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Lars Wik, MD, PhD; Jo Kramer-Johansen, MD; Helge Myklebust, BEng; Hallstein Sørebø, MD; Leif Svensson, MD; Bob Fellows, MD; Petter Andreas Steen, MD, PhD

JAMA. 2005;293:299-304.

Context  Cardiopulmonary resuscitation (CPR) guidelines recommend target values for compressions, ventilations, and CPR-free intervals allowed for rhythm analysis and defibrillation. There is little information on adherence to these guidelines during advanced cardiac life support in the field.

Objective  To measure the quality of out-of-hospital CPR performed by ambulance personnel, as measured by adherence to CPR guidelines.

Design and Setting  Case series of 176 adult patients with out-of-hospital cardiac arrest treated by paramedics and nurse anesthetists in Stockholm, Sweden, London, England, and Akershus, Norway, between March 2002 and October 2003. The defibrillators recorded chest compressions via a sternal pad fitted with an accelerometer and ventilations by changes in thoracic impedance between the defibrillator pads, in addition to standard event and electrocardiographic recordings.

Main Outcome Measure  Adherence to international guidelines for CPR.

Results  Chest compressions were not given 48% (95% CI, 45%-51%) of the time without spontaneous circulation; this percentage was 38% (95% CI, 36%-41%) when subtracting the time necessary for electrocardiographic analysis and defibrillation. Combining these data with a mean compression rate of 121/min (95% CI, 118-124/min) when compressions were given resulted in a mean compression rate of 64/min (95% CI, 61-67/min). Mean compression depth was 34 mm (95% CI, 33-35 mm), 28% (95% CI, 24%-32%) of the compressions had a depth of 38 mm to 51 mm (guidelines recommendation), and the compression part of the duty cycle was 42% (95% CI, 41%-42%). A mean of 11 (95% CI, 11-12) ventilations were given per minute. Sixty-one patients (35%) had return of spontaneous circulation, and 5 of 6 patients discharged alive from the hospital had normal neurological outcomes.

Conclusions  In this study of CPR during out-of-hospital cardiac arrest, chest compressions were not delivered half of the time, and most compressions were too shallow. Electrocardiographic analysis and defibrillation accounted for only small parts of intervals without chest compressions.

Author Affiliations: National Competence Center for Emergency Medicine (Dr Wik), Institute for Experimental Medical Research (Drs Wik, Kramer-Johansen, and Steen), Division of Prehospital Emergency Medicine (Drs Wik, Sørebø, and Steen), and Division of Surgery (Dr Steen), Ulleval University Hospital, Oslo, Norway; Norwegian Air Ambulance, Department of Research and Education in Acute Medicine, Drøbak, Norway (Dr Kramer-Johansen); Laerdal Medical, Corp, Stavanger, Norway (Mr Myklebust); Sodersjukhuset, Stockholm, Sweden (Dr Svensson); London Ambulance Service NHS Trust, London, England (Dr Fellows).

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