Abstract 82: Mechanical CPR Is Associated with Poor Neurologically Intact Survival in a Statewide Registry

Abstract

BACKGROUND: Large, randomized trials have concluded that mechanical CPR (mech-CPR) is equivalent to manual CPR (man-CPR) with respect to outcomes from out-of-hospital cardiac arrest (OHCA). However, outside of such well-controlled settings, the performance of mech-CPR is uncertain. We sought to determine the association, if any, between mech-CPR use and outcomes in a large, statewide registry of cardiac arrest. METHODS: The Utah State CARES registry began collecting outcomes on all cardiac arrests in the state of Utah in July of 2012. We analyzed data from this registry to determine the comparative performance of resuscitations utilizing mech-CPR vs man-CPR. Neurologically-intact survival was defined as a Cerebral Performance Category score of 1 or 2. RESULTS: Mech-CPR was performed on 237/1,567 OHCAs (15%) during the 1.5 year period of analysis. The majority of devices used were of the load-distributing band type 213/237 (90%). Neurologically-intact survival was 10/237 (4%) in the cohort receiving mech-CPR vs 149/1,330 (11%) in the cohort receiving man-CPR. When controlling for Utstein variables (TABLE), mech-CPR was associated with significantly reduced odds of neurologically-intact survival, with an adjusted odds ratio 0.4 (95% CI 0.2-0.9). CONCLUSIONS: We observed a statistically significant association between mech-CPR use during resuscitation and reduced odds of neurologically-intact survival in our statewide cardiac arrest database. Outside of randomized trials, the resuscitation performance of mech-CPR devices may suffer from poor implementation or increased application to non-viable survivors. Residual confounding of this observational finding is also possible.