Simon Schmidbauer1, Johan Herlitz2, Thomas Karlsson3, Christer Axelsson4, Hans Friberg5. 1. Lund University, Skåne University Hospital, Dept. of Clinical Sciences, Anaesthesiology and Intensive Care, Malmö, Sweden; Center for Cardiac Arrest at Lund University, Lund University, Lund, Sweden. Electronic address: simon.schmidbauer@med.lu.se. 2. Institute of Internal Medicine, Dept. of Metabolism and Cardiovascular Research, Sahlgrenska University Hospital, Gothenburg, Sweden; University of Borås, Prehospen-Centre for Prehospital Research, Faculty of Caring Science, Work Life and Social Welfare, Sweden. 3. Health Metrics, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. 4. University of Borås, Prehospen-Centre for Prehospital Research, Faculty of Caring Science, Work Life and Social Welfare, Sweden. 5. Lund University, Skåne University Hospital, Dept. of Clinical Sciences, Anaesthesiology and Intensive Care, Malmö, Sweden; Center for Cardiac Arrest at Lund University, Lund University, Lund, Sweden.
Abstract
OBJECTIVE: To evaluate the implementation of automated chest compression cardiopulmonary resuscitation (ACC-CPR) after out-of-hospital cardiac arrest (OHCA) in Sweden during the years 2011 through 2015. The association between ACC-CPR and 30-day survival was studied as a secondary objective. METHODS: The Swedish cardiopulmonary resuscitation registry is a prospectively recorded nationwide registry of modified Utstein parameters including all patients with attempted resuscitation after OHCA. Propensity score matching (PSM) was used to adjust for known confounders in the secondary analysis. RESULTS: Of the 24,316 patients included in the study population, 32.4% received ACC-CPR, with substantial regional variation ranging from 0.8% to 78.8%. Male gender and an initial shockable rhythm were associated with ACC-CPR, whereas crew witnessed status was associated with manual CPR. Potential markers of prolonged resuscitation attempts (drug administration and endotracheal intubation) were more prevalent in the ACC-CPR group. The unadjusted 30-day survival rate was 6.3% for ACC-CPR patients. The adjusted odds ratio for 30-day survival regarding use of an ACC device was 0.72 (95% CI 0.62-0.84, p<0.001, n=13922). CONCLUSION: The use of ACC devices varied significantly between Swedish regions and overall survival to 30days was low among patients receiving ACC-CPR. Although measured and unmeasured confounding might explain our finding of lower survival rates for patients exposed to ACC-CPR, specific guidelines recommending when and how ACC-CPR should be used are warranted as there might be circumstances where these devices do more harm than good.
OBJECTIVE: To evaluate the implementation of automated chest compression cardiopulmonary resuscitation (ACC-CPR) after out-of-hospital cardiac arrest (OHCA) in Sweden during the years 2011 through 2015. The association between ACC-CPR and 30-day survival was studied as a secondary objective. METHODS: The Swedish cardiopulmonary resuscitation registry is a prospectively recorded nationwide registry of modified Utstein parameters including all patients with attempted resuscitation after OHCA. Propensity score matching (PSM) was used to adjust for known confounders in the secondary analysis. RESULTS: Of the 24,316 patients included in the study population, 32.4% received ACC-CPR, with substantial regional variation ranging from 0.8% to 78.8%. Male gender and an initial shockable rhythm were associated with ACC-CPR, whereas crew witnessed status was associated with manual CPR. Potential markers of prolonged resuscitation attempts (drug administration and endotracheal intubation) were more prevalent in the ACC-CPR group. The unadjusted 30-day survival rate was 6.3% for ACC-CPR patients. The adjusted odds ratio for 30-day survival regarding use of an ACC device was 0.72 (95% CI 0.62-0.84, p<0.001, n=13922). CONCLUSION: The use of ACC devices varied significantly between Swedish regions and overall survival to 30days was low among patients receiving ACC-CPR. Although measured and unmeasured confounding might explain our finding of lower survival rates for patients exposed to ACC-CPR, specific guidelines recommending when and how ACC-CPR should be used are warranted as there might be circumstances where these devices do more harm than good.
Authors: Urs Pietsch; David Reiser; Volker Wenzel; Jürgen Knapp; Mario Tissi; Lorenz Theiler; Simon Rauch; Lorenz Meuli; Roland Albrecht Journal: Scand J Trauma Resusc Emerg Med Date: 2020-07-25 Impact factor: 2.953