Kettle, Andrew D




Emergency Medical Services (EMS), Out of Hospital Cardiac Arrest (OOHCA), 30 Minutes of on Scene CPR, Return of Spontaneous Circulation (ROSC), Bystander CPR



30 Minutes of On Scene CPR in Out of Hospital Cardiac Arrest

Sponsor: Andrew Kettle (Charlestown Ambulance Rescue Service)

Background: Many EMS systems have mandated 30 minutes of on-scene CPR to improve outcomes in out-of-hospital cardiac arrest (OOHCA). In January of 2017, Rhode Island joined this cohort of states to implement this intervention. This in combination with high quality CPR should be providing the best outcomes for patients across the state. There has been no research done to identify the effects of this change. Long-term survivability (months to years post-arrest), neurological capabilities, and subsequent health issues related to the cardiac arrest encounter were not addressed.

Methods: This retrospective study analyzed the Cardiac Arrest Registry for Enhanced Service (CARES) Report to identify OOHCA cases throughout the state from January 1, 2017 to December 31, 2018. Patient demographics, presenting rhythm, airway management, chemical interventions, and ROSC were recorded using a standardized EMS charting system by either the highest ranking EMS provider on the ambulance or the individual holding the license who can provide the highest level of care. All patient identifiers were removed from the database prior to access. Statistical analysis was performed using IBS SPSS software to determine if there was a statistical significance to the data.

Initial Findings: For 2017 there was a total of 423 cases. Of those, 339 did not achieve ROSC. There were 84 cases where ROSC was achieved prehospitally. Therefore for 2017 there was 19.9% ROSC achieved. In 2018 there were a total of 683 cases. Of those, 512 did not achieve ROSC. There were 171 cases where ROSC was achieved prehospitally. For 2018 there was 25% ROSC achieved. In completing a Chi Squared analysis for outcomes between the two years, the Chi Square Value is 0.898, with a p value of 0.343. Given the p value is greater than 0.05, this increase is not statistically significant.

Conclusions: Although the increase is not statistically significant, the increase between 2017 and 2018 shows that high quality CPR can increase good outcomes. To increase this number further, the state should focus on continuing education and ensuring quality improvement among EMS services.