No Benefit in Neurologic Outcomes of Survivors of Out-of-Hospital Cardiac Arrest with Mechanical Compression Device

Abstract

In our study, use of the mechanical CPR device was associated with a poor neurologic outcome at hospital discharge. However, this difference was no longer evident after logistic regression adjusting for confounding variables. Resuscitation management following institution of mechanical CPR, specifically medication and airway management, may account for the poor outcome reported. Further investigation of resuscitation management when a mechanical CPR device is utilized is necessary to optimize survival benefit.

Metrics of mechanical chest compression device use in out‐of‐hospital cardiac arrest

“…Because of factors that tend to delay use of mCPR devices until after the initial minutes of resuscitation, this same bias likely affects the results of the many observational studies that have attempted to compare manual and mCPR; unfortunately, this cannot be confirmed because these studies did not measure or report timing metrics. [7][8][9][10][11][12][13] Three RCTs conducted between 2008 and 2013 compared manual and mechanical chest compression in OHCA; primary end points of those trials found that survival was similar for manual CPR and mCPR. [3][4][5] Since then, much has been learned about how to monitor and optimize use of the devices, but those improvements have not yet been tested in a randomized controlled trial.…”

“…For example, in our study, survival is significantly lower in the sCPR + mCPR group than in the sCPR‐only group, a difference that would be consistent with resuscitation time bias; the decision to apply the device was not made until the patient had remained pulseless through at least 2 cycles of CPR. Because of factors that tend to delay use of mCPR devices until after the initial minutes of resuscitation, this same bias likely affects the results of the many observational studies that have attempted to compare manual and mCPR; unfortunately, this cannot be confirmed because these studies did not measure or report timing metrics 7‐13 …”

“…The use of mCPR involves not only the device but also its application, on mCPR devices report or analyze these important parameters. [3][4][5][6][7][8][9][10][11][12][13] A detailed analysis of a small subset of cases in 1 RCT revealed that the median pause in CPR for device deployment was over 30 seconds. 14…”

“…The time and manner of device application may potentially influence resuscitation quality and outcomes. Neither the large randomized controlled trials (RCTs) nor the majority of observational trials on mCPR devices report or analyze these important parameters 3‐13 . A detailed analysis of a small subset of cases in 1 RCT revealed that the median pause in CPR for device deployment was over 30 seconds 14 …”

Automatische externe Reanimationsgeräte

“…Auch hinsichtlich des neurologischen Behandlungsergebnisses von primär erfolgreich reanimierten Patienten fehlt der klare Nachweis eines selektiven Vorteils durch die ACCD-Anwendung [7,8]. Bei fehlendem Überlebens-vorteil und ohne signifikanten Einfluss auf den neurologischen Folgezustand für die Patienten stellt sich damit neben der Entlastung der Rettungskräfte vor allem die Frage nach einer höheren Sicherheit in der Anwendung von ACCD im Vergleich zu mCCim Sinne der Patienten insbesondere durch eine niedrigere Verletzungsfrequenz und -intensität.…”