Mechanical CPR linked to worse outcomes, even in carefully choreographed resuscitation

  • Gonzales L & al.
  • Am J Emerg Med
  • 11 Aug 2018

  • curated by Jenny Blair, MD
  • Clinical Essentials
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Takeaway

  • Patients experiencing out-of-hospital cardiac arrest (OHCA) are more likely to survive if rescuers used manual rather than mechanical chest compressions during highly choreographed resuscitations.
  • Authors: “Our system now uses mechanical CPR only for moving patients, managing rescuer fatigue in prolonged resuscitations, and/or for ongoing resuscitations during transport to hospital.”

Why this matters

  • Use of mechanical CPR devices is growing.
  • In 2013, Austin-Travis County (Texas) emergency medical service (EMS) linked interruptions in chest compressions from mechanical CPR devices to flattened OHCA survival. 

Key results

  • Manual vs mechanical CPR (unadjusted):
    • Survival: OR, 2.6 (95% CI, 1.3-5.3);
    • Return of spontaneous circulation (ROSC): OR, 1.6 (95% CI, 1.1-2.3).
  • Manual vs mechanical CPR (propensity-matched):
    • Survival: 13.6% (n=24) vs 6.8% (n=12) (difference, 6.8%; 95% CI, 0.5%-13.3%);
    • ROSC: 38.6% (n=68) vs 28.4% (n=50) (difference, 10.2%; 95% CI, 0.4%-20.0%).

Study design

  • Retrospective, observational cohort study of 444 adult, nontraumatic OHCAs attended by Austin-Travis County EMS in 2016.
  • Researchers developed, trained crews in choreographed "pit crew" resuscitations incorporating mechanical CPR. 
  • Not all responders had mechanical unit available.
  • Using propensity-score matching, researchers evaluated mechanical vs manual chest compressions in patients who did not respond to early resuscitation.
  • Outcome was survival to hospital discharge.
  • Funding: None.

Limitations

  • Single-system, nonrandomized study.

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