OHCA: mechanical CPR linked to higher ROSC rates

  • Seewald S & al.
  • PLoS One
  • 1 Jan 2019

  • curated by Jenny Blair, MD
  • Clinical Essentials
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Takeaway

  • For patients experiencing out-of-hospital cardiac arrest (OHCA), mechanical CPR was associated with higher rates of return of spontaneous circulation (ROSC) than was manual CPR in this registry study.
  • Results contradict those of 2 recent publications using hard clinical outcomes, while a recent Cochrane review concluded mechanical and manual CPR delivered similar outcomes.

Why this matters

  • Rescuer fatigue can erode manual CPR quality.
  • Studies of survival with mechanical CPR have yielded mixed results.

Key results

  • ROSC ORs on multivariate analysis, mechanical vs manual CPR:
    • Adjusting for epidemiologic and EMS treatment factors: 1.27 (95% CI, 1.09-1.48);
    • Adjusting for above plus CPR duration: 1.77 (95% CI, 1.48-2.12).
  • Observed vs predicted ROSC rates:
    • Manual CPR: 41.2% vs 39.2%;
    • Mechanical CPR: 51.5% vs 42.5%; 
    • Mechanical vs manual difference: P<.001.>

Study design

  • Retrospective analysis of German Resuscitation Registry data, 2007-2014.
  • Authors assessed OHCA patients treated with mechanical vs manual CPR (n=912 vs 18,697, respectively).
  • Outcome: ROSC (palpable pulse for ≥20 seconds).
  • Funding: None.

Limitations

  • Resuscitations of children and trauma victims, those lasting
  • Potential residual confounding.
  • No hard clinical outcomes.

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