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. 2022 Oct:179:9-17.
doi: 10.1016/j.resuscitation.2022.07.039. Epub 2022 Aug 4.

Head and thorax elevation during cardiopulmonary resuscitation using circulatory adjuncts is associated with improved survival

Johanna C Moore  1 , Paul E Pepe  2 , Kenneth A Scheppke  3 , Charles Lick  4 , Sue Duval  5 , Joseph Holley  6 , Bayert Salverda  7 , Michael Jacobs  8 , Paul Nystrom  9 , Ryan Quinn  10 , Paul J Adams  11 , Mack Hutchison  12 , Charles Mason  12 , Eduardo Martinez  11 , Steven Mason  11 , Armando Clift  11 , Peter M Antevy  3 , Charles Coyle  3 , Eric Grizzard  13 , Sebastian Garay  3 , Remle P Crowe  14 , Keith G Lurie  15 , Guillaume P Debaty  16 , José Labarère  17
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Free article

Head and thorax elevation during cardiopulmonary resuscitation using circulatory adjuncts is associated with improved survival

Johanna C Moore et al. Resuscitation. 2022 Oct.
Free article

Abstract

Background: Survival after out-of-hospital cardiac arrest (OHCA) remains poor. A physiologically distinct cardiopulmonary resuscitation (CPR) strategy consisting of (1) active compression-decompression CPR and/or automated CPR, (2) an impedance threshold device, and (3) automated controlled elevation of the head and thorax (ACE) has been shown to improve neurological survival significantly versus conventional (C) CPR in animal models. This resuscitation device combination, termed ACE-CPR, is now used clinically.

Objectives: To assess the probability of OHCA survival to hospital discharge after ACE-CPR versus C-CPR.

Methods: As part of a prospective registry study, 227 ACE-CPR OHCA patients were enrolled 04/2019-07/2020 from 6 pre-hospital systems in the United States. Individual C-CPR patient data (n = 5196) were obtained from three large published OHCA randomized controlled trials from high-performing pre-hospital systems. The primary study outcome was survival to hospital discharge. Secondary endpoints included return of spontaneous circulation (ROSC) and favorable neurological survival. Propensity-score matching with a 1:4 ratio was performed to account for imbalances in baseline characteristics.

Results: Irrespective of initial rhythm, ACE-CPR (n = 222) was associated with higher adjusted odds ratios (OR) of survival to hospital discharge relative to C-CPR (n = 860), when initiated in <11 min (3.28, 95 % confidence interval [CI], 1.55-6.92) and < 18 min (1.88, 95 % CI, 1.03-3.44) after the emergency call, respectively. Rapid use of ACE-CPR was also associated with higher probabilities of ROSC and favorable neurological survival.

Conclusions: Compared with C-CPR controls, rapid initiation of ACE-CPR was associated with a higher likelihood of survival to hospital discharge after OHCA.

Keywords: ACD-CPR; Active compression-decompression CPR; Cardiac arrest; Cardiopulmonary resuscitation; Head up CPR; ITD; Impedance threshold device.

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