Real-time compression feedback for patients with in-hospital cardiac arrest: a multi-center randomized controlled clinical trial

Reza Goharani, Amir Vahedian-Azimi, Behrooz Farzanegan, Farshid R Bashar, Mohammadreza Hajiesmaeili, Seyedpouzhia Shojaei, Seyed J Madani, Keivan Gohari-Moghaddam, Sevak Hatamian, Seyed M M Mosavinasab, Masoum Khoshfetrat, Mohammad A Khabiri Khatir, Andrew C Miller, MORZAK Collaborative, Reza Goharani, Amir Vahedian-Azimi, Behrooz Farzanegan, Farshid R Bashar, Mohammadreza Hajiesmaeili, Seyedpouzhia Shojaei, Seyed J Madani, Keivan Gohari-Moghaddam, Sevak Hatamian, Seyed M M Mosavinasab, Masoum Khoshfetrat, Mohammad A Khabiri Khatir, Andrew C Miller, MORZAK Collaborative

Abstract

Objective: To determine if real-time compression feedback using a non-automated hand-held device improves patient outcomes from in-hospital cardiac arrest (IHCA).

Methods: We conducted a prospective, randomized, controlled, parallel study (no crossover) of patients with IHCA in the mixed medical-surgical intensive care units (ICUs) of eight academic hospitals. Patients received either standard manual chest compressions or compressions performed with real-time feedback using the Cardio First Angel™ (CFA) device. The primary outcome was sustained return of spontaneous circulation (ROSC), and secondary outcomes were survival to ICU and hospital discharge.

Results: One thousand four hundred fifty-four subjects were randomized; 900 were included. Sustained ROSC was significantly improved in the CFA group (66.7% vs. 42.4%, P < 0.001), as was survival to ICU discharge (59.8% vs. 33.6%) and survival to hospital discharge (54% vs. 28.4%, P < 0.001). Outcomes were not affected by intra-group comparisons based on intubation status. ROSC, survival to ICU, and hospital discharge were noted to be improved in inter-group comparisons of non-intubated patients, but not intubated ones.

Conclusion: Use of the CFA compression feedback device improved event survival and survival to ICU and hospital discharge.

Trial registration: The study was registered with Clinicaltrials.gov (NCT02845011), registered retrospectively on July 21, 2016.

Keywords: CPR; Cardio First Angel™; Chest compression; Critical care; Intensive care; Resuscitation.

Conflict of interest statement

The protocol was approved by the investigational review board at Baqiyatallah University of Medical Sciences (IR.BMSU.REC.1394.441), which was accepted by each of the participating medical centers: Baqiyatallah Hospital, Shariati Hospital, Masih Daneshvari Hospital, Loghman Hakim Hospital, Shahid Madani Hospital, Ghaem Hospital, Besat Hospital, and Rouhani Hospital. Consent was required and covered both study participation and publication of findings. Informed consent was required prior to cardiac arrest event and could be provided by the patient, legal guardian, or healthcare surrogate.The informed consent included permission to present and publish de-identified results.The authors declare that they have no competing interests.Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Flow diagram of patient enrollment
Fig. 2
Fig. 2
Proper deployment (a) and rescuer position (b) while using the Cardio First Angel™ device

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