Association of Mechanical Cardiopulmonary Resuscitation Device Use With Cardiac Arrest Outcomes
2016; Lippincott Williams & Wilkins; Volume: 134; Issue: 25 Linguagem: Inglês
10.1161/circulationaha.116.026053
ISSN1524-4539
AutoresDavid G. Buckler, Rita V. Burke, Maryam Y. Naim, Andrew MacPherson, Richard N Bradley, Benjamin S. Abella, Joseph W. Rossano,
Tópico(s)Trauma Management and Diagnosis
ResumoHomeCirculationVol. 134, No. 25Association of Mechanical Cardiopulmonary Resuscitation Device Use With Cardiac Arrest Outcomes Free AccessLetterPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessLetterPDF/EPUBAssociation of Mechanical Cardiopulmonary Resuscitation Device Use With Cardiac Arrest OutcomesA Population-Based Study Using the CARES Registry (Cardiac Arrest Registry to Enhance Survival) David G. Buckler, NRP, Rita V. Burke, PhD, MPH, Maryam Y. Naim, MD, Andrew MacPherson, MD, Richard N. Bradley, MD, Benjamin S. Abella, MD, MPhil and Joseph W. Rossano, MD, MSFor the CARES Surveillance Group David G. BucklerDavid G. Buckler From Center for Resuscitation Science and Department of Emergency Medicine, University of Pennsylvania, Philadelphia (D.G.B., B.S.A.); Division of Pediatric Surgery, Children's Hospital Los Angeles, Los Angeles, CA (R.V.B.); Keck School of Medicine, University of Southern California, Los Angeles, CA (R.V.B.); Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia (M.Y.N., J.W.R.); Department of Emergency Medicine, University of British Columbia, Vancouver, BC, Canada (A.M.); and Department of Emergency Medicine, McGovern School of Medicine, University of Texas Health and Science, Houston. , Rita V. BurkeRita V. Burke From Center for Resuscitation Science and Department of Emergency Medicine, University of Pennsylvania, Philadelphia (D.G.B., B.S.A.); Division of Pediatric Surgery, Children's Hospital Los Angeles, Los Angeles, CA (R.V.B.); Keck School of Medicine, University of Southern California, Los Angeles, CA (R.V.B.); Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia (M.Y.N., J.W.R.); Department of Emergency Medicine, University of British Columbia, Vancouver, BC, Canada (A.M.); and Department of Emergency Medicine, McGovern School of Medicine, University of Texas Health and Science, Houston. , Maryam Y. NaimMaryam Y. Naim From Center for Resuscitation Science and Department of Emergency Medicine, University of Pennsylvania, Philadelphia (D.G.B., B.S.A.); Division of Pediatric Surgery, Children's Hospital Los Angeles, Los Angeles, CA (R.V.B.); Keck School of Medicine, University of Southern California, Los Angeles, CA (R.V.B.); Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia (M.Y.N., J.W.R.); Department of Emergency Medicine, University of British Columbia, Vancouver, BC, Canada (A.M.); and Department of Emergency Medicine, McGovern School of Medicine, University of Texas Health and Science, Houston. , Andrew MacPhersonAndrew MacPherson From Center for Resuscitation Science and Department of Emergency Medicine, University of Pennsylvania, Philadelphia (D.G.B., B.S.A.); Division of Pediatric Surgery, Children's Hospital Los Angeles, Los Angeles, CA (R.V.B.); Keck School of Medicine, University of Southern California, Los Angeles, CA (R.V.B.); Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia (M.Y.N., J.W.R.); Department of Emergency Medicine, University of British Columbia, Vancouver, BC, Canada (A.M.); and Department of Emergency Medicine, McGovern School of Medicine, University of Texas Health and Science, Houston. , Richard N. BradleyRichard N. Bradley From Center for Resuscitation Science and Department of Emergency Medicine, University of Pennsylvania, Philadelphia (D.G.B., B.S.A.); Division of Pediatric Surgery, Children's Hospital Los Angeles, Los Angeles, CA (R.V.B.); Keck School of Medicine, University of Southern California, Los Angeles, CA (R.V.B.); Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia (M.Y.N., J.W.R.); Department of Emergency Medicine, University of British Columbia, Vancouver, BC, Canada (A.M.); and Department of Emergency Medicine, McGovern School of Medicine, University of Texas Health and Science, Houston. , Benjamin S. AbellaBenjamin S. Abella From Center for Resuscitation Science and Department of Emergency Medicine, University of Pennsylvania, Philadelphia (D.G.B., B.S.A.); Division