Manual and mechanically-assisted chest compressions showed no differences in 4-hour survival or neurological outcomes in patients with out-of-hospital cardiac arrest, researchers found.
Compared with manual cardiopulmonary resuscitation (CPR), pneumatic device-assisted chest compressions with defibrillation during compressions had statistically similar outcomes for 4-hour survival (P>0.99), according to Sten Rubertsson, MD, PhD, of Uppsala University Hospital in Sweden, and colleagues.
Neurological outcomes -- as measured by Cerebral Performance Category (CPC) score -- were also not different at intensive care unit (ICU) discharge, at hospital discharge, at 1 month following CPR, or at 6 months following CPR, they wrote online in the Journal of the American Medical Association.
Cardiac arrest has been dubbed "one of the most lethal public health problems in the U.S." in an American Heart Association consensus statement. However, bystanders can provide effective CPR or defibrillation until emergency medical personnel arrive, as long as they have proper training and/or instruction.
Data from the study were presented during the European Society of Cardiology meeting in September 2013, where Rubertsson noted that the study outcomes were "a bit disappointing," given that the LUCAS mechanical chest compression device had been marketed for a decade.
"The effectiveness of manual chest compression depends on the endurance and skills of the rescuers, and manual compressions provide only approximately 30% of normal cardiac output," they wrote in their published piece, adding that manual CPR can be mired by hands-off time and administration while a patient is being transported.
The researchers compared manual versus mechanical chest compression outcomes in the LINC (LUCAS in Cardiac Arrest) study, which included 1,300 patients who received mechanical chest compressions from the LUCAS Chest Compression System, combined with defibrillation, during ongoing compressions. Another 1,289 patients received manual CPR.
Patients were followed for 4-hour survival and for good neurological outcomes at ICU discharge, hospital discharge, and at one and six months. The authors defined a "good" neurological outcome as a score of 1 or 2 on the CPC test, which translated to "full recovery or mild disability" and "moderate disability but independent in activities of daily living," respectively.
Rates of 4-hour survival were 23.6% for those treated with mechanical CPR and 23.7% for those who received manual CPR (risk difference –0.05%, 95% CI minus 3.3%-3.2%). Among those who survived, good neurological outcomes were achieved by 62% versus 54% at ICU discharge, 92% versus 86% at hospital discharge, 94% versus 88% at 1 month, and 99% versus 94% at 6 months.
The authors speculated that outcomes did not differ due to consistent quality of manual chest compressions or a delay in defibrillation among those treated with mechanical CPR.
They also noted that their research was limited by use of number of defibrillations delivered rather than placement of suction cups on the mechanical device or depth of compressions with manual CPR, as well as potential inaccuracies or inconsistencies in when and which rhythms were recorded.
SOURCE: MedPage Today