Abstract 458: Pause Duration During Manual CPR is Associated With Survival and Favorable Neurological Outcome in All-Rhythm OHCA
Bibliographic record
Abstract
Introduction: AHA guidelines emphasize the importance of limiting pauses during CPR to less than 10 seconds due to the association of interruptions in chest compressions (CC) with adverse outcomes. Previous literature has associated shorter peri-shock pause times with greater odds of survival and longest pause in CC with lower odds of survival, though these analyses were restricted to patients with initial shockable rhythm. The aim of this analysis is to investigate the association between CC pause duration and patient outcomes in all-rhythm OHCA. Methods: OHCA cases from three EMS Agencies in Arizona between Jan 2016-Dec 2016 (n=229) were analyzed. De-identified prehospital patient data were linked to outcome data as part of the state quality program. Pauses calculated from CPR pad accelerometer data were defined by a minimum duration of 1000 ms. Mean pause duration was calculated by case as the average of all pauses, while longest pause duration was defined as the single longest pause in CC. Descriptive statistics and multivariate logistic regression was performed in STATA 15.1. Primary outcome measures defined were ROSC, survival-to-discharge, and favorable neurological outcome (Cerebral Performance Category 1 or 2). Covariates included in the statistical model include time in CPR, age, witnessed arrest, initial shockable rhythm, bystander CPR, and CPR quality. Results: A total of 37.1% of patients (n=85) achieved prehospital ROSC, 12.7% (n=29) survived, and 10.5% (n=24) had favorable neurological outcome. Average mean and longest pause duration was 8.13 + 0.76 s and 24.93 + 2.84 in survivors with favorable neurological outcome compared to 9.21 + 0.47 s and 35.56 + 3.55 s in non-survivors. Mean pause duration was associated with survival (adjusted OR 0.89, 95% CI 0.80-0.99) and favorable neurological outcome (adjusted OR 0.83, 95% CI 0.72-0.97). Longest pause duration was associated with favorable neurological outcome (adjusted OR 0.97, 95% CI 0.94-1.00). Conclusions: Prolonged pauses in CC during prehospital resuscitation was associated with worse survival and neurological function in OHCA patients with all cardiac rhythms. Pause duration should be kept as brief as possible due to the impact upon outcomes regardless of presenting cardiac rhythm.
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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 | 0.004 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| 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".