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 C Nystrom, Ryan Quinn, Paul J. Adams, Guillaume P. Debaty, Mack Hutchison, Charles Mason, Eduardo Martinez, Steven Mason, Armando Clift, Peter Antevy, Charles Coyle, Eric GrizzardSebastian Garay, Keith G Lurie, Paul E. Pepe

Research output: Contribution to journalArticlepeer-review

13 Scopus citations

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). ROSCprob for all rhythms was 34%(77/227). Median age (range) was 66 years (19-101) and 68% men. The ROSCprob for 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). ROSCprob also 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), ROSCprob declined 5.6% for every minute elapsed (p = 0.024). For shockable rhythms, between 6 and 15 min (n = 23), ROSCprob declined 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.

Original languageEnglish (US)
Pages (from-to)63-69
Number of pages7
JournalResuscitation
Volume170
DOIs
StatePublished - Jan 2022

Bibliographical note

Funding Information:
The authors would like to thank the hundreds of first responders and EMS personnel from the 11 sites who participated in the registry.

Publisher Copyright:
© 2021 Elsevier B.V.

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