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Functional Survival After Cardiac Arrest: Impact of CPR Adjuncts Combined With Head/Thorax Elevation

Monday, January 22, 2024
9:00 AM – 9:10 AM MT
Location: Connections Central - Star Research Theater
Introduction: In the U.S., the odds of surviving to successful hospital discharge (SURV) following out-of-hospital cardiac arrest (OHCA) has remained unchanged for decades. Recently, however, evolving use of rapidly-applied non-invasive (FDA-cleared) adjuncts that augment blood flow during CPR (impedance threshold device, active compression-decompression and automated gradual head-up positioning [AHUP]) has been shown to significantly improve SURV, even when compared to published NIH clinical trial outcomes involving high-performance EMS systems. To also confirm SURV advantages using current nationwide outcomes, this head-to-head SURV comparison was performed using the large U.S. Cardiac Arrest Registry to Enhance Survival (CARES).


Methods: Prospectively-collected (1/1/22 to 6/30/23) across several U.S. states (AL,FL,IL,MN,OK,TN,VA), data from the AHUP-CPR registry of adult non-traumatic OHCA managed by first-in basic life support (BLS) crews using AHUP-CPR, were compared to the progressive U.S. systems that track OHCA outcomes with CARES, including neuro-intact (Cerebral Performance Categories 1-2) survival (NI-SURV) during 2021-2022.


Results: When comparing 1,458 AHUP-CPR patients to 286,525 CARES patients, baseline characteristics were remarkably parallel: age (64.6 vs 62.1yrs); males (63.6% vs 62.6%); median time (min/sec) systemwide from 9-1-1 call to EMS starting CPR (T-CPR and IQR) was 8:35, IQR 6:22–11:07 vs 7:48, 5:48–10:42, respectively. Median time from 9-1-1 call to AHUP-CPR application (T-AHUP) was 11:47 (IQR 9:11–15:15). NI-SURV for all OHCA cases, regardless of presenting ECG tracing or response interval, was 10.6% for AHUP-CPR vs 7.3% for CARES (p < 0.0001). Differences were even more pronounced in bystander-witnessed OHCA presenting with ventricular dysrhythmias (VF/VT): 35.2% (n=82) vs 27.5% (n=9,551); p< 0.009. Though comparative CARES data were not available, NI-SURV for pulseless electrical activity and asystole were 9.9% and 1.9%, respectively, when using AHUP-CPR, well-exceeding both historical and (other) contemporary datasets.


Conclusions: This comparison of AHUP-CPR and concurrent CARES data further confirms very strong associations between rapid application of AHUP adjuncts and markedly improved survival with favorable brain function after OHCA.