Faster time to automated elevation of the head and thorax during cardiopulmonary resuscitation increases the probability of return of spontaneous circulation
Johanna C Moore, Sue Duval, Charles Lick, Joseph Holley, Kenneth A Scheppke, Bayert Salverda, Carolina Rojas-Salvador, Michael Jacobs, Paul Nystrom, Ryan Quinn, Paul J Adams, Guillaume P Debaty, Mack Hutchison, Charles Mason, Eduardo Martinez, Steven Mason, Armando Clift, Peter Antevy, Charles Coyle, Eric Grizzard, Sebastian Garay, Keith G Lurie, Paul E Pepe, Johanna C Moore, Sue Duval, Charles Lick, Joseph Holley, Kenneth A Scheppke, Bayert Salverda, Carolina Rojas-Salvador, Michael Jacobs, Paul Nystrom, Ryan Quinn, Paul J Adams, Guillaume P Debaty, Mack Hutchison, Charles Mason, Eduardo Martinez, Steven Mason, Armando Clift, Peter Antevy, Charles Coyle, Eric Grizzard, Sebastian Garay, Keith G Lurie, Paul E Pepe
Abstract
Objectives: Resuscitation in the Head Up position improves outcomes in animals treated with active compression decompression cardiopulmonary resuscitation and an impedance threshold device (ACD + ITD CPR).We assessed impact of time to deployment of an automated Head Up position (AHUP) based bundle of care after out-of-hospital cardiac arrest on return of spontaneous circulation (ROSC).
Methods: Observational data were analyzed from a patient registry. Patients received treatment with 1) ACD + and/or automated CPR 2) an ITD and 3) an AHUP device. Probability of ROSC (ROSCprob) from the 9-1-1 call to AHUP device placement was assessed with a restricted cubic spline model and linear regression.
Results: Of 11 sites, 6 recorded the interval from 9-1-1 to AHUP device (n = 227). ROSCprobfor all rhythms was 34%(77/227). Median age (range) was 66 years (19-101) and 68% men. TheROSCprobfor shockable rhythms was 47%(18/38). Minutes from 9-1-1 to AHUP device (median, range) varied between sites: 1) 6.4(4,15), 2) 8.0(5,19), 3) 9.9(4, 12), 4) 14.1(6, 36), 5) 15.9(6, 34), 6) 19.0(8, 38),(p = 0.0001).ROSCprobalso varied; 1) 55.1%(16/29), 2) 60%(3/5), 3) 50%(3/6), 4) 22.7%(17/75), 5) 26.4%(9/34), and 6) 37.1%(29/78), (p = 0.019). For all rhythms between 4 and 12 min (n = 85),ROSCprobdeclined 5.6% for every minute elapsed (p = 0.024). For shockable rhythms, between 6 and 15 min (n = 23),ROSCprobdeclined 9.0% for every minute elapsed (p = 0.006).
Conclusions: Faster time to deployment of an AHUP based bundle of care is associated with higher incidence of ROSC. This must be considered when evaluating and implementing this bundle.
Conflict of interest statement
Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
Copyright © 2021 The Authors. Published by Elsevier B.V. All rights reserved.
Source: PubMed