Abstract 18761: Mechanical CPR associated With Decreased Survival From Out-of-hospital Cardiac Arrest
Background: Randomized trials have shown mechanical CPR yields equivalent outcomes when compared to manual CPR for out-of-hospital cardiac arrest (OHCA). Many Emergency Medical Services (EMS) agencies have adopted mechanical CPR but data are lacking on the association of mechanical CPR with survival in real-world clinical practice.
Objective: To assess the utilization of mechanical CPR and its association with survival to hospital discharge among adult cardiac arrest patients in Pennsylvania.
Methods: Utilizing data from Pennsylvania within the Cardiac Arrest Registry to Enhance Survival, we identified all resuscitation events in which mechanical CPR was used and compared these to all other manual CPR cases. Events where ROSC occurred before mechanical CPR would have arrived on scene were excluded. Demographic and survival data were analyzed using chi-squared testing for categorical variables and t-test for continuous variables. Multivariable regression was used to control for confounding, including: age, witnessed arrest, arrest location, bystander CPR, arrest rhythm, and no flow time.
Results: From 1/2012 to 12/2014, 10,457 cardiac arrests met inclusion criteria. Of those 1955 (19%) received mechanical CPR. Mean age was 66.7 ±15.9 years, and 34% received bystander CPR. Survival to hospital discharge was lower in the cohort receiving mechanical CPR compared to the cohort receiving manual CPR (106/1836 [5.8%] vs. 583/8048[7.2%], p=0.02). Good neurologic outcome was similarly reduced (80/1836[4.4%] vs. 453/8046[5.6%], p=0.02). In the adjusted model, use of mechanical CPR corresponded to reduced odds of survival to discharge (OR 0.75; CI 0.59-0.95; p=0.02) and good neurologic recovery (OR 0.75; CI 0.57-0.98; p=0.04). In this population, race or ethnicity were not associated with survival. We were unable to control for hospital and EMS agency characteristics or duration of resuscitation as possible confounders.
Conclusions: Mechanical CPR is associated with a 25% lower likelihood of survival from OHCA in Pennsylvania, even after adjustments for patient and arrest characteristics. Further research needs to be conducted to understand factors associated with mechanical CPR use and OHCA outcomes, including possible unmeasured confounders.
Author Disclosures: D. Buckler: None. K. Li: None. E. Heisler: None. D. Kupas: Employment; Significant; Geisinger Medical Center. Other; Significant; Commonwealth EMS Medical Director. M. Leary: Research Grant; Significant; American Heart Association, Laerdal Foundation. Other Research Support; Modest; In-kind: Laerdal Medical, In-kind: Physiocontrol. Ownership Interest; Modest; Resuscor. Consultant/Advisory Board; Modest; Stryker Medical. B. Abella: Research Grant; Significant; NIH NHLBI, Philips Healthcare, Medtronic Foundation, Stryker Medical. Honoraria; Modest; Medivance, Stryker Medical. Ownership Interest; Modest; Resuscor. Consultant/Advisory Board; Modest; Velomedix Corp., Heartsine Corp. L. Becker: Research Grant; Significant; Philips Medical Systems, NIH, BeneChil, Inc., Zoll Medical, Medtronic Foundation, Nihon Kohden Corp.. Honoraria; Modest; Universities of Lecturing - Keio University - Tokyo. Honoraria; Significant; Philips Medical Systems, Helar Technology. Ownership Interest; Modest; Helar Technologies. Consultant/Advisory Board; Modest; NIH Data Safety Monitoring Board. Other; Modest; Volunteer Member: American Heart Association.
- © 2015 by American Heart Association, Inc.