Interaction Effect Between Prehospital Mechanical Chest Compression Device Use and Post-Cardiac Arrest Care on Clinical Outcomes After Out-Of-Hospital Cardiac Arrest.

Abstract

Prehospital application of a mechanical chest compression device (MCD) and post-cardiac arrest (PCA) care including coronary reperfusion therapy (CRT) or targeted temperature management (TTM) could affect the clinical outcome in out-of-hospital cardiac arrest (OHCA). This study aimed to assess whether the effect of PCA care including CRT or TTM differs according to prehospital MCD use in patients with OHCA. Adult OHCA cases with a presumed cardiac etiology and with survival to admission from 2016 to 2017 were enrolled from the Korean nationwide OHCA registry. The main exposures were CRT and TTM during PCA care. The primary outcome was good neurologic recovery defined by a cerebral performance category score of 1 or 2 at hospital discharge. We conducted interaction analyses between MCD use and PCA care including CRT or TTM. Four thousand three hundred sixty-six OHCA cases were enrolled and 7.9% underwent MCD application. TTM and CRT were performed in 11.2% and 17.9% of the study population. In the interaction analysis, the adjusted odds ratios of TTM and CRT for good neurologic recovery were 2.41 (1.90-3.06) and 3.40 (2.79-4.14) in patients without MCD use and 1.89 (0.97-3.68), and 1.54 (0.79-3.01) in patients with MCD use. The effect of PCA care on neurologic outcomes was different according to MCD use in OHCA. The association of good neurologic outcome and PCA care was not observed in the prehospital MCD use group compared with that in the MCD nonuse group.