Use of an automated, load-distributing band chest compression device for out-of-hospital cardiac arrest resuscitation

Context Only 1% to 8% of adults with out-of-hospital cardiac arrest survive to hospital discharge. Objective To compare resuscitation outcomes before and after an urban emergency medical services ( EMS) system switched from manual cardiopulmonary resuscitation ( CPR) to load-distributing band ( LDB) CPR. Design, Setting, and Patients A phased, observational cohort evaluation with intention-to-treat analysis of 783 adults with out-of-hospital, nontraumatic cardiac arrest. A total of 499 patients were included in the manual CPR phase ( January 1, 2001, to March 31, 2003) and 284 patients in the LDB-CPR phase ( December 20, 2003, to March 31, 2005); of these patients, the LDB device was applied in 210 patients. Intervention Urban EMS system change from manual CPR to LDB-CPR. Main Outcome Measures Return of spontaneous circulation ( ROSC), with secondary outcome measures of survival to hospital admission and hospital discharge, and neurological outcome at discharge. Results Patients in the manual CPR and LDB-CPR phases were comparable except for a faster response time interval ( mean difference, 26 seconds) and more EMS-witnessed arrests ( 18.7% vs 12.6%) with LDB. Rates for ROSC and survival were increased with LDB-CPR compared with manual CPR ( for ROSC, 34.5%; 95% confidence interval [ CI], 29.2%-40.3% vs 20.2%; 95% CI, 16.9%-24.0%; adjusted odds ratio [ OR], 1.94; 95% CI, 1.38-2.72; for survival to hospital admission, 20.9%; 95% CI, 16.6%-26.1% vs 11.1%; 95% CI, 8.6%-14.2%; adjusted OR, 1.88; 95% CI, 1.23-2.86; and for survival to hospital discharge, 9.7%; 95% CI, 6.7%-13.8% vs 2.9%; 95% CI, 1.7%-4.8%; adjusted OR, 2.27; 95% CI, 1.11-4.77). In secondary analysis of the 210 patients in whom the LDB device was applied, 38 patients ( 18.1%) survived to hospital admission ( 95% CI, 13.4%-23.9%) and 12 patients ( 5.7%) survived to hospital discharge ( 95% CI, 3.0%9.3%). Among patients in the manual CPR and LDB-CPR groups who survived to hospital discharge, there was no significant difference between groups in Cerebral Performance Category ( P=. 36) or Overall Performance Category ( P=. 40). The number needed to treat for the adjusted outcome survival to discharge was 15 ( 95% CI, 9-33). Conclusion Compared with resuscitation using manual CPR, a resuscitation strategy using LDB-CPR on EMS ambulances is associated with improved survival to hospital discharge in adults with out-of-hospital nontraumatic cardiac arrest.