Cardiopulmonary resuscitation quality: Widespread variation in data intervals used for analysis

AIM: There is a growing body of evidence for the relationship between CPR quality and survival in cardiac arrest patients. We sought to describe the characteristics of the analysis intervals used across studies. METHODS: Relevant papers were selected as described in our recent systematic review. From these papers we collected information about (1) the time interval used for analysis; (2) the event that marked the beginning of the analysis interval; and (3) the minimum amount of CPR quality data required for a case to be included in the analysed cohort. We then compared this data across papers. RESULTS: Twenty-one studies reported on the association between CPR quality and cardiac arrest patient survival. In two thirds of studies data from the start of the resuscitation episode was analysed, in particular the first 5minutes. Commencement of the analysis interval was marked by various events including ECG pad placement and first chest compression. Nine studies specified a minimum amount of data that had to have been collected for the individual case to be included in the analysis; most commonly one minute of data. The use of shorter intervals allowed for inclusion of more cases as it included cases that did not have a complete dataset. CONCLUSION: To facilitate comparisons across studies, a standardized definition of the data analysis interval should be developed; one that maximises the amount of cases available without compromising the data's representability of the resuscitation effort

Mechanical versus manual chest compressions in the treatment of in-hospital cardiac arrest patients in a non-shockable rhythm : a randomised controlled feasibility trial (COMPRESS-RCT)

Background Mechanical chest compression devices consistently deliver high-quality chest compressions. Small very low-quality studies suggest mechanical devices may be effective as an alternative to manual chest compressions in the treatment of adult in-hospital cardiac arrest patients. The aim of this feasibility trial is to assess the feasibility of conducting an effectiveness trial in this patient population. Methods COMPRESS-RCT is a multi-centre parallel group feasibility randomised controlled trial, designed to assess the feasibility of undertaking an effectiveness to compare the effect of mechanical chest compressions with manual chest compressions on 30-day survival following in-hospital cardiac arrest. Over approximately two years, 330 adult patients who sustain an in-hospital cardiac arrest and are in a non-shockable rhythm will be randomised in a 3:1 ratio to receive ongoing treatment with a mechanical chest compression device (LUCAS 2/3, Jolife AB/Stryker, Lund, Sweden) or continued manual chest compressions. It is intended that recruitment will occur on a 24/7 basis by the clinical cardiac arrest team. The primary study outcome is the proportion of eligible participants randomised in the study during site operational recruitment hours. Participants will be enrolled using a model of deferred consent, with consent for follow-up sought from patients or their consultee in those that survive the cardiac arrest event. The trial will have an embedded qualitative study, in which we will conduct semi-structured interviews with hospital staff to explore facilitators and barriers to study recruitment. Discussion The findings of COMPRESS-RCT will provide important information about the deliverability of an effectiveness trial to evaluate the effect on 30-day mortality of routine use of mechanical chest compression devices in adult in-hospital cardiac arrest patients