Impact of audiovisual feedback in resuscitation on return of spontaneous circulation and survival

Abstract

Abstract Funding Acknowledgements Type of funding sources: None. BACKGROUND Treatment with an automated external defibrillator (AED) and cardiopulmonary resuscitation (CPR) are important factors for outcome in out-of-hospital cardiac arrest (OHCA). Audiovisual (AV) feedback from an AED may improve quality of cardiopulmonary resuscitation (CPR). However, the association between AV feedback in resuscitation and clinical outcomes is not well assessed in real-life OHCA. PURPOSE We sought to assess the association between AV feedback from an AED with rates of return of spontaneous circulation (ROSC) and 30-day survival in a real-life cohort of OHCA patients. METHODS We included 325 patients treated with an AED in the time period 2016-2019 from the Capital Region of Denmark. AED ECG data was analyzed before merging with data from the Danish Cardiac Arrest Register. Patients were divided into a "feedback" and a "non-feedback" group, depending on the presence of AV feedback in the AED applied before arrival of the Emergency Medical Services. Rates of ROSC upon admission and 30-day survival were compared between groups using the chi-square test. Further, uni- and multivariate logistic regression models were applied to assess the association between AV feedback and ROSC along with survival. Multivariate models were adjusted for sex, age, primary ECG rhythm and location of OHCA. RESULTS A total of 155 (47.7%) patients had an AED applied with AV feedback and 170 (52.3%) without AV feedback. There was no difference in Utstein characteristics between groups. Overall ROSC at hospital admission and 30-day survival was 39.1% (n = 127) and 29.2% (n = 95). While there was no difference in 30-day survival between feedback groups (p = 0.49), we found a decreased rate of ROSC at hospital admission for the feedback group compared to the non-feedback group, 32.9% (n = 51) versus 44.7% (n = 76), (p = 0.03), respectively (Figure 1). In the univariate logistic regression analysis, the feedback group showed a decreased chance of ROSC (OR 0.61, 95%CI 0.38-0.95, p = 0.03), which remained significant even after adjustment in the multivariate model (OR 0.54, 95%CI 0.33-0.86, p = 0.01). There was no significant association with 30-day survival in uni- and multivariate analyses with an OR of 0.82 (95%CI 0.51-1.32, p = 0.42) and OR 0.90 (95%CI 0.49-1.67, p = 0.74), respectively. CONCLUSION We found an association of decreased rates of ROSC at hospital admission, though no association with 30-day survival, when comparing use of AEDs with and without AV feedback in real-life OHCA patients. Abstract Figure. ROSC and 30-day survival