Document Type

Conference Proceeding

Publication Date

5-2024

Publication Title

Academic Emergency Medicine

Abstract

Background and Objectives: Out-of-hospital cardiac arrest (OHCA) is a leading cause of death in the United States, with over 350,000 per year. Despite improvements in care, OHCA outcomes remain low. Chest compressions can be administered manually or via an automated mechanical device. Mechanical CPR (mCPR) devices are designed to achieve return of spontaneous circulation (ROSC) by delivering consistent compression depth and rate. This retrospective cohort of the Michigan Cardiac Arrest Registry to Enhance Survival (CARES) compared survival to hospital discharge with good neurological status (CPC 1 or 2) between manual and mechanical CPR. Methods: The CDC collaborated with Emory University in 2004 to develop a national registry of OHCA data. CARES uses Utstein-style reporting guidelines, which provide a standard, structured framework to collect and report data of cardiac arrest. From the Michigan CARES registry, a retrospective cohort of 65,641 OHCA from 2013 to 2022 were reviewed. After excluding pediatric arrests (N= 1454), cases where ROSC was achieved before EMS arrival (N= 519), and missing data on CPR modality (N= 12,650) were left with 51,018 for analysis. Multivariable logistic regression was used to conduct 1:1 nearest neighbor propensity score matching and to estimate the adjusted average marginal effect of mCPR used on hospital discharge with good neurological status, defined as CPC of 1 or 2. Results: Patient population was described as subgroups of mCPR and manual CPR. Average age was (67.0, 64.2) years with (62.5%, 59.7%) being male. (17%, 16.4%) of our sample had shockable cardiac rhythm. After statistically adjusting for age, sex, arrest location, witnessed arrest, AED application, etiology of arrest (cardiac vs. noncardiac), shockable cardiac rhythm, and epinephrine use, no difference in risk of surviving to hospital discharge with good neurological status between those who received manual and mCPR was found (Risk Difference = −0.001; SE = 0.002; 95%CI = −0.0005 to 0.04; p= 0.81) Conclusion: Previous analysis from 2015 indicated worse neurological outcome for mCPR, our propensity matched analysis has demonstrated no difference in risk of survival to hospital discharge with good neurological status between those who received manual and mCPR. This study contributes valuable insights to the discussion surrounding OHCA management. There may be future benefit to identify subgroups most likely to benefit from mCPR.

Volume

31

Issue

S1

First Page

25

Comments

Society for Academic Emergency Medicine SAEM Annual Meeting, May 14-17, 2024, Phoenix, AZ

Last Page

26

DOI

10.1111/acem.14533

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