Treatment of non-traumatic out-of-hospital cardiac arrest with active compression decompression cardiopulmonary resuscitation plus an impedance threshold device

RESUSCITATION

卷:84

Article

Frascone, Ralph J.¹  Wayne, Marvin A.²  Swor, Robert A.^3,5  Mahoney, Brian D.⁴  Olinger, Michael L.⁶  Tupper, David E.⁷  Setum, Cindy M.⁸  Burkhart, Nathan⁸  Klann, Lucinda⁸  Salzman, Joshua G.¹  Wewerka, Sandi S.¹  Yannopoulos, Demetris⁹  Lurie, Keith G.⁹  O'Neil, Brian J.¹⁰  Holcomb, Richard G.¹¹  Aufderheide, Tom P.¹² 

[1] Reg Hosp, Dept Emergency Med, St Paul, MN USA

[2] PeaceHealth St Joseph Med Ctr, Whatcom Cty Emergency Med Serv, Dept Emergency Med, Bellingham, WA USA

[3] William Beaumont Hosp, Dept Emergency Med, Royal Oak, MI 48072 USA

[4] Hennepin Cty Med Ctr, Dept Emergency Med, Minneapolis, MN 55415 USA

[5] St Joseph Hosp, Dept Emergency Med, Ann Arbor, MI USA

[6] Indiana Univ Sch Med, Dept Emergency Med, Indianapolis, IN 46202 USA

[7] Univ Minnesota, Med Ctr, Dept Neurol, Minneapolis, MN 55455 USA

[8] Adv Circulatory Syst Inc, Roseville, NSW, Australia

[9] Univ Minnesota, Div Cardiovasc, Med Ctr, Dept Med, Minneapolis, MN 55455 USA

[10] Wayne State Univ, Dept Emergency Med, Sch Med Specialist Chief, Detroit, MI USA

[11] Quintiles Consulting, Rockville, MD USA

[12] Med Coll Wisconsin, Dept Emergency Med, Milwaukee, WI 53226 USA

关键词: Cardiopulmonary resuscitation;    Heart arrest;    Out-of-hospital cardiac arrest;    Randomized controlled trial;    Mortality;    Outcome;   

DOI  :  10.1016/j.resuscitation.2013.05.002

来源: Elsevier

【 摘 要 】

Background: A recent out-of-hospital cardiac arrest (OHCA) clinical trial showed improved survival to hospital discharge (HD) with favorable neurologic function for patients with cardiac arrest of cardiac origin treated with active compression decompression cardiopulmonary resuscitation (CPR) plus an impedance threshold device (ACD + ICD) versus standard (S) CPR. The current analysis examined whether treatment with ACD + ITD is more effective than standard (S-CPR) for all cardiac arrests of non-traumatic origin, regardless of the etiology. Methods: This is a secondary analysis of data from a randomized, prospective, multicenter, intention-to-treat, OHCA clinical trial. Adults with presumed non-traumatic cardiac arrest were enrolled and followed for one year post arrest. The primary endpoint was survival to hospital discharge (HD) with favorable neurologic function (Modified Rankin Scale score <= 3). Results: Between October 2005 and July 2009, 2738 patients were enrolled (S-CPR = 1335; ACD + ITD = 1403). Survival to HD with favorable neurologic function was greater with ACD + ITD compared with S-CPR: 7.9% versus 5.7%, (OR 1.42, 95% CI 1.04, 1.95, p = 0.027). One-year survival was also greater: 7.9% versus 5.7%, (OR 1.43, 95% CI 1.04, 1.96, p = 0.026). Nearly all survivors in both groups had returned to their baseline neurological function by one year. Major adverse event rates were similar between groups. Conclusions: Treatment of out-of-hospital non-traumatic cardiac arrest patients with ACD + ITD resulted in a significant increase in survival to hospital discharge with favorable neurological function when compared with S-CPR. A significant increase survival rates was observed up to one year after arrest in subjects treated with ACD + ITD, regardless of the etiology of the cardiac arrest. (C) 2013 Elsevier Ireland Ltd. All rights reserved.

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