![]() 19 The ROC Epistry has been collecting population-based prospective data on OHCA from more than 260 emergency medical service (EMS) agencies since December, 2005. 18 The ROC PRIMED study used a cluster-randomized design to study the impact of early (after no more than 30 to 60 seconds of CPR) or delayed (after 180 seconds of CPR) first rhythm analysis on OHCA survival outcomes. ROC is a clinical network of 11 regional centres distributed across North America conducting research in the fields of OHCA and life-threatening traumatic injury. This is a retrospective analysis (completed in 2016) of a cohort of OHCA patients prospectively enrolled either in the Resuscitation Outcomes Consortium (ROC) PRIMED study (from June 2007-November 2009) or in the ROC Epistry following the completion of the ROC PRIMED study (January 2010-April 2011). 17 This study, however, was relatively small (2,103 patients including 42 survivors) and was under-powered to robustly evaluate the impact of CCF on ROSC or clinical outcomes such as survival to hospital discharge. 16 A single prior study of this rhythm group suggested that higher CCF could possibly be associated with a higher incidence of return of spontaneous circulation (ROSC) among non-shockable OHCA victims. 1 Importantly, cardiac arrest aetiology and physiology may differ in the non-shockable group such that optimal CPR, including CCF, may also differ. This group now represents almost 75% of all OHCA victims, and has a substantially poorer prognosis compared to patients with an initial shockable rhythm. Very little is known about the impact of CCF in a population of OHCA patients with initial non-shockable rhythms (asystole and pulseless electrical activity). However, most studies have involved patients with an initial shockable rhythm (ventricular fibrillation or tachycardia, VF/VT). Higher CCF has been associated with both higher 11- 13 and lower 14, 15 survival to hospital discharge for OHCA patients. There currently exists conflicting evidence supporting efforts to achieve a greater CCF.
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