• Christian Vaillancourt, Ashley Petersen, Eric N Meier, Jim Christenson, James J Menegazzi, Tom P Aufderheide, Graham Nichol, Robert Berg, Clifton W Callaway, Ahamed H Idris, Daniel Davis, Raymond Fowler, Debra Egan, Douglas Andrusiek, Jason E Buick, T J Bishop, M Riccardo Colella, Ritu Sahni, Ian G Stiell, Sheldon Cheskes, and Resuscitation Outcomes Consortium Investigators..
• Department of Emergency Medicine and Ottawa Hospital Research Institute, University of Ottawa, ON, Canada. Electronic address: cvaillancourt@ohri.ca.
• Resuscitation. 2020 Sep 1; 154: 93-100.

ObjectiveWe evaluated the effect of chest compression fraction (CCF) on survival to hospital discharge and return of spontaneous circulation (ROSC) in out-of-hospital cardiac arrest (OHCA) patients with non-shockable rhythms.MethodsThis is a retrospective analysis (completed in 2016) of a prospective cohort study which included OHCA patients from ten U.S. and Canadian sites (Resuscitation Outcomes Consortium Epistry and PRIMED study (2007-2011)). We included all OHCA victims of presumed cardiac aetiology, not witnessed by emergency medical services (EMS), without automated external defibrillator shock prior to EMS arrival, receiving > 1 min of CPR with CPR process measures available, and initial non-shockable rhythm. We measured CCF using the first 5 min of electronic CPR records.ResultsDemographics of 12,928 adult patients were: mean age 68; male 59.9%; public location 8.5%; bystander witnessed 35.2%; bystander CPR 39.3%; median interval from 911 to defibrillator turned on 10 min:04 s; initial rhythm asystole 64.8%, PEA 26.0%, other non-shockable 9.2%; compression rate 80-120/min (69.1%); median CCF 74%; ROSC 25.6%; survival to hospital discharge 2.4%. Adjusted odds ratio (OR); 95% confidence intervals (95%CI) of survival for each CCF category were: 0-40% (2.00; 1.16, 3.32); 41-60% (0.83; 0.54, 1.24); 61-80% (1.02; 0.77, 1.35); and 81-100% (reference group). Adjusted (OR; 95%CI) of ROSC for each CCF category were: 0-40% (1.02; 0.79, 1.30); 41-60% (0.83; 0.72, 0.95); 61-80% (0.85; 0.77, 0.94); and 81-100% (reference group).ConclusionsWe observed an incremental benefit from higher CCF on the incidence of ROSC, but not survival, among non-shockable OHCA patients with CCF higher than 40%.Copyright © 2020 Elsevier B.V. All rights reserved.

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