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Abstract
Background Out-of-hospital cardiac arrest (OHCA) survival remains poor worldwide, especially for patients with non-shockable rhythms. A physiologically-distinct neuroprotective (NP) cardiopulmonary resuscitation (CPR) strategy combining automated head-up positioning (AHUP), an impedance threshold device (ITD), and manual active compression-decompression (ACD) and/or an automated suction-cup based compression device was recently shown in animal models to increase cerebral blood flow1 and neurologically-intact survival2. We assessed the effectiveness of NP-CPR on overall survival and favorable neurological survival after OHCA.
Method This Institutional Review Board-approved observational study from a prospective NP-CPR registry compared patients treated with NP-CPR (n=227) from 6 United States pre-hospital systems with individual conventional (C) CPR control subjects (n=5,352) with data obtained from three large published North American OHCA randomized controlled trials. The primary endpoint was hospital survival. Favorable neurological function was a secondary endpoint. Multivariate logistic regression analyses (MLRA) and propensity-score 4:1 (C-CPR:NP-CPR) matching analyses (PSMA) were performed.
Results Regardless of the presenting rhythm, faster initiation of NP-CPR was associated with higher adjusted odds ratios (ORs)[95% confidence interval(CI)] of survival and favorable neurological survival, using MLRA and PSMA. Specifically when NP-CPR was initiated <10 and <15 minutes after the emergency call for help, the ORs[CI] for survival were 4.0[1.7–9.6] and 2.0[1.1–3.8], respectively, with PSMA. When NP-CPR was initiated <12 minutes after the emergency call, the ORs[CI] for survival with favorable neurological function were 2.29[1.04–5.04] and 3.35[1.42–7.89] with MLRA and PSMA, respectively.
Conclusion Compared with matched C-CPR controls rapid NP-CPR application was associated with a significantly higher probability of overall survival and favorable neurological survival after OHCA.
References
Moore JC, Segal N, Lick MC, et al. Head and thorax elevation during active compression decompression cardiopulmonary resuscitation with an impedance threshold device improves cerebral perfusion in a swine model of prolonged cardiac arrest. Resuscitation. Aug 05 2017;doi:10.1016/j.resuscitation.2017.07.03
Moore JC, Salverda B, Rojas-Salvador C, Lick M, Debaty G, G Lurie K. Controlled sequential elevation of the head and thorax combined with active compression decompression cardiopulmonary resuscitation and an impedance threshold device improves neurological survival in a porcine model of cardiac arrest. Resuscitation. Jan 2021;158:220–227. doi:10.1016/j.resuscitation.2020.09.030
Conflict of interest No authors have a conflict of interest except for Keith Lurie, who is a co-inventor of the automated head up positioning device used in the study and a co-founder of AdvancedCPR Solutions LLC that funded the study.
Funding AdvancedCPR Solutions LLC paid for the IRB application and provided some of the test devices to some of the test sites.
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