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Wik L, Kramer-Johansen J, Myklebust H, et al. Quality of Cardiopulmonary Resuscitation During Out-of-Hospital Cardiac Arrest. JAMA. 2005;293(3):299–304. doi:10.1001/jama.293.3.299
Author Affiliations: National Competence Center
for Emergency Medicine (Dr Wik), Institute for Experimental Medical Research
(Drs Wik, Kramer-Johansen, and Steen), Division of Prehospital Emergency Medicine
(Drs Wik, Sørebø, and Steen), and Division of Surgery (Dr Steen),
Ulleval University Hospital, Oslo, Norway; Norwegian Air Ambulance, Department
of Research and Education in Acute Medicine, Drøbak, Norway (Dr Kramer-Johansen);
Laerdal Medical, Corp, Stavanger, Norway (Mr Myklebust); Sodersjukhuset, Stockholm,
Sweden (Dr Svensson); London Ambulance Service NHS Trust, London, England
Context Cardiopulmonary resuscitation (CPR) guidelines recommend target values
for compressions, ventilations, and CPR-free intervals allowed for rhythm
analysis and defibrillation. There is little information on adherence to these
guidelines during advanced cardiac life support in the field.
Objective To measure the quality of out-of-hospital CPR performed by ambulance
personnel, as measured by adherence to CPR guidelines.
Design and Setting Case series of 176 adult patients with out-of-hospital cardiac arrest
treated by paramedics and nurse anesthetists in Stockholm, Sweden, London,
England, and Akershus, Norway, between March 2002 and October 2003. The defibrillators
recorded chest compressions via a sternal pad fitted with an accelerometer
and ventilations by changes in thoracic impedance between the defibrillator
pads, in addition to standard event and electrocardiographic recordings.
Main Outcome Measure Adherence to international guidelines for CPR.
Results Chest compressions were not given 48% (95% CI, 45%-51%) of the time
without spontaneous circulation; this percentage was 38% (95% CI, 36%-41%)
when subtracting the time necessary for electrocardiographic analysis and
defibrillation. Combining these data with a mean compression rate of 121/min
(95% CI, 118-124/min) when compressions were given resulted in a mean compression
rate of 64/min (95% CI, 61-67/min). Mean compression depth was 34 mm (95%
CI, 33-35 mm), 28% (95% CI, 24%-32%) of the compressions had a depth of 38
mm to 51 mm (guidelines recommendation), and the compression part of the duty
cycle was 42% (95% CI, 41%-42%). A mean of 11 (95% CI, 11-12) ventilations
were given per minute. Sixty-one patients (35%) had return of spontaneous
circulation, and 5 of 6 patients discharged alive from the hospital had normal
Conclusions In this study of CPR during out-of-hospital cardiac arrest, chest compressions
were not delivered half of the time, and most compressions were too shallow.
Electrocardiographic analysis and defibrillation accounted for only small
parts of intervals without chest compressions.
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