of Pediatric Surgery, Children's Hospital Los Angeles, Los Angeles, CA (R.V.B.); Keck School of Medicine, University of Southern California, Los Angeles, CA (R.V.B.); Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia (M.Y.N., J.W.R.); Department of Emergency Medicine, University of British Columbia, Vancouver, BC, Canada (A.M.); and Department of Emergency Medicine, McGovern School of Medicine, University of Texas Health and Science, Houston. and Joseph W. RossanoJoseph W. Rossano From Center for Resuscitation Science and Department of Emergency Medicine, University of Pennsylvania, Philadelphia (D.G.B., B.S.A.); Division of Pediatric Surgery, Children's Hospital Los Angeles, Los Angeles, CA (R.V.B.); Keck School of Medicine, University of Southern California, Los Angeles, CA (R.V.B.); Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia (M.Y.N., J.W.R.); Department of Emergency Medicine, University of British Columbia, Vancouver, BC, Canada (A.M.); and Department of Emergency Medicine, McGovern School of Medicine, University of Texas Health and Science, Houston. and For the CARES Surveillance Group Originally published20 Dec 2016https://doi.org/10.1161/CIRCULATIONAHA.116.026053Circulation. 2016;134:2131–2133The use of mechanical cardiopulmonary resuscitation devices (mCPR) to deliver CPR has become more widespread, although a survival advantage has not been demonstrated in randomized, controlled trials.1–3 Little is known about real-world use of mCPR or the association with outcomes.CARES (Cardiac Arrest Registry to Enhance Survival), a US national registry of out-of-hospital cardiac arrest,4 was analyzed for adults with nontraumatic out-of-hospital cardiac arrest from January 2013 to December 2015. Patients treated with mCPR were compared with patients receiving manual CPR only. Time of arrest, time of first CPR, and timing of interventions were not reliably reported. However, patients had information about when return of spontaneous circulation (ROSC) occurred before or after advanced life support (ALS) measures. As part of a subgroup analysis, patients with ROSC before ALS were excluded because of the decreased likelihood of these patients receiving mCPR. The primary outcome of interest was neurologically favorable survival at hospital discharge, defined as a Cerebral Performance Category of 1 or 2. This project was deemed exempt from review by the Children's Hospital of Philadelphia and University of Pennsylvania Institutional Review boards.Statistical analyses included the Student t test and χ2 test as appropriate. A multivariable logistic regression model was created with the use of stepwise addition to control for Utstein-style arrest characteristics, including age, arrest location, bystander CPR and automated external defibrillator use, witnessed arrest status, initial rhythm, postarrest targeted temperature management, successful advanced airway placement, and impedance threshold device use. Separate analyses were performed for the cohort who did not have ROSC before ALS treatment. Statistical significance was defined as a 2-sided value of P<0.05, and analyses were performed with SAS/STAT version 9.4 (SAS Institute Inc, Cary, NC).During the study period, 80 861 subjects were included in the analysis (Figure). The median age was 62 years (interquartile range, 52–75 years), and 35.1% received bystander CPR. Compared with patients receiving manual CPR, those receiving mCPR were more likely to have an unwitnessed arrest (57.3% versus 55.7%), an automated external defibrillator placed (33.3% versus 28.3%), an advanced airway placed (87.4% versus 79.0%), and an impedance threshold device used (41.8% versus 13.4%) and to undergo prehospital targeted temperature management (16.6% versus 12.2%; P<0.05 for all).Download figureDownload PowerPointFigure. A, CONSORT (Consolidated Standards of Reporting Trials) Diagram; (B) survival to multiple end points by mechanical cardiopulmonary resuscitation (CPR); and (C) survival with good neurological function by agency mechanical CPR use. ALS indicates advanced life support; and ROSC, return of spontaneous circulation.From 2013 to 2015, use of mCPR increased from 20.6% to 23.4% (P 75% of arrests and 37.7% using mCPR in <25% of arrests.Survival to hospital discharge and neurologically favorable