Chest Compression First Equal to Immediate Defibrillation

But in out-of-hospital cardiac arrest with longer response time, compressions first may be better
By Beth Gilbert
HealthDay Reporter

MONDAY, Sept. 13 (HealthDay News) -- Chest compression prior to defibrillation is as successful as -- but not superior to -- immediate defibrillation in individuals who suffer out-of-hospital cardiac arrest, though it is possible that chest compression first is more beneficial when the response time is prolonged, according to a meta-analysis published online Sept. 9 in BMC Medicine.

To compare the effect of chest compression-first versus defibrillation-first on survival in patients with out-of-hospital cardiac arrest, Pascal Meier, M.D., of the University of Michigan Medical Center in Ann Arbor, and colleagues pooled data from four randomized trials that included a total of 1,503 subjects.

The investigators did not find any significant differences between chest compression-first and defibrillation-first in the rate of return of spontaneous circulation, survival to hospital discharge, or favorable neurologic outcomes. However, odds ratio (OR) point estimates favored chest compression first for one-year survival (OR, 1.38; P = 0.092) and for cases with response times greater than five minutes (OR, 1.45, P = 0.353), but the 95 percent confidence interval crossed one for both one-year survival and prolonged response time, indicating insufficient estimate precision.

"Based on our study, current guidelines emphasizing early defibrillation still are important," Meier said in a statement. "However, since the outcomes with the chest compression-first approach were not inferior and might be even better in the long-term, and in case of longer response times, this study may have an impact on future guidelines."

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