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Use of automated chest compression devices after out-of-hospital cardiac arrest in Sweden

Schmidbauer, Simon LU ; Herlitz, Johan; Karlsson, Thomas; Axelsson, Christer and Friberg, Hans LU (2017) In Resuscitation 120. p.95-102
Abstract

Objective To evaluate the implementation of automated chest compression cardiopulmonary resuscitation (ACC-CPR) after out-of-hospital cardiac arrest (OHCA) in Sweden during the years 2011 through 2015. The association between ACC-CPR and 30-day survival was studied as a secondary objective. Methods The Swedish cardiopulmonary resuscitation registry is a prospectively recorded nationwide registry of modified Utstein parameters including all patients with attempted resuscitation after OHCA. Propensity score matching (PSM) was used to adjust for known confounders in the secondary analysis. Results Of the 24,316 patients included in the study population, 32.4% received ACC-CPR, with substantial regional variation ranging from 0.8% to 78.8%.... (More)

Objective To evaluate the implementation of automated chest compression cardiopulmonary resuscitation (ACC-CPR) after out-of-hospital cardiac arrest (OHCA) in Sweden during the years 2011 through 2015. The association between ACC-CPR and 30-day survival was studied as a secondary objective. Methods The Swedish cardiopulmonary resuscitation registry is a prospectively recorded nationwide registry of modified Utstein parameters including all patients with attempted resuscitation after OHCA. Propensity score matching (PSM) was used to adjust for known confounders in the secondary analysis. Results Of the 24,316 patients included in the study population, 32.4% received ACC-CPR, with substantial regional variation ranging from 0.8% to 78.8%. Male gender and an initial shockable rhythm were associated with ACC-CPR, whereas crew witnessed status was associated with manual CPR. Potential markers of prolonged resuscitation attempts (drug administration and endotracheal intubation) were more prevalent in the ACC-CPR group. The unadjusted 30-day survival rate was 6.3% for ACC-CPR patients. The adjusted odds ratio for 30-day survival regarding use of an ACC device was 0.72 (95% CI 0.62–0.84, p < 0.001, n = 13922). Conclusion The use of ACC devices varied significantly between Swedish regions and overall survival to 30 days was low among patients receiving ACC-CPR. Although measured and unmeasured confounding might explain our finding of lower survival rates for patients exposed to ACC-CPR, specific guidelines recommending when and how ACC-CPR should be used are warranted as there might be circumstances where these devices do more harm than good.

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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Automated chest compression devices, Mechanical chest compression devices, Mechanical compressions, Out-of-hospital cardiac arrest, Outcome
in
Resuscitation
volume
120
pages
95 - 102
publisher
Elsevier
external identifiers
  • scopus:85029499990
  • wos:000413760500023
ISSN
0300-9572
DOI
10.1016/j.resuscitation.2017.09.004
language
English
LU publication?
yes
id
9a2eb82d-1d76-4b86-a76b-72b4e2ef7e5b
date added to LUP
2017-10-06 10:18:05
date last changed
2018-10-03 10:53:38
@article{9a2eb82d-1d76-4b86-a76b-72b4e2ef7e5b,
  abstract     = {<p>Objective To evaluate the implementation of automated chest compression cardiopulmonary resuscitation (ACC-CPR) after out-of-hospital cardiac arrest (OHCA) in Sweden during the years 2011 through 2015. The association between ACC-CPR and 30-day survival was studied as a secondary objective. Methods The Swedish cardiopulmonary resuscitation registry is a prospectively recorded nationwide registry of modified Utstein parameters including all patients with attempted resuscitation after OHCA. Propensity score matching (PSM) was used to adjust for known confounders in the secondary analysis. Results Of the 24,316 patients included in the study population, 32.4% received ACC-CPR, with substantial regional variation ranging from 0.8% to 78.8%. Male gender and an initial shockable rhythm were associated with ACC-CPR, whereas crew witnessed status was associated with manual CPR. Potential markers of prolonged resuscitation attempts (drug administration and endotracheal intubation) were more prevalent in the ACC-CPR group. The unadjusted 30-day survival rate was 6.3% for ACC-CPR patients. The adjusted odds ratio for 30-day survival regarding use of an ACC device was 0.72 (95% CI 0.62–0.84, p &lt; 0.001, n = 13922). Conclusion The use of ACC devices varied significantly between Swedish regions and overall survival to 30 days was low among patients receiving ACC-CPR. Although measured and unmeasured confounding might explain our finding of lower survival rates for patients exposed to ACC-CPR, specific guidelines recommending when and how ACC-CPR should be used are warranted as there might be circumstances where these devices do more harm than good.</p>},
  author       = {Schmidbauer, Simon and Herlitz, Johan and Karlsson, Thomas and Axelsson, Christer and Friberg, Hans},
  issn         = {0300-9572},
  keyword      = {Automated chest compression devices,Mechanical chest compression devices,Mechanical compressions,Out-of-hospital cardiac arrest,Outcome},
  language     = {eng},
  month        = {11},
  pages        = {95--102},
  publisher    = {Elsevier},
  series       = {Resuscitation},
  title        = {Use of automated chest compression devices after out-of-hospital cardiac arrest in Sweden},
  url          = {http://dx.doi.org/10.1016/j.resuscitation.2017.09.004},
  volume       = {120},
  year         = {2017},
}