survival were greater in patients not receiving mCPR (11.3% versus 7.0%, P<0.0001 for overall survival; 9.5% versus 5.6%, P<0.0001 for neurologically favorable survival). When patients with ROSC before provision of ALS care were excluded, neurologically favorable survival was also greater in those not receiving mCPR (5.9% versus 4.6%; P<0.0001; Figure). When Utstein-style characteristics and ROSC before ALS care were controlled for, mCPR was still associated with a decreased likelihood of neurologically favorable survival (adjusted odds ratio, 0.74; 95% confidence interval, 0.68–0.81; P<0.001).Outcomes were also assessed with frequency of emergency medical services agency mCPR use, excluding cases when ROSC was achieved before ALS care was instituted. Overall survival and neurologically favorable survival were greatest among emergency medical services agencies that never used mCPR compared with agencies that used mCPR for 75% of cases (Figure).The finding that survival to hospital discharge with favorable neurological function was more likely among patients treated with manual CPR compared with those receiving mCPR is in contrast to the results of randomized, controlled trials that demonstrated no benefit, but also no harm, from mCPR use. However, these findings are consistent with a recent analysis of out-of-hospital cardiac arrest in Utah that found mCPR to be associated with poor neurologically favorable survival.5 It is important to note that real-world implementation of new technologies is different from the environment of a well-designed randomized, controlled trial. Effects from uncontrolled and unidentified confounders may affect the results. It is also important to note that in the present study there were significant differences in arrest characteristics of patients receiving mCPR that may contribute to the poor observed survival. However, the association of mCPR use and worse neurologically favorable survival persisted when for these variables were controlled for in multivariable analysis and when cases with ROSC before ALS were excluded.In conclusion, the use of mCPR during out-of-hospital cardiac arrest was associated with lower neurologically favorable survival within emergency medical services agencies participating in CARES. Although the use of mCPR devices increased during the study period, deployment rates remained highly variable, and the majority of agencies did not use them. Further research is required to identify circumstances in which mCPR may benefit patients with out-of-hospital cardiac arrest; however, our data indicate that mCPR for routine cardiac arrest care was associated with worse outcomes.David G. Buckler, NRP*Rita V. Burke, PhD, MPH*Maryam Y. Naim, MDAndrew MacPherson, MDRichard N. Bradley, MDBenjamin S. Abella, MD, MPhilJoseph W. Rossano, MD, MSFor the CARES Surveillance GroupAcknowledgmentsThe authors thank the member sites of CARES for their contributions to this project. Participating sites can be access on the Web at https://mycares.net/sitepages/map.jsp.DisclosuresDr MacPherson has received travel reimbursements for service as Canadian vice-chair of the American Red Cross Scientific Advisory Council. Dr Bradley has received travel reimbursements for service as chairman of the Resuscitation Sub-Council, American Red Cross Scientific Advisory Council and is an uncompensated board member of the Citizen CPR Foundation. Dr Abella has received research funding from the National Institutes of Health, the Patient-Centered Outcomes Research Institute, the Medtronic Foundation, the American Heart Association, and CR Bard. He has received honoraria from Philips Healthcare and CR Bard, as well as in-kind research support from Laerdal Medical Corp. The other authors report no conflicts.Footnotes*Mr Buckler and Dr Burke contributed equally.Circulation is available at http://circ.ahajournals.org.Correspondence to: Joseph W. Rossano, MD, MS, Children's Hospital of Philadelphia, 34th Street & Civic Center Boulevard, Philadelphia, PA 19104. E-mail [email protected]References1. Brooks SC, Anderson ML, Bruder E, Daya MR, Gaffney A, Otto CW, Singer AJ, Thiagarajan RR, Travers AH. Part 6: alternative techniques and ancillary devices for cardiopulmonary resuscitation: 2015 American Heart Association guidelines update for cardiopulmonary resuscitation and emergency cardiovascular care.Circulation. 