Out-of-hospital cardiac arrest outcomes with “pit crew” resuscitation and scripted initiation of mechanical CPR - 15/08/18

Doi : 10.1016/j.ajem.2018.08.031

Louis Gonzales ^a, Brandon K. Oyler ^b, Jeff L. Hayes ^a, Mark E. Escott ^a, Jose G. Cabanas ^c, Paul R. Hinchey ^c, Lawrence H. Brown ^b,^d,^{^⁎}
^a Office of the Medical Director, Austin-Travis County Emergency Medical Services System, Austin, TX, USA
^b Emergency Medicine Residency Program, Department of Surgery and Perioperative Care, Dell Medical School at the University of Texas, Austin, TX, USA
^c Wake County Emergency Medical Services, Raleigh, NC, USA
^d James Cook University, Mount Isa Centre for Rural and Remote Health, Townsville, QLD, Australia

^⁎Corresponding author at: Emergency Medicine Residency Program, Department of Surgery and Perioperative Care, Dell Medical School at the University of Texas, Austin, TX, USA.Emergency Medicine Residency ProgramDepartment of Surgery and Perioperative CareDell Medical School at the University of TexasAustinTXUSA

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Abstract

Objective

To compare OHCA outcomes in patients managed with mechanical versus manual CPR in an EMS system with a “pit crew” approach to resuscitation and a scripted sequence for the initiation of mechanical CPR.

Methods

Through a year-long quality improvement effort we standardized the initial resuscitative efforts for OHCA, prioritizing a “pit crew” approach to high quality manual CPR, early defibrillation and basic airway management ahead of a scripted sequence for initiating mechanical CPR. We then analyzed outcomes for adult, non-traumatic OHCA attended in the following year (2016). We used a propensity score matched analysis to compare ROSC, survival to discharge, and neurologic status among patients managed with manual versus mechanical CPR while controlling for patient demographics and arrest characteristics.

Results

Of 444 eligible OHCAs, 217 received manual and 227 received mechanical CPR. Crude ROSC (39.2% vs. 29.1%) and survival to discharge (13.8% vs. 5.7%) were higher with manual CPR. In the propensity matched analysis (n = 176 manual CPR; 176 mechanical CPR), both ROSC (38.6% vs. 28.4%; difference: 10.2%; CI: 0.4% to 20.0%) and survival to discharge (13.6% vs. 6.8%; difference: 6.8%; CI: 0.5% to 13.3%) remained significantly higher for patients receiving manual CPR.

Conclusions

In this EMS system with a standardized, “pit crew” approach to OHCA that prioritized initial high-quality initial resuscitative efforts and scripted the sequence for initiating mechanical CPR, use of mechanical CPR was associated with decreased ROSC and decreased survival to discharge.

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Plan

Quality improvement evaluation and intervention

Propensity score matched analysis

☆	Presented at the National Association of EMS Physicians Annual Meeting, San Diego, CA, January 2018.
☆☆	Grant support: None.
★	Conflicts of interest: None.
★★	LG, JLH, JGC, PRH and LHB conceived and designed the study. LG, JLH, JGC and PRH supervised the conduct of the trial and data collection. LG and LHB managed the data, including quality control. LHB provided statistical advice on study design and analyzed the data; LG, BKO, MEE, JLH, JGC, PRH and LB reviewed and interpreted the data. LG, BKO and LHB drafted the manuscript, and all authors contributed substantially to its revision. LG and LHB take responsibility for the paper as a whole.