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Impact of ‘synchronous’ and ‘asynchronous’ CPR modality on quality bundles and outcome in out-of-hospital cardiac arrest patients

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Abstract

During cardiopulmonary resuscitation (CPR), the need to interrupt chest compressions to provide synchronous ventilations prevents blood flow continuity, reducing the possibility to ensure high-quality CPR bundles of care and, thus, having a potentially negative impact on perfusion and patient outcome. Contemporaneous asynchronous chest compressions and ventilations may avoid these potentially negative effects. Only a few studies measured the CPR quality metrics during synchronous and asynchronous CPR modality and its relation to patient outcome. A prospective observational study was conducted on 285 consecutive adult patients with out-of-hospital cardiac arrest treated by EMS teams over a 30-month period. Ventilation rate, chest compression fraction (i.e. cardiac arrest time spent delivering uninterrupted chest compressions compared to total cardiac arrest time) and chest compression rate per minute were collected in real time by defibrillators and analysed through a dedicated software (electrical cardiac activity through the ECG, chest compression and ventilations through the transthoracic impedance) during synchronous and asynchronous CPR modalities. During asynchronous CPR modality, higher ventilation rate and chest compression fraction (p  < 0.001), and lower chest compression rate per minute (p < 0.001) were ensured, being all cited metrics more adherent to the high-quality CPR bundles. Ventilation rate provided during the whole CPR was an independent predictor for a good neurological outcome (OR 3.795, p = 0.005). Asynchronous chest compression and ventilation ensured the most adequate chest compression fraction, uninterrupted chest compression rate and ventilation rate.

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Acknowledgements

The authors thank the whole staff of the Emergency Medical Service and the Cardiovascular Department of Trieste University Hospital for their collaboration.

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Department of Medicine, Surgery and Health Sciences, University of Trieste, Strada di Fiume 447, 34100, Trieste, Italy

    Gianfranco Sanson

  2. Istituto di Ricerche Farmacologiche “Mario Negri”, Via Giuseppe La Masa 19, 20156, Milan, Italy

    Giuseppe Ristagno

  3. Emergency Medical Service, Azienda Sanitaria Universitaria Integrata, Via Giovanni Sai 1-3, 34128, Trieste, Italy

    Giuseppe Davide Caggegi, Marco Zambon, Domenico Montalbano & Sreten Vukanovic

  4. School of Medicine, University of Trieste, Strada di Fiume 447, 34100, Trieste, Italy

    Athina Patsoura

  5. School of Nursing, University of Trieste, Piazzale Valmaura 9, 34100, Trieste, Italy

    Veronica Xu

  6. Regional Emergency Medical Service System, Azienda Regionale di Coordinamento per la Salute, via Pozzuolo, 330, 33057, Udine, Italy

    Vittorio Antonaglia

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  1. Gianfranco Sanson
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Correspondence to Gianfranco Sanson.

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This research conforms with the principles outlined in the Declaration of Helsinki. The study was approved by the Institutional Ethical Committee as a part of the Italian Registry of Cardiac Arrest-RIAC study.

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Sanson, G., Ristagno, G., Caggegi, G.D. et al. Impact of ‘synchronous’ and ‘asynchronous’ CPR modality on quality bundles and outcome in out-of-hospital cardiac arrest patients. Intern Emerg Med 14, 1129–1137 (2019). https://doi.org/10.1007/s11739-019-02138-9

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