Treatment of non-traumatic out-of-hospital cardiac arrest with active compression decompression cardiopulmonary resuscitation plus an impedance threshold device |
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Authors: | Ralph J Frascone Marvin A Wayne Robert A Swor Brian D Mahoney Robert M Domeier Michael L Olinger David E Tupper Cindy M Setum Nathan Burkhart Lucinda Klann Joshua G Salzman Sandi S Wewerka Demetris Yannopoulos Keith G Lurie Brian J O’Neil Richard G Holcomb Tom P Aufderheide |
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Institution: | 1. Department of Emergency Medicine, Regions Hospital, St. Paul, MN, United States;2. Whatcom County Emergency Medical Services, Department of Emergency Medicine, PeaceHealth St. Joseph Medical Center, Bellingham, WA, United States;3. Department of Emergency Medicine, William Beaumont Hospital, Royal Oak, MI, United States;4. Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, MN, United States;5. Department of Emergency Medicine, St. Joseph Hospital, Ann Arbor, MI, United States;6. Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN, United States;g Department of Neurology, University of Minnesota Medical Center, Minneapolis, MN, United States;h Advanced Circulatory Systems, Inc., Roseville, MN, United States;i Department of Medicine, Cardiovascular Division, University of Minnesota Medical Center, Minneapolis, MN, United States;j Department of Emergency Medicine, Wayne State University, School of Medicine Specialist-in-Chief, Detroit, MI, United States;k Quintiles Consulting, Rockville, MD, United States;l Department of Emergency Medicine, Medical College of Wisconsin, Milwaukee, WI, United States |
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Abstract: | BackgroundA recent out-of-hospital cardiac arrest (OHCA) clinical trial showed improved survival to hospital discharge (HD) with favorable neurologic function for patients with cardiac arrest of cardiac origin treated with active compression decompression cardiopulmonary resuscitation (CPR) plus an impedance threshold device (ACD + ICD) versus standard (S) CPR. The current analysis examined whether treatment with ACD + ITD is more effective than standard (S-CPR) for all cardiac arrests of non-traumatic origin, regardless of the etiology.MethodsThis is a secondary analysis of data from a randomized, prospective, multicenter, intention-to-treat, OHCA clinical trial. Adults with presumed non-traumatic cardiac arrest were enrolled and followed for one year post arrest. The primary endpoint was survival to hospital discharge (HD) with favorable neurologic function (Modified Rankin Scale score ≤ 3).ResultsBetween October 2005 and July 2009, 2738 patients were enrolled (S-CPR = 1335; ACD + ITD = 1403). Survival to HD with favorable neurologic function was greater with ACD + ITD compared with S-CPR: 7.9% versus 5.7%, (OR 1.42, 95% CI 1.04, 1.95, p = 0.027). One-year survival was also greater: 7.9% versus 5.7%, (OR 1.43, 95% CI 1.04, 1.96, p = 0.026). Nearly all survivors in both groups had returned to their baseline neurological function by one year. Major adverse event rates were similar between groups.ConclusionsTreatment of out-of-hospital non-traumatic cardiac arrest patients with ACD + ITD resulted in a significant increase in survival to hospital discharge with favorable neurological function when compared with S-CPR. A significant increase survival rates was observed up to one year after arrest in subjects treated with ACD + ITD, regardless of the etiology of the cardiac arrest. |
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Keywords: | Cardiopulmonary resuscitation Heart arrest Out-of-hospital cardiac arrest Randomized controlled trial Mortality Outcome |
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