2015; 132(suppl 2):S436–S443. doi: 10.1161/CIR.0000000000000260.LinkGoogle Scholar2. Perkins GD, Lall R, Quinn T, Deakin CD, Cooke MW, Horton J, Lamb SE, Slowther AM, Woollard M, Carson A, Smyth M, Whitfield R, Williams A, Pocock H, Black JJ, Wright J, Han K, Gates S; PARAMEDIC Trial Collaborators. Mechanical versus manual chest compression for out-of-hospital cardiac arrest (PARAMEDIC): a pragmatic, cluster randomised controlled trial.Lancet. 2015; 385:947–955. doi: 10.1016/S0140-6736(14)61886-9.CrossrefMedlineGoogle Scholar3. Rubertsson S, Lindgren E, Smekal D, Östlund O, Silfverstolpe J, Lichtveld RA, Boomars R, Ahlstedt B, Skoog G, Kastberg R, Halliwell D, Box M, Herlitz J, Karlsten R. Mechanical chest compressions and simultaneous defibrillation vs conventional cardiopulmonary resuscitation in out-of-hospital cardiac arrest: the LINC randomized trial.JAMA. 2014; 311:53–61. doi: 10.1001/jama.2013.282538.CrossrefMedlineGoogle Scholar4. Bagai A, McNally BF, Al-Khatib SM, Myers JB, Kim S, Karlsson L, Torp-Pedersen C, Wissenberg M, van Diepen S, Fosbol EL, Monk L, Abella BS, Granger CB, Jollis JG. Temporal differences in out-of-hospital cardiac arrest incidence and survival.Circulation. 2013; 128:2595–2602. doi: 10.1161/CIRCULATIONAHA.113.004164.LinkGoogle Scholar5. Youngquist ST, Ockerse P, Hartsell S, Stratford C, Taillac P. Mechanical chest compression devices are associated with poor neurological survival in a statewide registry: a propensity score analysis.Resuscitation. 2016; 106:102–107. doi: 10.1016/j.resuscitation.2016.06.039.CrossrefMedlineGoogle Scholar Previous Back to top Next FiguresReferencesRelatedDetailsCited By Obermaier M, Zimmermann J, Popp E, Weigand M, Weiterer S, Dinse-Lambracht A, Muth C, Nußbaum B, Gräsner J, Seewald S, Jensen K and Seide S (2021) Automated mechanical cardiopulmonary resuscitation devices versus manual chest compressions in the treatment of cardiac arrest: protocol of a systematic review and meta-analysis comparing machine to human, BMJ Open, 10.1136/bmjopen-2020-042062, 11:2, (e042062), Online publication date: 1-Feb-2021. Nehme Z, Ball J, Stephenson M, Walker T, Stub D and Smith K (2021) Effect of a resuscitation quality improvement programme on outcomes from out-of-hospital cardiac arrest, Resuscitation, 10.1016/j.resuscitation.2021.03.007, 162, (236-244), Online publication date: 1-May-2021. Levy M, Kern K, Yost D, Chapman F and Hardig B (2020) Metrics of mechanical chest compression device use in out‐of‐hospital cardiac arrest, Journal of the American College of Emergency Physicians Open, 10.1002/emp2.12184, 1:6, (1214-1221), Online publication date: 1-Dec-2020. Friberg N, Schmidbauer S, Walther C and Englund E (2019) Skeletal and soft tissue injuries after manual and mechanical chest compressions, European Heart Journal - Quality of Care and Clinical Outcomes, 10.1093/ehjqcco/qcy062, 5:3, (259-265), Online publication date: 1-Jul-2019. Gonzales L, Oyler B, Hayes J, Escott M, Cabanas J, Hinchey P and Brown L (2019) Out-of-hospital cardiac arrest outcomes with "pit crew" resuscitation and scripted initiation of mechanical CPR, The American Journal of Emergency Medicine, 10.1016/j.ajem.2018.08.031, 37:5, (913-920), Online publication date: 1-May-2019. Zhu N, Chen Q, Jiang Z, Liao F, Kou B, Tang H and Zhou M (2019) A meta-analysis of the resuscitative effects of mechanical and manual chest compression in out-of-hospital cardiac arrest patients, Critical Care, 10.1186/s13054-019-2389-6, 23:1, Online publication date: 1-Dec-2019. Dyson K, Stub D, Bernard S and Smith K (2018) Controversial Issues, Cardiology Clinics, 10.1016/j.ccl.2018.03.004, 36:3, (367-374), Online publication date: 1-Aug-2018. Geller B and Abella B (2018) Evolving Strategies in Cardiac Arrest Management, Cardiology Clinics, 10.1016/j.ccl.2017.08.004, 36:1, (73-84), Online publication date: 1-Feb-2018. Becker T, Berning A, Prabhu A, Callaway C, Guyette F and Martin-Gill C (2018) An assessment of ventilation and perfusion markers in out-of-hospital cardiac arrest patients receiving mechanical CPR with endotracheal or supraglottic airways, Resuscitation, 10.1016/j.resuscitation.2017.11.054, 122, (61-64), Online publication date: 1-Jan-2018. Louie M, Chang T and Grundmeier R (2018) Recent