Use of an Automated, Load-Distributing Band Chest Compression Device for Out-of-Hospital Cardiac Arrest Resuscitation

CONTEXT Only 1% to 8% of adults with out-of-hospital cardiac arrest survive to hospital discharge. OBJECTIVE To compare resuscitation outcomes before and after an urban emergency medical services (EMS) system switched from manual cardiopulmonary resuscitation (CPR) to load-distributing band (LDB) CP...

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Published in:JAMA : the journal of the American Medical Association 2006-06, Vol.295 (22), p.2629-2637
Main Authors: Ong, Marcus Eng Hock, Ornato, Joseph P, Edwards, David P, Dhindsa, Harinder S, Best, Al M, Ines, Caesar S, Hickey, Scott, Clark, Bryan, Williams, Dean C, Powell, Robert G, Overton, Jerry L, Peberdy, Mary Ann
Format: Article
Language:English
Subjects:
Acquisitions & mergers
Aged
Aged, 80 and over
Ambulance services
Biological and medical sciences
Cardiopulmonary resuscitation
Cardiopulmonary Resuscitation - instrumentation
Cardiopulmonary Resuscitation - methods
CPR
Data analysis
Emergency Medical Services
Female
General aspects
Heart Arrest - therapy
Heart attacks
Humans
Male
Medical sciences
Middle Aged
Outcome Assessment (Health Care)
Paramedics
Public access
Survival Analysis
Travel & entertainment expenses
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Summary:CONTEXT Only 1% to 8% of adults with out-of-hospital cardiac arrest survive to hospital discharge. OBJECTIVE To compare resuscitation outcomes before and after an urban emergency medical services (EMS) system switched from manual cardiopulmonary resuscitation (CPR) to load-distributing band (LDB) CPR. DESIGN, SETTING, AND PATIENTS A phased, observational cohort evaluation with intention-to-treat analysis of 783 adults with out-of-hospital, nontraumatic cardiac arrest. A total of 499 patients were included in the manual CPR phase (January 1, 2001, to March 31, 2003) and 284 patients in the LDB-CPR phase (December 20, 2003, to March 31, 2005); of these patients, the LDB device was applied in 210 patients. INTERVENTION Urban EMS system change from manual CPR to LDB-CPR. MAIN OUTCOME MEASURES Return of spontaneous circulation (ROSC), with secondary outcome measures of survival to hospital admission and hospital discharge, and neurological outcome at discharge. RESULTS Patients in the manual CPR and LDB-CPR phases were comparable except for a faster response time interval (mean difference, 26 seconds) and more EMS-witnessed arrests (18.7% vs 12.6%) with LDB. Rates for ROSC and survival were increased with LDB-CPR compared with manual CPR (for ROSC, 34.5%; 95% confidence interval [CI], 29.2%-40.3% vs 20.2%; 95% CI, 16.9%-24.0%; adjusted odds ratio [OR], 1.94; 95% CI, 1.38-2.72; for survival to hospital admission, 20.9%; 95% CI, 16.6%-26.1% vs 11.1%; 95% CI, 8.6%-14.2%; adjusted OR, 1.88; 95% CI, 1.23-2.86; and for survival to hospital discharge, 9.7%; 95% CI, 6.7%-13.8% vs 2.9%; 95% CI, 1.7%-4.8%; adjusted OR, 2.27; 95% CI, 1.11-4.77). In secondary analysis of the 210 patients in whom the LDB device was applied, 38 patients (18.1%) survived to hospital admission (95% CI, 13.4%-23.9%) and 12 patients (5.7%) survived to hospital discharge (95% CI, 3.0%-9.3%). Among patients in the manual CPR and LDB-CPR groups who survived to hospital discharge, there was no significant difference between groups in Cerebral Performance Category (P = .36) or Overall Performance Category (P = .40). The number needed to treat for the adjusted outcome survival to discharge was 15 (95% CI, 9-33). CONCLUSION Compared with resuscitation using manual CPR, a resuscitation strategy using LDB-CPR on EMS ambulances is associated with improved survival to hospital discharge in adults with out-of-hospital nontraumatic cardiac arrest.
ISSN:0098-7484
1538-3598
DOI:10.1001/jama.295.22.2629