Manual Chest Compression vs Use of an Automated Chest Compression Device During Resuscitation Following Out-of-Hospital Cardiac Arrest

TLDR

High‑quality CPR improves cardiac and brain resuscitation, and automated load‑distributing band devices may generate greater organ blood flow than manual compressions. The study aimed to compare resuscitation outcomes after out‑of‑hospital cardiac arrest when an automated LDB‑CPR device was added to standard EMS care versus manual CPR. A multicenter, randomized trial enrolled patients with presumed cardiac‑origin arrest before EMS arrival, assigning 554 to LDB‑CPR and 517 to manual CPR, with primary endpoint survival to 4 hours after the 911 call and secondary endpoints survival to hospital discharge and neurological status. Automated LDB‑CPR did not improve 4‑hour survival (29.5 % vs 28.5 %) and was associated with a trend toward lower survival to discharge (9.9 % vs 5.8 %) and worse neurological outcomes (7.5 % vs 3.1 % cerebral performance category 1–2). Device design requires further evaluation; the trial is registered at.

Abstract

High-quality cardiopulmonary resuscitation (CPR) may improve both cardiac and brain resuscitation following cardiac arrest. Compared with manual chest compression, an automated load-distributing band (LDB) chest compression device produces greater blood flow to vital organs and may improve resuscitation outcomes.To compare resuscitation outcomes following out-of-hospital cardiac arrest when an automated LDB-CPR device was added to standard emergency medical services (EMS) care with manual CPR.Multicenter, randomized trial of patients experiencing out-of-hospital cardiac arrest in the United States and Canada. The a priori primary population was patients with cardiac arrest that was presumed to be of cardiac origin and that had occurred prior to the arrival of EMS personnel. Initial study enrollment varied by site, ranging from late July to mid November 2004; all sites halted study enrollment on March 31, 2005.Standard EMS care for cardiac arrest with an LDB-CPR device (n = 554) or manual CPR (n = 517).The primary end point was survival to 4 hours after the 911 call. Secondary end points were survival to hospital discharge and neurological status among survivors.Following the first planned interim monitoring conducted by an independent data and safety monitoring board, study enrollment was terminated. No difference existed in the primary end point of survival to 4 hours between the manual CPR group and the LDB-CPR group overall (N = 1071; 29.5% vs 28.5%; P = .74) or among the primary study population (n = 767; 24.7% vs 26.4%, respectively; P = .62). However, among the primary population, survival to hospital discharge was 9.9% in the manual CPR group and 5.8% in the LDB-CPR group (P = .06, adjusted for covariates and clustering). A cerebral performance category of 1 or 2 at hospital discharge was recorded in 7.5% of patients in the manual CPR group and in 3.1% of the LDB-CPR group (P = .006).Use of an automated LDB-CPR device as implemented in this study was associated with worse neurological outcomes and a trend toward worse survival than manual CPR. Device design or implementation strategies require further evaluation.clinicaltrials.gov Identifier: NCT00120965.