Advances in Technology and Its Applications to Pediatric Emergency Care, Pediatric Clinics of North America, 10.1016/j.pcl.2018.07.013, 65:6, (1229-1246), Online publication date: 1-Dec-2018. Ondruschka B, Baier C, Bayer R, Hammer N, Dreßler J and Bernhard M (2018) Chest compression-associated injuries in cardiac arrest patients treated with manual chest compressions versus automated chest compression devices (LUCAS II) – a forensic autopsy-based comparison, Forensic Science, Medicine and Pathology, 10.1007/s12024-018-0024-5, 14:4, (515-525), Online publication date: 1-Dec-2018. Hayashida K, Tagami T, Fukuda T, Suzuki M, Yonemoto N, Kondo Y, Ogasawara T, Sakurai A, Tahara Y, Nagao K, Yaguchi A, Morimura N, Kitamura N, Nomura T, Shimizu N, Akashi A, Inokuchi S, Masui Y, Miura K, Tsutsumi H, Takuma K, Atsushi I, Nakano , Tanaka H, Ikegami K, Arai T, Kitamura N, Oda S, Kobayashi K, Suda T, Ono K, Furuya R, Koido Y, Iwase F, Kanesaka S, Okada Y, Unemoto K, Sadahiro T, Iyanaga M, Muraoka A, Hayashi M, Miyake Y, Yokokawa H, Koyama Y, Tsuchiya A, Kashiyama T, Hayashi M, Oshima K, Kiyota K, Hamabe Y, Yokota H, Hori S, Inaba S, Sakamoto T, Harada N, Kimura A, Kanai M, Otomo Y, Sugita M, Kinoshita K, Sakurai T, Kitano M, Matsuda K, Tanaka K, Yoshihara K, Yoh K, Suzuki J, Toyoda H, Mashiko K, Shimizu N, Muguruma T, Shimada T, Kobe Y, Shoko T, Nakanishi K, Shiga T, Yamamoto T, Sekine K and Izuka S (2017) Mechanical Cardiopulmonary Resuscitation and Hospital Survival Among Adult Patients With Nontraumatic Out‐of‐Hospital Cardiac Arrest Attending the Emergency Department: A Prospective, Multicenter, Observational Study in Japan (SOS‐KANTO [Survey of Survivors after Out‐of‐Hospital Cardiac Arrest in Kanto Area] 2012 Study), Journal of the American Heart Association, 6:11, Online publication date: 1-Nov-2017. Moore J, Bartos J, Matsuura T and Yannopoulos D (2017) The future is now, Current Opinion in Critical Care, 10.1097/MCC.0000000000000405, 23:3, (215-222), Online publication date: 1-Jun-2017. Youngquist S, Scheppke K and Pepe P (2017) Supportive technology in the resuscitation of out-of-hospital cardiac arrest patients, Current Opinion in Critical Care, 10.1097/MCC.0000000000000409, 23:3, (209-214), Online publication date: 1-Jun-2017. Schmidbauer S, Herlitz J, Karlsson T, Axelsson C and Friberg H (2017) Use of automated chest compression devices after out-of-hospital cardiac arrest in Sweden, Resuscitation, 10.1016/j.resuscitation.2017.09.004, 120, (95-102), Online publication date: 1-Nov-2017. Lowenstern A, Mandawat A and Newby L (2017) In-hospital cardiac arrest: Complex clinical challenges in need of unique solutions, American Heart Journal, 10.1016/j.ahj.2017.07.021, 193, (104-107), Online publication date: 1-Nov-2017. Spigner M, Braude D, Pruett K, Ortiz C, Glazer J and Marinaro J (2022) The Use of Predictive Modeling to Compare Prehospital eCPR Strategies, Prehospital Emergency Care, 10.1080/10903127.2022.2079782, (1-8) Sheraton M, Columbus J, Surani S, Chopra R and Kashyap R (2021) Effectiveness of Mechanical Chest Compression Devices over Manual Cardiopulmonary Resuscitation: A Systematic Review with Meta-analysis and Trial Sequential Analysis, Western Journal of Emergency Medicine, 10.5811/westjem.2021.3.50932, 22:4, (810-819) Seewald S, Obermaier M, Lefering R, Bohn A, Georgieff M, Muth C, Gräsner J, Masterson S, Scholz J, Wnent J and Schäfer A (2019) Application of mechanical cardiopulmonary resuscitation devices and their value in out-of-hospital cardiac arrest: A retrospective analysis of the German Resuscitation Registry, PLOS ONE, 10.1371/journal.pone.0208113, 14:1, (e0208113) Latsios G, Leopoulou M, Synetos A, Karanasos A, Melidi E, Toutouzas K and Tsioufis K (2021) The role of automated compression devices in out-of- and in- hospital cardiac arrest. Can we spare rescuers' hands?, Emergency Care Journal, 10.4081/ecj.2021.9525, 17:2 December 20, 2016Vol 134, Issue 25 Advertisement Article InformationMetrics © 2016 American Heart Association, Inc.https://doi.org/10.1161/CIRCULATIONAHA.116.026053PMID: 27994028 Originally publishedDecember 20, 2016 Keywordscardiopulmonary resuscitationheart arrestPDF download Advertisement SubjectsCardiopulmonary ArrestEpidemiologyQuality and OutcomesSudden Cardiac Death
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