New Study on Importance of Continuous Compressions

[MonkeyArrow]

http://www.nejm.org/doi/full/10.1056/NEJMoa1509139

Very, very interesting results that debunk the majority of literature that has been coming out in recent years about minimizing hands-off time. The sample size was huge and in all analyses, there was no difference in or a greater survival to discharge and neurologically intact discharge with compressions at a 30:2 ratio than continuous compressions without rescue breathing.

In the methods, the authors briefly did mention excluding patients in the control group who did not meet study protocol (meaning pauses were too long?). This brings into question the true validity of how applicable the study is to longer pauses, as rescue breathing is a 3 second pause every 25 seconds, approximately. However of note, the authors did run an analysis removing the high rate of shockable rhythms and the results still did not favor the continuous group.

 

[Martyn]

In the methods, the authors briefly did mention excluding patients in the control group who did not meet study protocol (meaning pauses were too long?).

They were the dead ones...

 

[Doczilla]

The problem with studies like this is, cardiac arrest survivers often recover neurologically based on the most basic of factors (e.g down time, comorbidities, underlying cause, age etc) that more often than not, they can't tell the difference between the other stuff (remember the antiarrythmics and pressors debate?)

We know that it's hard to crank the coronary perfusion pressure up to where it needs to be, and we know that it's hard to get it back when we lose it. It's kind of a concept that stays true regardless of what the studies suggest.

The people who made it, were likely to make it to begin with based on the factors I mentioned. But those few people that might need that extra help definitely deserve it. It might be in my head but over the last few years I've seen a ton of ROSC cases that I didn't expect (one of them asystole----->sinus tach) , and it really seems like the CPR changes are helping.

 

[Luno]

http://www.nejm.org/doi/full/10.1056/NEJMoa1509139

Very, very interesting results that debunk the majority of literature that has been coming out in recent years about minimizing hands-off time. The sample size was huge and in all analyses, there was no difference in or a greater survival to discharge and neurologically intact discharge with compressions at a 30:2 ratio than continuous compressions without rescue breathing.

In the methods, the authors briefly did mention excluding patients in the control group who did not meet study protocol (meaning pauses were too long?). This brings into question the true validity of how applicable the study is to longer pauses, as rescue breathing is a 3 second pause every 25 seconds, approximately. However of note, the authors did run an analysis removing the high rate of shockable rhythms and the results still did not favor the continuous group.

I would hesitate to use broad, sweeping conclusions with regards to this survey. Especially since your conclusions are not supported by the study and transpose the 30:2 ratio with minimizing hands off time. And a point of clarification, there was a difference in outcomes, however it was not statistically significant...