Mechanical chest compression does not seem to improve outcome after out-of hospital cardiac arrest. A single center observational trial
Institution:
1. Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria;2. Municipal Ambulance Service of Vienna, Vienna, Austria;1. Anesthesia Department, Regional Hospital Treviso, Treviso, Italy;2. Intensive Care Department, Regional Hospital Treviso, Treviso, Italy;3. Emergency Department, Regional Hospital Treviso, Treviso, Italy;1. Physio-Control, Inc., 11811 Willows Road NE, Redmond, WA 98052, USA;2. Regional Ambulance Service Utrecht, Jan van Eyck Lane 6, 3723 BC Bilthoven, Utrecht, The Netherlands;3. South Western Ambulance Service NHS Foundation Trust, Abbey Ct, Exeter EX2 7HY, England, United Kingdom;4. Department of Surgical Sciences/Anaesthesiology and Intensive Care Medicine, Uppsala University, Akademiska sjukhuset entrence 70, 1 tr, Uppsala, Sweden;1. Advanced Medical Emergency and Critical Care Center, Yamaguchi University Hospital, Ube, Yamaguchi, Japan;2. Acute and General Medicine, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi, Japan;1. Section of Cardiology, Department of Medicine, University of Chicago Medical Center, 5841 S. Maryland Ave, Chicago, IL 60637, USA;2. Centegra Health System, 360 North Terra Cotta, Crystal Lake, IL 60012, USA;3. MaineHealth Cardiology, Maine Medical Partners, 96 Campus Drive, Scarborough, ME 04074, USA;4. Section of Emergency Medicine, Department of Medicine, University of Chicago Medical Center, 5841 S. Maryland Ave, Chicago, IL 60637, USA;5. Department of Medicine, University of Chicago Medical Center, 5841 S. Maryland Ave, Chicago, IL 60637, USA;1. Department of Emergency Medicine, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan, ROC;2. Department of Emergency Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan, ROC;3. Department of Surgery, Faculty of Medicine, School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan, ROC;4. Department of Nursery, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan, ROC;5. Graduate Institute of Healthcare Administration and Medical Informatics, Kaohsiung Medical University, Kaohsiung, Taiwan, ROC;6. Department of Anesthesiology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan, ROC;7. Department of Anesthesiology, Faculty of Medicine, School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan, ROC;1. Warwick Clinical Trials Unit, University of Warwick, Coventry CV4 7AL, UK;2. School of Health Sciences, Faculty of Health and Medical Sciences, Duke of Kent Building, University of Surrey, Guildford GU2 7XH, UK;3. South Central Ambulance Service NHS Foundation Trust, Otterbourne, UK;4. NIHR Southampton Respiratory Biomedical Research Unit, University Hospital Southampton NHS Foundation Trust, Southampton, Hampshire, UK;5. North East Ambulance Service NHS Foundation Trust, Bernicia House, Goldcrest Way, Newburn Riverside, Newcastle upon Tyne NE15 8NY, UK;6. Academic Department of Anaesthesia, Critical Care, Pain and Resuscitation, Heart of England NHS Foundation Trust, Birmingham B9 5SS, UK;7. Surrey Perioperative, Anaesthetic and Critical Care Collaborative Research Group, Surrey Health Partners, Egerton Road, Guildford GU2 8DR, UK
Abstract:
AimRecently three large post product placement studies, comparing mechanical chest compression (cc) devices to those who received manual cc, found equivalent outcome results for both groups. Thus the question arises whether those results could be replicated using the devices on a daily routine.MethodsWe prospectively enrolled 948 patients over a 12 months period. Chi-Square test and Mann–Whitney-U test were used to assess differences between “manual” and “mechanical” cc subgroups. Uni- and multivariate Cox regression hazard analysis were used to assess the influence of cc type on survival.ResultsA mechanical cc device was used in 30.1% (n = 283) cases. Patients who received mechanical cc had a significantly worse neurological outcome – measured in cerebral performance category (CPC) – than the manual cc group (56.8% vs. 78.6%, p = 0.009). Patients receiving mechanical cc were significantly younger, more were male and were more likely to have bystander CPR and an initially shock-able ECG rhythm. There was no difference in the quality of CPR that might explain the worse outcome in mechanical cc patients.ConclusionEven with high quality CPR in both, manual and mechanical cc groups, outcome in patients who received mechanical cc was significantly worse. The anticipated benefits of a higher compression ratio and a steadier compression depth of a mechanical cc device remain uncertain. In this study selection for mechanical cc was not standardized, and was non-random. This merits further investigation. Further research on how mechanical cc is chosen and used should be considered.Clinical trial registration: https://ekmeduniwien.at/core/catalog/2013/ (EK-Nr:1221/2013)
