saturation (rSO 2 ) monitoring as useful in detecting return of spontaneous resuscitation (ROSC) and that coronary and cerebral perfusion decreases with the 2-minute rhythm check. On the basis of our previous study, we began the TripleCPR 16 study, which omits 2-minute rhythm checks because stopping chest compression to check rhythm may increase cerebral damage and decrease the ROSC. Methods: The multicenter, prospective TripleCPR 16 study began in January 2017. The inclusion criterion is a cardiopulmonary arrest patient aged ≥16 years with a non-shockable rhythm on hospital arrival. Subjects are divided into 3 groups based on their mean cerebral rSO 2 value in the first minute of arrival: ≥50%, <50% to 40%, and <40%. Continuous mechanical chest compression is performed on all subjects for 16 minutes or until their rSO 2 value exceeds the initial value by 10%, 20%, or 35%, respectively. We are comparing the TripleCPR 16 study results with our previous hospital data obtained from 90 patients who underwent every 2-minute rhythm checks and mechanical chest compression. Result: Currently, 162 patients are registered. Rates of ROSC were 32.1% for these patients and 38.9% for the previous 90 patients (p=0.33). There were no severe adverse events. Subanalysis of the data of Osaka University Hospital alone showed no significant increase of rSO 2 value in the 24 patients with non-sonographic cardiac activity and 21 patients with Stanford type A aortic dissection diagnosed by CT scan, and only one patient in each group achieved ROSC. When excluding the patients with Stanford type A aortic dissection, rates of ROSC were 49.4% for the patients in this study and 39.3% for the previous 90 patients (p=0.21). Conclusion: The TripleCPR 16 study is ongoing without severe adverse events. In the patients with non-sonographic cardiac activity or Stanford type A aortic dissection, rSO 2 values did not increase and it was difficult to achieve ROSC. The 2-minute rhythm check is not essential for chest compression in patients with a non-shockable rhythm.