The following is a summary of “Survival for Nonshockable Cardiac Arrests Treated With Noninvasive Circulatory Adjuncts and Head/Thorax Elevation,” published in the February 2024 issue of Critical Care by Bachista et al.
Despite cardiopulmonary resuscitation (CPR), patients in cardiac arrest with asystole/pulseless electrical activity have historically had dismal survival rates.
Researchers conducted a retrospective study to assess if adding noninvasive circulation aids and gradual head-thorax elevation to conventional CPR (C-CPR) improves survival rates for out-of-hospital cardiac arrest (OHCA) with nonshockable rhythms.
They compared patient data from national emergency medical services (EMS) registries using CPR-enhancing adjuncts and automated head/thorax-up positioning (AHUP-CPR) with reference control data from two National Institutes of Health clinical trials. In addition to direct comparisons, they employed propensity score matching and matched time to EMS-initiated CPR (TCPR) to create cohorts with similar distributions of characteristics affecting OHCA outcomes.
The results showed that both AHUP-CPR and C-CPR groups had a median TCPR of 8 minutes. Median time to AHUP initiation was 11 minutes. Regardless of response time, the unadjusted survival rate to hospital discharge was 7.4% (28/380) for AHUP-CPR vs. 3.1% (58/1,852) for C-CPR (OR: 2.46 [95% CI: 1.55–3.92]). After propensity score matching, the rates were 7.6% (27/353) vs. 2.8% (10/353) (OR: 2.84 [95% CI: 1.35–5.96]). Faster AHUP-CPR application significantly increased the odds of survival and favorable neurological outcomes.
Investigators concluded that Non-shockable cardiac arrest patients had higher survival and good neurological function with rapid AHUP-CPR compared to C-CPR.