Early versus Later Rhythm Analysis in Patients with Out-of-Hospital Cardiac Arrest
Journal Club Summary
Stiell IG, Nichol G, Leroux BG, Rea TD, Ornato JP, Powell J, Christenson J, Callaway CW, Kudenchuk PJ, Aufderheide TP, Idris AH, Daya MR, Wang HE, Morrison LJ, Davis D, Andrusiek D, Stephens S, Cheskes S, Schmicker RH, Fowler R, Vaillancourt C, Hostler D, Zive D, Pirrallo RG, Vilke GM, Sopko G, Weisfeldt M; ROC Investigators.
N Engl J Med. 2011 Sep 1;365(9):787-97.
This large cluster randomized trial conducted by the ROC Consortium enrolled 9,933 Canadian and U.S. out-of-hospital cardiac arrest patients and found no difference in outcomes with a brief period, as compared with a longer period, of EMS-administered CPR before the first analysis of cardiac rhythm. This was a real-life effectiveness (pragmatic) trial conducted in difficult circumstances that, despite some problems with protocol compliance, has definitively shown that there is no reason to delay analysis and defibrillation for OOHCA patients.
By Dr. Ian Stiell