10: PROFOUND INCREASES IN NEUROINTACT PATIENT SURVIVAL FOR NONSHOCKABLE (ASYSTOLE/PEA) CARDIAC ARRESTS

Abstract

Introduction: The neuroprotective approach to basic CPR (NPCPR) using adjuncts to lower ICP and enhance cardiac venous return (including gradual head/torso-up positioning [HTup]), has significantly improved overall neuro-intact survival (SURVni) for out-of-hospital cardiac arrest (OHCA) patients (Resuscitation 2022). However, as ~80% of OHCA cases have non-shockable (asystole/PEA) presentations (N-Sh) and attendant grim prognoses, the specific aim was to confirm if (and by how much) NPCPR-improved SURVni applies to N-Sh OHCA cases. Methods: Five U.S. EMS agencies using NPCPR prospectively tracked SURVni and all known SURVni related factors: age; sex; witnessed arrest; bystander CPR; T-CPR (time from 9-1-1 call to EMS crews starting CPR); initial ECG; and T-htup (9-1-1 call to HTup start). An automated HTup device (occiput raised to 22cm over several mins) was combined with active compression-decompression and impedance threshold devices (all FDA-cleared). For rigorous comparisons, conventional CPR (C-CPR) controls were derived from 2 large (n=10,053) published NIH trials involving (criteria-compliant) high-performance EMS systems (eg, recorded /monitored /reported CPR quality). Using propensity scoring for the pivotal SURVni factors, 353 N-Sh NPCPR patients were well-matched with 353 N-Sh C-CPR patients and compared for SURVni (mRS < or =3 or CPC 1 or 2). Results: For both 353 NPCPR patients and 353 controls: 2/3 were in asystole; mean ages 66; 8 min median T-CPR (IQR 6-10). Median T-htup = 11 min (IQR 9-15). Before propensity matching, the overall unadjusted OR [95%CI] for NPCPR SURVni (vs C-CPR) was 3.09 [1.64-5.81] and 3.87 [1.27-11.78] after matching (incl. responses >20 min). Analogous to AEDs in shockable OHCA, the earlier NPCPR was applied, SURVni improved: NPCPR SURVni was >10-fold higher, 6.1% v 0.6% (10/165 v 1/165) when T-htup < 11 mins [OR 10.59;1.34-83.63] or (cumulatively) 4.6% v 0.4% (13/281 v 1/281) if < 16 mins [OR 13.58;1.76-104.54]. Conclusions: Even compared to top-performing EMS systems, NPCPR, especially applied early, was associated with markedly-improved SURVni odds for asystole/PEA patients, with or without propensity score matching. As most EMS systems can initiate CPR for the majority of patients in < 12 min, NPCPR may potentially salvage many more lives than previously projected.