Spotlight on research

Sunday, March 1, 2009

This research examines whether it is more effective to shock a patient in cardiac arrest immediately, or whether it is better to carry out 3 minutes of cardiopulmonary resuscitation (CPR) before defibrillation. Over a period of 761 days, the South Australian Ambulance Service participated in a randomized control trial (RCT) that included 202 patients who were in ventricular fibrillation (VF) cardiac arrest. These patients were randomized into two groups: one group received immediate defibrillation (n=105); the other group received CPR first (n=97). Overall, 28 patients survived the arrest and were discharged from hospital. Eighteen of the surviving patients were defibrillated immediately, and 10 were given CPR first before defibrillation. Overall, the authors conclude that there is no benefit to delivering 3 minutes of CPR before first defibrillation in out-of-hospital VF cardiac arrest. In addition, an unexpected finding emerged from a major challenge encountered within this RCT. The resuscitation guidelines changed midway through the study, and this resulted in a change of clinical practice in the management of cardiac arrest, which clearly has to be considered in any interpretation of the results. Although the authors emphasize that their analysis of this change did not demonstrate statistical significance, they indicate that the data collected demonstrate a strong trend towards improved survival rates after the implementation of the new resuscitation guidelines.

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