Abstract
Ho et al. commented on the possibility that most of the subjects in the 120 compressions per minute (CPM) arm received a significant amount of chest compressions with 100 CPM by emergency medical system (EMS) personnel before arriving at hospital. Cardiopulmonary resuscitation (CPR) provided by bystander and/or EMS personnel may confound the results of our study because randomization and intervention were made at the emergency department (ED) instead of at initiation of resuscitation effort at the pre-hospital phase. In our study, most subjects (93.4% of the CPR-100 group and 92.9% of the CPR-120 group) received EMS CPR (1). During the study period, the subjects received manual CPR according to the 2010 CPR guidelines, which recommended compression rate of at least 100 CPM but not exceeding 120 CPM (2). This recommendation does not seem to result in favoring 100 CPM over 120 CPM during pre-hospital resuscitation. A retrospective analysis of the Resuscitation Outcome Consortium (ROC) data revealed that mean chest compression rate during CPR provided by EMS personnel was 111 ± 19 CPM, which was a middle value between 100 and 120 CPM (3). However, a lack of information on compression rate during pre-hospital resuscitation may be one of limiting factors in the course of applying our study results to clinical practice.
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