Irisawa, Taro

Background: High quality manual chest compressions (CC) can be achieved on scene during resuscitation of cardiac arrest patients, but manual CC quality can deteriorate during patient extrication and transport. The purpose of this study was to describe the effect on CC quality of an integrated manual/mechanical chest compression protocol developed to maintain CC quality and patient/provider safety throughout resuscitation. Methods: CC quality was monitored using a monitor with accelerometer-based CC sensing (E Series/X Series, ZOLL Medical) during the treatment of consecutive out-of-hospital cardiac arrest patients between 3/1/2013-4/30/2015. The EMS agency performed manual CC guided by real-time audiovisual feedback on scene but deployed the AutoPulse load-distributing band CC device (LDB, ZOLL Medical) in a choreographed manner for extrication and transport. The LDB was also placed prophylactically on patients after ROSC. Descriptive statistics are reported as median (IQR). Results: A total of 71 OHCA patients were treated (median age 58 yrs, 66 % male) of which 39 received only manual CC and 32 received both manual and LDB CCs (22 with LDB deployed during ongoing manual CC and 10 with LDB placed after ROSC). With real-time CC feedback, high quality CCs were performed [depth 2.38 in (2.17-2.64), rate 100.3 cpm (99.2-102.5), CC fraction 87.0% (83.8-89.5)]. For patients requiring transport, the LDB was started after 14.2 min (11.6-19.2) of manual CC and was placed with minimal interruptions- total of 27.5 sec (23-42) pause time in 2 minutes prior to LDB deployment. During transport, CC fraction remained high (91.7%; 89.3-95.4) with use of LDB. Seven of 10 patients prophylactically placed on the LDB rearrested, 3 rearrested during transport. Conclusion: A choreographed and rehearsed integrated chest compression protocol featuring both manual and mechanical compressions, allows for high quality resuscitation with minimal compression interruptions. Placement of a mechanical device on patients after ROSC may be beneficial as over two-thirds of patients in this study rearrested, one-third of which occurred during transport when delivery of manual compressions is difficult and potentially dangerous.

Background: Previous observational studies have demonstrated that outcomes after OHCA can be significantly improved with therapies such as mild therapeutic hypothermia and percutaneous coronary intervention (PCI). However, the optimal candidate and timing for PCI in OHCA remains unknown. This study aimed to assess the impact of emergent PCI on survival and neurological outcome after OHCA. Methods: This is a prospective observational study from a statewide OHCA database in Arizona. Patients included were greater than 18 years old who received CPR and were admitted to one of 34 recognized cardiac receiving centers. Patients who did not achieve ROSC, died within 2 hours of hospital arrival, and DNAR patients were excluded since the likelihood of PCI impacting outcome in these patients is questionable. An in-hospital post-arrest database, including PCI (Y/N), was linked with an Utstein-style OHCA database. Univariate and multivariate logistic regression were utilized to assess the association between PCI and survival to hospital discharge and neurological outcome. Results: During this study period (1-1-2011-12-31-2013), there were a total of 6,543 adult OHCA patients. After exclusions, 782 patients with suspected cardiac etiology OHCA were analyzed. The median age of patients was 64.0 years (Q1:54.0, Q3:73.0) and 70.2% were male. Among them 458 (58.6%) and 238 (30.4%) patients underwent the emergency coronary angiogram (CAG), and Primary PCI, respectively. Among PCI patients, the rate of survival to hospital discharge was 75.2%, vs. 60.4% for those without PCI (p<0.001) and good cerebral outcome (CPC 1-2) was found in 67.6%, vs. 44.3% of those without PCI (p<0.001). After adjusting for age, gender, initial rhythm, bystander CPR, and hypothermia, the Odds Ratio was 1.2 (95% CI:0.8-1.8) for survival and 2.8 (95% CI:1.5-5.1) for good neurologic outcome (CPC 1-2) among PCI patients. Conclusion: This study shows an association with emergent PCI and good neurologic outcome after OHCA. Further study is necessary to determine a potential causal relationship between PCI and outcome.