Hands-On Times, Adherence to Recommendations and Variance in Execution among Three Different CPR Algorithms: A Prospective Randomized Single-Blind Simulator-Based Trial.

Sami Rifai,Sebastian G Russo,Heidrun Schwager,Dietmar Wetzchewald,Stephan Marsch,Franziska Tschan,Timur Sellmann

doi:10.3390/ijerph17217946

Abstract

Background: Alternative cardiopulmonary resuscitation (CPR) algorithms, introduced to improve outcomes after cardiac arrest, have so far not been compared in randomized trials with established CPR guidelines. Methods: 286 physician teams were confronted with simulated cardiac arrests and randomly allocated to one of three versions of a CPR algorithm: (1) current International Liaison Committee on Resuscitation (ILCOR) guidelines (“ILCOR”), (2) the cardiocerebral resuscitation (“CCR”) protocol (3 cycles of 200 uninterrupted chest compressions with no ventilation), or (3) a local interpretation of the current guidelines (“Arnsberg“, immediate insertion of a supraglottic airway and cycles of 200 uninterrupted chest compressions). The primary endpoint was percentage of hands-on time. Results: Median percentage of hands-on time was 88 (interquartile range (IQR) 6) in “ILCOR” teams, 90 (IQR 5) in “CCR” teams (p = 0.001 vs. “ILCOR”), and 89 (IQR 4) in “Arnsberg” teams (p = 0.032 vs. “ILCOR”; p = 0.10 vs. “CCR”). “ILCOR” teams delivered fewer chest compressions and deviated more from allocated targets than “CCR” and “Arnsberg” teams. “CCR” teams demonstrated the least within-team and between-team variance. Conclusions: Compared to current ILCOR guidelines, two alternative CPR algorithms advocating cycles of uninterrupted chest compressions resulted in very similar hands-on times, fewer deviations from targets, and less within-team and between-team variance in execution.

Highlights

Based on international consensus of collaborating partners in International Liaison Committee on Resuscitation (ILCOR) (International LiaisonCommittee on Resuscitation), national and regional resuscitation organizations regularly publish guidelines for cardiopulmonary resuscitation (CPR) [1,2]
The aim of the present study was to compare the adherence to algorithms with hands-on time as primary outcome, of the current CPR guidelines, the Cardiocerebral Resuscitation protocol, and the Arnsberg algorithm, in simulated cardiac arrests
An interpretation of the ILCOR algorithm advocating immediate insertion of a supraglottic airway in order to achieve cycles of 200 uninterrupted chest compressions as soon as possible resulted in higher hands-on times, less deviation from allocated targets, and less variance than the original ILCOR

Summary

Introduction

Based on international consensus of collaborating partners in ILCOR (International LiaisonCommittee on Resuscitation), national and regional resuscitation organizations regularly publish guidelines for cardiopulmonary resuscitation (CPR) [1,2]. The outcome of victims of cardiac arrest has remained poor [3,4,5], which prompted the development of alternative CPR algorithms for adults. One such example is the cardiocerebral resuscitation (CCR) protocol, introduced for primary out-of-hospital cardiac arrests (OHCA), i.e., arrests of cardiac origin. Liaison Committee on Resuscitation (ILCOR) guidelines (“ILCOR”), (2) the cardiocerebral resuscitation (“CCR”) protocol (3 cycles of 200 uninterrupted chest compressions with no ventilation), or (3) a local interpretation of the current guidelines (“Arnsberg“, immediate insertion of a supraglottic airway and cycles of 200 uninterrupted chest compressions).

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Discussion

Conclusion