Treatment of non-traumatic out-of-hospital cardiac arrest with active compression decompression cardiopulmonary resuscitation plus an impedance threshold device

Abstract

Background A 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 aetiology. Methods This 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). Results Between October 2005 to 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. Conclusions Treatment 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. Clinical Trial Registration NCT 00189423 (http://www.clinicaltrials.gov)

The Development of Innovative Handheld Devices to Augment Cardiopulmonary Resuscitation Therapy and External Cardioversion and Defibrillation

“…They found a 38% increase in survival to hospital discharge with favorable neurologic outcomes, and a 39% relative increase in one-year survival following cardiac arrest for ACD plus ITD CPR, independent of the cause of cardiac arrest. 24 A 2015 review concluded that compared with standard CPR, ACD plus ITD CPR achieved increased blood flow and associated patient survival rates for out-of-hospital cardiac arrest regardless of etiology. 7 …”

“…21,22,41 One trial comparing conventional CPR and ACD plus ITD CPR found increased one-year survival following cardiac arrest with ACD plus ITD CPR use. 8,24 Due to a lack of research on this method, however, it is not a recommended alternative for conventional CPR unless performed by trained personnel. 29 Mechanical chest compression piston devices are also mentioned in the guidelines.…”

What is new in the 2015 American Heart Association guidelines, what is recycled from 2010, and what is relevant for emergency medicine in Canada

“…15 The combination of ITD with active compression-decompression CPR may be a reasonable alternative to conventional CPR in settings with available equipment and properly trained personnel. 16,17 Conventional manual chest compressions remain the standard of care for the treatment of cardiac arrest, but mechanical chest compression devices may be a reasonable alternative for use by properly trained personnel. [18][19][20] When rapidly implemented, extracorporeal cardiopulmonary resuscitation (ECPR) can prolong viability for patients who are not resuscitated with conventional CPR.…”

The Association of Health Status and Providing Consent to Continued Participation in an Out‐of‐hospital Cardiac Arrest Trial Performed Under Exception From Informed Consent

“…2,3 Briefly, the study compared the safety and effectiveness of two methods of cardiopulmonary resuscitation (CPR; active compression decompression CPR plus an impedance threshold device, and standard CPR) administered by emergency medical services (EMS) providers at seven sites across the United States. The primary study endpoint was survival to hospital discharge with favorable neurologic function (Modified Rankin Scale score ≤ 3) in subjects with arrests of presumed cardiac etiologies.…”

“…2,3 Demographic and cardiac arrest characteristics were obtained from EMS run reports and hospital admission data. Outcome data were collected in a variety of ways, depending on the informed consent status of the patient.…”