著者
Atsushi Sugiyama Sue Duval Yuji Nakamura Katsunori Yoshihara Demetris Yannopoulos
出版者
The Japanese Circulation Society
雑誌
Circulation Journal (ISSN:13469843)
巻号頁・発行日
vol.80, no.10, pp.2124-2132, 2016-09-23 (Released:2016-09-23)
参考文献数
42
被引用文献数
7 13

Background:The quality of cardiopulmonary resuscitation (CPR) has been recently shown to affect clinical outcome. The Resuscitation Outcomes Consortium (ROC) Prehospital Resuscitation Impedance Valve and Early Versus Delayed Analysis (PRIMED) trial showed no differences in outcomes with an active vs. sham impedance threshold device (ITD), a CPR adjunct that enhances circulation. It was hypothesized the active ITD would improve survival with favorable neurological outcomes in witnessed out-of-hospital cardiac arrest patients when used with high-quality CPR.Methods and Results:Using the publicly accessible ROC PRIMED database, a post-hoc analysis was performed on all witnessed subjects with both compression rate and depth data (n=1,808) who received CPR within the study protocol definition of adequate CPR quality (compression rate 80–120/min and depth 4–6 cm; n=929). Demographics were similar between sham and active ITD groups. In witnessed subjects who received quality CPR, survival with favorable neurological function was 11.9% for the active ITD subjects (56/470) vs. 7.4% for the sham (34/459) (odds ratio 1.69 [95% confidence interval 1.08, 2.64]). There were no statistically significant differences for this primary outcome when CPR was performed outside the boundaries of the definition of adequate CPR quality. Multivariable models did not change these associations.Conclusions:An active ITD combined with adequate-quality conventional CPR has the potential to significantly improve survival after witnessed cardiac arrest. (Circ J 2016; 80: 2124–2132)

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@HeidiAbdelhady I think basically because the ROC PRIMED Trial from 10 years ago did not show a clear benefit. But the post-hoc analysis of that study selecting out good quality CPR patients is very intriguing: https://t.co/W9aaPvnbNm
@DrHowieMell @smithECGBlog @DitchDoc14 The ROC PRIMED study documented CPR quality. There was some *really crappy CPR performed in some patients. Take a look at this post hoc analysis paper looking at the good CPR group: https://t.co/W9aaPvnbNm The neuro intact survival benefit is hard to ignore.
@momedic9019 @smithECGBlog @DrHowieMell @DitchDoc14 ROC-PRIMED was an OHCA RCT that looked at ITD without the plunger (ResQTrial was with). It was a negative trial... but there was some really poor documented CPR. A post hoc analysis looking at the good CPR group again showed neuro intact benefit. https://t.co/W9aaPvnbNm
@DitchDoc14 @smithECGBlog @DrHowieMell Great question. The ROC PRIMED post-hoc analysis Steve mentioned is provocative: https://t.co/W9aaPvnbNm
@EM_RESUS ResQTrial: https://t.co/qpjIv8Tosb ITD with high quality standard CPR: https://t.co/9qfTZNgho4 Next up: "Head up CPR:" https://t.co/KtO45gyEAM
@TheLubbeMan @EM_RESUS @moojo14 this article shows that you don't need the plunger for the ITD to improve outcomes: https://t.co/9qfTZNgho4 Better with the plunger (ResQPump, with 25 pounds of suction to decrease intathoracic pressure and increase venous return and decrease ICP.

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