Approaches to improve blood flow and use of medications during CPR may improve survival following cardiac arrest
Overview
Two studies involving the Emergency Medical Services of King County will evaluate whether differences in how CPR is performed, or the receipt of antiarrhythmic drugs will improve survival following cardiac arrest. The studies are entitled ROC-CCC (Resuscitation Outcomes Consortium - Continuous Chest Compression Study) and ROC-ALPS (Resuscitation Outcomes Consortium - Amiodarone, Lidocaine or neither (Placebo) Study). These studies are supported by the National Institute of Health and will involve 10 communities from across the United States and Canada. Seattle and greater King County are one of the 10 communities.
Cardiac arrest is the sudden, abrupt loss of heart function. Death usually occurs within minutes unless cardiopulmonary resuscitation (CPR), rapid defibrillation, and paramedic interventions are available.
Cardiopulmonary resuscitation, better known as CPR, is a proven medical intervention for improving survival after cardiac arrest. CPR consists of pumping on the patient’s chest and delivering breaths to produce some circulation until the heart can be restarted. Giving breaths provides oxygen such that with each subsequent compression, oxygen-rich blood is pumped forward. In many communities, CPR is performed by compressing the chest, with a brief interruption in order to give two breaths. In other communities, CPR is performed by giving breaths without interrupting chest compressions, because this affords continuous flow of blood at all times. This study will compare these two methods of CPR, treating some persons in cardiac arrest with one method (chest compressions interrupted for breaths) or the other (chest compressions that are not interrupted when a breath is given) to confirm which is better at saving lives.
Another consideration is whether heart rhythm medications are helpful when electrical shock alone is unable to stop a dangerous heart rhythm. Although medications like lidocaine and amiodarone are often used in hope of helping to restore a normal heart rhythm, it is not known if these drugs are actually life-saving. In fact, it is possible that these medications are not actually helpful for treating cardiac arrest, could have side effects that might cancel out any good they might do, or may even make outcome cardiac arrest worse than not receiving them at all. This can’t be known unless the drugs are compared against one another, as well as compared against giving neither one. This study will compare these medications, treating some patients in cardiac arrest with all standard treatments in addition to which some patients will receive lidocaine, some amiodarone, and some will receive neither of these rhythm medications (that is, a placebo, or salt water). After hospital arrival, all patients will receive standard care for their condition.
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