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Cardiac resuscitation: the importance of minimal interruptions
Minimally interrupted cardiac resuscitation (MICR) is a new approach to out-of-hospital cardiac arrest that focuses on maximising myocardial and cerebral perfusion through a series of coordinated interventions. It is designed to minimise the interruption of chest compressions, provide immediate pre-shock chest compressions for prolonged ventricular fibrillation, delay or eliminate endotracheal intubation, minimise positive pressure ventilations and decrease the time interval to intravenous adrenaline administration. More specifically, the approach involves an initial series of 200 uninterrupted chest compressions, followed by a rhythm analysis with a single shock only, then 200 immediate post-shock chest compressions before pulse check or rhythm analysis, early administration of adrenaline and delayed endotracheal intubation.
Bobrow et al investigated whether this technique might be used to improve survival in patients with an out-of-hospital arrest in Arizona, USA. They designed a prospective study of survival-to-hospital discharge that was conducted over a 34-month period. First, patient outcomes were assessed before and after MICR training of emergency personnel. In a second analysis, patients from the two metropolitan cities and 60 additional fire departments in Arizona who had received MICR were compared with patients who received standard advanced life support.
Among 886 patients in the two cities studied, survival-to-hospital discharge increased from 1.8% (4/218) before MICR training to 5.4% (36/668) afterwards (odds ratio (OR) = 3.0). In the subgroup with witnessed cardiac arrest and ventricular fibrillation, survival increased from 4.7% (2/43) before MCIR training to 17.6% (23/131) after MICR training (OR = 8.6). In the analysis of protocol compliance involving 2460 patients with cardiac arrest, survival was significantly better among patients who received MICR than among those who did not (9.1% vs 3.8%; OR = 2.7), as well as patients with witnessed ventricular fibrillation (28.4% vs 11.9%; OR = 3.4).
Resuscitation protocols to date have emphasised the importance of early defibrillation, yet the approach used in this study implies that …