Application of mechanical cardiopulmonary resuscitation devices and their value in out-of-hospital cardiac arrest: A retrospective analysis of the German Resuscitation Registry.
Journal
PloS one
ISSN: 1932-6203
Titre abrégé: PLoS One
Pays: United States
ID NLM: 101285081
Informations de publication
Date de publication:
2019
2019
Historique:
received:
30
03
2018
accepted:
12
11
2018
entrez:
3
1
2019
pubmed:
3
1
2019
medline:
19
9
2019
Statut:
epublish
Résumé
Cardiac arrest is an event with a limited prognosis which has not substantially changed since the first description of cardiopulmonary resuscitation (CPR) in 1960. A promising new treatment approach may be mechanical CPR devices (mechanical CPR). In a retrospective analysis of the German Resuscitation Registry between 2007-2014, we examined the outcome after using mechanical CPR on return of spontaneous circulation (ROSC) in adults with out-of-hospital cardiac arrest (OHCA). We compared mechanical CPR to manual CPR. According to preclinical risk factors, we calculated the predicted ROSC-after-cardiac-arrest (RACA) score for each group and compared it to the rate of ROSC observed. Using multivariate analysis, we adjusted the influence of the devices' application on ROSC for epidemiological factors and therapeutic measures. We included 19,609 patients in the study. ROSC was achieved in 51.5% of the mechanical CPR group (95%-CI 48.2-54.8%, ROSC expected 42.5%) and in 41.2% in the manual CPR group (95%-CI 40.4-41.9%, ROSC expected 39.2%). After multivariate adjustment, mechanical CPR was found to be an independent predictor of ROSC (OR 1.77; 95%-CI 1.48-2.12). Duration of CPR is a key determinant for achieving ROSC. Mechanical CPR was associated with an increased rate of ROSC and when adjusted for risk factors appeared advantageous over manual CPR. Mechanical CPR devices may increase survival and should be considered in particular circumstances according to a physicians' decision, especially during prolonged resuscitation.
Sections du résumé
BACKGROUND
Cardiac arrest is an event with a limited prognosis which has not substantially changed since the first description of cardiopulmonary resuscitation (CPR) in 1960. A promising new treatment approach may be mechanical CPR devices (mechanical CPR).
METHODS
In a retrospective analysis of the German Resuscitation Registry between 2007-2014, we examined the outcome after using mechanical CPR on return of spontaneous circulation (ROSC) in adults with out-of-hospital cardiac arrest (OHCA). We compared mechanical CPR to manual CPR. According to preclinical risk factors, we calculated the predicted ROSC-after-cardiac-arrest (RACA) score for each group and compared it to the rate of ROSC observed. Using multivariate analysis, we adjusted the influence of the devices' application on ROSC for epidemiological factors and therapeutic measures.
RESULTS
We included 19,609 patients in the study. ROSC was achieved in 51.5% of the mechanical CPR group (95%-CI 48.2-54.8%, ROSC expected 42.5%) and in 41.2% in the manual CPR group (95%-CI 40.4-41.9%, ROSC expected 39.2%). After multivariate adjustment, mechanical CPR was found to be an independent predictor of ROSC (OR 1.77; 95%-CI 1.48-2.12). Duration of CPR is a key determinant for achieving ROSC.
CONCLUSIONS
Mechanical CPR was associated with an increased rate of ROSC and when adjusted for risk factors appeared advantageous over manual CPR. Mechanical CPR devices may increase survival and should be considered in particular circumstances according to a physicians' decision, especially during prolonged resuscitation.
Identifiants
pubmed: 30601816
doi: 10.1371/journal.pone.0208113
pii: PONE-D-18-09631
pmc: PMC6314607
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
e0208113Déclaration de conflit d'intérêts
The authors have declared that no competing interests exist.
Références
Resuscitation. 2012 Aug;83(8):961-5
pubmed: 22310728
Eur J Emerg Med. 2011 Oct;18(5):251-6
pubmed: 21593673
Resuscitation. 2014 Jun;85(6):741-8
pubmed: 24642406
Resuscitation. 2012 Oct;83(10):1212-8
pubmed: 22465945
JAMA. 2006 Jun 14;295(22):2620-8
pubmed: 16772625
Cochrane Database Syst Rev. 2014 Feb 27;(2):CD007260
pubmed: 24574099
Circulation. 2005 Aug 30;112(9):1259-65
pubmed: 16116053
Lancet. 2015 Mar 14;385(9972):947-55
pubmed: 25467566
Circulation. 2016 Dec 20;134(25):2131-2133
pubmed: 27994028
Eur Heart J. 2011 Jul;32(13):1649-56
pubmed: 21515626
Resuscitation. 2016 Sep;106:102-7
pubmed: 27422305
Resuscitation. 1998 Jun;37(3):149-52
pubmed: 9715774
Circulation. 2009 Sep 29;120(13):1241-7
pubmed: 19752324
Resuscitation. 2015 Nov;96:328-40
pubmed: 25438254
J Exp Med. 1906 Dec 21;8(6):713-25
pubmed: 19867068
JAMA. 2014 Jan 1;311(1):53-61
pubmed: 24240611
Circulation. 2002 May 14;105(19):2270-3
pubmed: 12010909
Crit Care Med. 2013 Jul;41(7):1782-9
pubmed: 23660728
Resuscitation. 2009 Feb;80(2):199-203
pubmed: 19081171
Am J Emerg Med. 2010 May;28(4):391-8
pubmed: 20466215
Resuscitation. 2015 Oct;95:100-47
pubmed: 26477701