Clinical Health Updates

Uncertain value of automated chest compression device for cardiac arrest

Clinical Question:
Which method of resuscitation optimizes outcomes of out-of-hospital cardiac arrest: manual chest compression or the use of an automated chest compression device?

Bottom Line:
Current evidence is unable to support a recommendation for the use of either manual chest compression or an automated chest compression device for out-of-hospital cardiac arrest resuscitation. Overall survival with good neurologic function at hospital discharge occurs in fewer than 10% of individuals with the use of either cardiac pulmonary resuscitation (CPR) method.

Hallstrom A, Rea TD, Sayre MR, et al. Manual chest compression vs use of an automated chest compression device during resuscitation following out-of-hospital cardiac arrest. A randomized trial. JAMA 2006;295:2620-2628.

Study Design:
Randomized controlled trial (nonblinded)

High-quality cardiopulmonary resuscitation (CPR) may improve both cardiac and brain resuscitation following cardiac arrest. Compared with manual chest compression, an automated load-distributing band (LDB) chest compression device produces greater blood flow to vital organs and may improve resuscitation outcomes. To compare resuscitation outcomes following out-of-hospital cardiac arrest when an automated LDB-CPR device was added to standard emergency medical services (EMS) care with manual CPR. The author did a multicenter, randomized trial of patients experiencing out-of-hospital cardiac arrest in the United States and Canada. The a priori primary population was patients with cardiac arrest that was presumed to be of cardiac origin and that had occurred prior to the arrival of EMS personnel. Initial study enrollment varied by site, ranging from late July to mid November 2004; all sites halted study enrollment on March 31, 2005. Standard EMS care for cardiac arrest with an LDB-CPR device (n = 554) or manual CPR (n = 517). The primary end point was survival to 4 hours after the 911 call. Secondary end points were survival to hospital discharge and neurological status among survivors. Following the first planned interim monitoring conducted by an independent data and safety monitoring board, study enrollment was terminated. No difference existed in the primary end point of survival to 4 hours between the manual CPR group and the LDB-CPR group overall (N = 1071; 29.5% vs 28.5%; P = .74) or among the primary study population (n = 767; 24.7% vs 26.4%, respectively; P = .62). However, among the primary population, survival to hospital discharge was 9.9% in the manual CPR group and 5.8% in the LDB-CPR group (P = .06, adjusted for covariates and clustering). A cerebral performance category of 1 or 2 at hospital discharge was recorded in 7.5% of patients in the manual CPR group and in 3.1% of the LDB-CPR group (P = .006).