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A Randomized Controlled Trial of Compression Rates during Cardiopulmonary Resuscitation
황성오,차경철,김규석,조유환,정성필,유제성,신종환,이휘재,박유석,김승환,최상천,박은정,김원영,서동우,문성우,한갑수,최한성,강형구,박승민,권운용,최은희 대한의학회 2016 Journal of Korean medical science Vol.31 No.9
The objective of this study was to compare the efficacy of cardiopulmonary resuscitation (CPR) with 120 compressions per minute (CPM) to CPR with 100 CPM in patients with nontraumatic out-of-hospital cardiac arrest. We randomly assigned patients with nontraumatic out-of-hospital cardiac arrest into two groups upon arrival to the emergency department (ED). The patients received manual CPR either with 100 CPM (CPR-100 group) or 120 CPM (CPR-120 group). The primary outcome measure was sustained restoration of spontaneous circulation (ROSC). The secondary outcome measures were survival discharge from the hospital, one-month survival, and one-month survival with good functional status. Of 470 patients with cardiac arrest, 136 patients in the CPR-100 group and 156 patients in the CPR-120 group were included in the final analysis. A total of 69 patients (50.7%) in the CPR-100 group and 67 patients (42.9%) in the CPR-120 group had ROSC (absolute difference, 7.8% points; 95% confidence interval [CI], -3.7 to 19.2%; P = 0.183). The rates of survival discharge from the hospital, one-month survival, and one-month survival with good functional status were not different between the two groups (16.9% vs. 12.8%, P = 0.325; 12.5% vs. 6.4%, P = 0.073; 5.9% vs. 2.6%, P = 0.154, respectively). We did not find differences in the resuscitation outcomes between those who received CPR with 100 CPM and those with 120 CPM. However, a large trial is warranted, with adequate power to confirm a statistically non-significant trend toward superiority of CPR with 100 CPM. (Clinical Trial Registration Information: www.cris.nih.go.kr, cris.nih.go.kr number, KCT0000231)
황성오 대한의사협회 2013 대한의사협회지 Vol.56 No.7
Sudden cardiac arrest is a growing medical issue in developed countries. Annually, more than 25,000 out-of-hospital cardiac arrests (OHCA) occur in Korea. Only 3% of victims with OHCA discharge alive from hospital and less than 1% of them survive neurologically intact. Major changes of recent guidelines for cardiopulmonary resuscitation (CPR) and emergency cardiac care includes modification of basic life support (BLS) sequence from A-B-C to C-A-B, an emphasis on minimally interrupted, high-quality chest compression, the introduction of chest compression-only CPR, and addition of integrated post-cardiac arrest care concept as the fifth chain in the Chain of Survival. Repetition of 2-minutes of CPR, rhythm check, and defibrillation if indicated is recommended as a universal algorithm during BLS. Defibrillation and drug administration including epinephrine should not be delayed to place an advanced airway during CPR. Important interventions during post-cardiac arrest care are comprised of the optimization of ventilation (arterial CO2 tension, 40 to 45 mmHg) and oxygenation (arterial O2 saturation, 94% to 98%), glucose control (blood glucose, 144 to 180 mg/dL), therapeutic hypothermia (body temperature,32oC to 34oC) for unresponsive patients, and percutaneous coronary intervention for the patient with ST-segment elevation. Systemic approaches to increase public awareness of cardiac arrest and CPR, to spread CPR education to citizen, and to implement public access defibrillation are a prerequisite for improving survival from OHCA in the community. Effective advanced life support and integrated post-cardiac arrest care should be provided to increase neurologically intact survival among the patients resuscitated from cardiac arrest.