Abstract 168: Integrated Autopulse CPR Improves Survival From Out-of Hospital Cardiac Arrests Compared to Manual CPR After Controlling for EMS Response Times
Background: The randomized controlled trial, Circulation Improving Resuscitation Care (CIRC), found that Emergency Medical Services (EMS) treated Out-of-Hospital Cardiac arrest (OHCA) survival was equivalent for integrated AutoPulse CPR (iA-CPR) and high quality Manual CPR (M-CPR) after controlling for covariates (study site, patient age, witnessed arrest, and initial rhythm). Recently, early compressions have been emphasized. In CIRC we did not control for the effect of EMS response times. Consequently, we wanted to determine the influence of EMS response time on survival to hospital discharge and to reanalyze the CIRC trial data controlling for this time.
Methods: We conducted a secondary analysis of the CIRC patients with witnessed arrest and shockable initial rhythm. The EMS response time was calculated by subtracting EMS documented arrival time from 9-1-1 call received time. A dichotomous variable was collected where EMS documented if there was a delay in accessing the patient after arrival at the scene (the actual time of the delay was not available). Logistic regression analysis was conducted controlling for the study covariates (study site and patient age), as well as response time, and patient access delay.
Results: Of 4,231 patients in the CIRC trial, 659 (16%) had a witnessed cardiac arrest with an initial shockable rhythm and complete response time and survival data. Response time and number of access delay in the M-CPR (349 patients) arm compared to iA-CPR (310 patients) were 7.25 minutes and 33 delays versus 7.35 minutes and 67 delays, respectively. Increasing EMS response time (OR 0.93; 95% CI: 0.88-0.99, p=0.026) and access delay (OR 0.59; 95% CI: 0.36-0.99, p=0.046) were found to be negatively associated with survival to hospital discharge. Controlling for the study covariates, EMS response time, and access delay, logistic regression found improved survival to hospital discharge with iA-CPR (OR 1.46; 95% CI: 1.03-2.07, p=0.036).
Conclusion: EMS response time and access delay are significant predictors of hospital survival and their effect should be controlled. Compared to high quality M-CPR, iA-CPR resulted in a statistically significant improvement in survival to hospital discharge for adult witnessed shockable OHCA patients.
- © 2013 by American Heart Association, Inc.