Comparison of Circumferential Chest Compression and Standard Cardio-Pulmonary Resuscitation in Out-of-Hospital Cardiac Arrest

Marcus Eng Hock Ong, MD, FRCS(A&E)Ed, AM

Advisor: Thomas Franck MD, MPH

Preceptor: Joseph P. Ornato MD, FACP, FACC, FACEP

Abstract

Purpose: The AutoPulse™ (Revivant Corporation, Sunnyvale, CA) is a novel non-invasive circumferential chest compression device. We aimed to compare the resuscitation outcomes with Circumferential Chest Compression CPR (Autopulse-CPR) and Standard CPR (STD-CPR) in Out-of-Hospital Cardiac Arrest (OHCA).

Design: We conducted a phased, non-randomized, observational, before and after type evaluation of the Autopulse-CPR device in adult OHCA. Historical control data was obtained using OHCA patients who received standard manual CPR (STD-CPR).

Results : During the period January 2001 to March 2005, there were 500 cases during the standard CPR (STD-CPR) phase and 408 cases during the autopulse (CCC-CPR) phase. In the CCC-CPR phase, the Autopulse was applied for 52.6% of cardiac arrest cases. Patients in the two phases were comparable in all respects except for a slightly faster response time (mean difference of 32 seconds) in the CCC-CPR group. There was significantly higher ROSC in the CCC-CPR group (30.1%) compared to the STD-CPR group (20.4%), adjusted OR 1.66, 95%CI [1.21, 2.29]. The adjusted OR for survival to hospital admission in the CCC-CPR group (16.5%) compared to the STD-CPR group (10.3%) was 1.59, 95%CI [1.05, 2.43]. The adjusted OR for survival to hospital discharge in the CCC-CPR group (7.4%) compared to the STD-CPR group (2.8%), was 1.69, 95%CI [1.63, 1.76]. There was no significant difference between the two groups in CPC (p-value 0.75) and OPC (p-value 0.72). The Number Needed to Treat (NNT) for the unadjusted outcome survival to discharge was 21 (95% CI 13, 59).

Conclusion: This study provides the first real-world evidence that adoption of this device in an EMS setting can lead to improved outcomes in cardiac arrest.