Prognostic Impact of In-Hospital Use of Mechanical Cardiopulmonary Resuscitation Devices Compared with Manual Cardiopulmonary Resuscitation: A Nationwide Population-Based Observational Study in South Korea

Abstract

Background and Objectives: This study analyzed the prognostic impact of mechanical cardiopulmonary resuscitation (CPR) devices in out-of-hospital cardiac arrest (OHCA) patients, in comparison to manual CPR. Materials and Methods: This study was a nationwide population-based observational study in South Korea. Data were retrospectively collected from 142,905 OHCA patients using the South Korean Out-of-Hospital Cardiac Arrest Surveillance database. We included adult OHCA patients who received manual or mechanical CPR in the emergency room. The primary outcome was survival at discharge and the secondary outcome was sustained return of spontaneous circulation (ROSC). Statistical analysis included propensity score matching and multivariate logistic regression. Results: A total of 19,045 manual CPR and 1125 mechanical CPR cases (671 AutoPulse^TM vs. 305 Thumper^TM vs. 149 LUCAS^TM) were included. In the matched multivariate analyses, all mechanical CPR devices were associated with a lower ROSC than that of manual CPR. AutoPulse^TM was associated with lower survival in the multivariate analysis after matching (aOR with 95% CI: 0.57 (0.33-0.96)), but the other mechanical CPR devices were associated with similar survival to discharge as that of manual CPR. Witnessed arrest was commonly associated with high ROSC, but the use of mechanical CPR devices and cardiac origin arrest were associated with low ROSC. Only target temperature management was the common predictor for high survival. Conclusions: The mechanical CPR devices largely led to similar survival to discharge as that of manual CPR in OHCA patients; however, the in-hospital use of the AutoPulse^TM device for mechanical CPR may significantly lower survival compared to manual CPR.

Keywords: cardiopulmonary resuscitation; chest compression; heart arrest; mechanical device.

Figure 1

Flow diagram for the identification of relevant studies. A star (*) indicates chest compression in emergency room. OHCA, out-of-hospital cardiac arrest; ER, emergency room; DOA, dead on arrival; ROSC, return of spontaneous circulation; DNR, do not resuscitate; and CC, chest compression.

Figure 2

Forest plot of matched multivariate analysis for three types of mechanical CPR devices. (A) AutoPulse^TM for sustained ROSC. (B) AutoPulse^TM for survival at discharge. (C) Thumper^TM for sustained ROSC. (D) Thumper^TM for survival at discharge. (E) LUCAS^TM for sustained ROSC. (F) LUCAS^TM for survival at discharge. * was given a statistical significance of p < 0.05. ** was set at p < 0.01 indicating statistical significance.