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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.
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 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 C Rates of ROS and survival were increased with LDB-CPR compared with those of EMS-witnessed arrests (18.7% vs 12.6%) with LDB. 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] 1.38-2.72; 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) 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% -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.