ABSTRACTS
Probability of a Shockable Presenting Rhythm Based on Initial CPR ProviderAuthor: Melisa Martin, EdD, MHS, Paramedic | | Associate Authors: Michael W. Hubble, PhD, Sara E. Houston, MHS, NRP, Stephen Taylor, MHS, Ginny K. Renkiewicz, PhD
Introduction A shockable presenting rhythm upon EMS arrival is associated with cardiac arrest survival. Although EMS response time is known to be associated with increased rates of shockable presenting rhythms upon EMS arrival, the impact of the type of provider who first administers CPR on the likelihood of a shockable presenting rhythm has not been explored. Objective To evaluate the impact of the first provider of CPR on the likelihood of a shockable presenting rhythm. Methods This retrospective study used national data collected between January 2020 and December 2020 from the ESO Data Collaborative. Patients included were adults who suffered a nontraumatic, witnessed arrest prior to EMS arrival. Logistic regression was used to calculate the odds ratio (OR) for a shockable presenting rhythm by when CPR was initiated (prior to first responder arrival, upon first responder arrival, or upon EMS arrival). Results A total of 13,645 patients were included, of which 70% received CPR prior to EMS arrival and 27% had a shockable presenting rhythm. The sample was largely White (74%) and male (62%) with a cardiac etiology of arrest (82%). After controlling for age, sex, minority status, arrest etiology, and EMS response time, patients were less likely to present with a shockable rhythm if CPR was first initiated after arrival of first responders (OR = 0.84, p < 0.001) or EMS providers (OR = 0.78, p < 0.001) compared to bystanders. This outcome was more pronounced with EMS response times of less than 5 minutes. Conclusion We found bystander initiation of CPR to be associated with an increased likelihood of a shockable presenting rhythm.
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