Abstract 5: CPR Fraction Prior to Defibrillation Determines Survival in Prehospital Cardiac Arrest in the Resuscitation Outcomes Consortium (ROC) Epistry
Bibliographic record
Abstract
Introduction : In 2005, the American Heart Association recommended increased “hands-on time” during cardiopulmonary resuscitation (CPR) based on animal research and small case series. This study estimated the effect of increasing CPR fraction (proportion of resuscitation time with active CPR) on survival in a cohort of patients with out-of hospital ventricular fibrillation or ventricular tachycardia (VF/VT). Methods: Patients were selected from the ROC Epistry who had a confirmed VF/VT cardiac arrest that was not witnessed by Emergency Medical Services (EMS), received no public access defibrillation shock prior to EMS arrival, and had impedance recordings of CPR before the first shock. The proportion of each minute with active CPR, from defibrillator pad application until the first shock, was measured from the electronic resuscitation record by skilled readers who were blinded to hospital discharge outcome. The effect of increasing CPR fraction on survival to hospital discharge was adjusted for age, sex, bystander CPR, public location, interval from 911 call to defibrillator activation, chest compression rate, and ROC community. Results: Of 7963 EMS-treated cases of cardiac arrest without public access defibrillation, 1893 had an initial rhythm of VF/VT and 283 of those had electronic tracings and confirmed outcome. Mean age was 63 years and 81% were male. Bystanders performed CPR on 51% and 41% arrested in a public location. Outcomes and odds ratios (OR) with 95% confidence intervals (CI) of survival are shown from lowest to highest category of CPR fraction. Conclusions: This study provides preliminary evidence that increasing CPR fraction is associated with increased survival from VF/VT cardiac arrest. Though the study was observational, relatively small, and able only to measure CPR fraction after pad application, these findings suggest that provision of minimally interrupted CPR has direct clinical impact on survival after VF cardiac arrest.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.006 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".