Abstract 385: Comparison of Rapid Implementation of Automated Head and Thorax Elevation With Active Compression Decompression Cardiopulmonary Resuscitation and an Impedance Threshold Device versus National Outcome Data: A Prospective Observational Study

Abstract

Background: Pre-clinical work has shown automated head and thorax elevation with active compression decompression CPR and an impedance threshold device (AHUP-CPR) improved 24-hour neurological survival. Propensity matched studies of out-of-hospital-cardiac arrest (OHCA) patients have shown a time dependent association between survival to hospital discharge (SHD) and application of AHUP CPR.Hypothesis: Rapid application of AHUP CPR for OHCA will have a higher incidence of SHD compared to national data. Methods: This is an ongoing prospective observational study of patients from an AHUP-CPR registry of non-traumatic adult OHCA receiving AHUP CPR as part of first responder care. OHCA patients from pre-hospital sites that consistently implemented rapid AHUP CPR were included. Patient demographics, arrest characteristics, ROSC, SHD, and SHD with favorable neurological function, defined as a Cerebral Performance Category score of 1 or 2, were recorded. Data are reported as means ± SD. Combined 2021 and 2022 data from the Cardiac Arrest Registry to Enhance Survival (CARES) were used for comparison of the primary study endpoint, SHD, and secondary endpoints. Chi-square testing was used to compare outcomes. Results: Of 11 registry sites, 7 (US States AL, FL, IL, MN, OK, TN, VA) met inclusion criteria and 1457 patients from January 2020 to June 2023 were enrolled. Average age was 65 ± 16.4 years, 61.8% (901) were male, and 71% (1035) received AHUP CPR. Average time (mm:ss) from 9-1-1 call to start of CPR was 9:52 (6:47) and time to start of AHUP CPR was 12:59 (5:51). Presenting rhythms were: asystole 47.8% (696), PEA 25.8% (376), and VF 20.5% (298). For all AHUP patients, SHD was 13.6% (198) versus 9.2% (26316/286525) for CARES (p < 0.0001). SHD with favorable neurological function was higher for AHUP (10.3% (150) versus 7.3% for CARES (20889), p < 0.0001) and ROSC (29.4% (428) vs 27.0% (77301), p = 0.039). Conclusions: In an unadjusted analysis, the incidence of SHD, ROSC, and neurologically favorable SHD with rapid implementation of AHUP-CPR was higher than nationally reported data. These results support prior findings of a time sensitive association between survival and time to AHUP-CPR. Additional analyses and study are needed for confirmation.