OasisLMS

INTRODUCTION: The modified physiological approach to CPR using head-up/torso-up (HTup) positions and adjuncts to lower ICP (and enhance venous return) clearly facilitates neuro-intact survival pre-clinically and markedly improves resuscitation rates in pilot clinical studies of out-of-hospital cardiac arrest (OHCA). The purpose here was to confirm improved neuro-intact patient survival (SNI) using this method. METHODS: Prospectively-collected data were obtained from a national AHUP registry in which 6 participating EMS agencies routinely tracked SNI for OHCA as well as T911-CPR, the elapsed time from 9-1-1 call to initiation of an automated HTup CPR device (AHUP) combined with manual (or automated) active compression-decompression and impedance threshold devices (all FDA-cleared). AHUP steadily elevates the head/torso over several minutes (occiput reaching 22 cm). For rigorous comparisons, conventional CPR (C-CPR) controls were derived from 3 large-scale published OHCA trials involving 5,330 patients from high-performance EMS systems including those that closely monitored, recorded and reported quality of CPR. Multivariate and propensity score analyses accounted for imbalances in characteristics (age; sex; bystander-witnessed; bystander CPR; shockable rhythm; T911-CPR (C-CPR or AHUP initiation). Each AHUP patient (n=227) was matched with up to 4 C-CPR patients (n=930) in propensity analysis. SNI was defined as achieving mRS3 (or CPC 1 or 2 in one study). RESULTS: Regardless of presenting cardiac rhythm, early initiation (T911-CPR < 20min) of the AHUP bundle was associated with profoundly higher rates of SNI vs. current published findings. Even compared to high-performance/highly-monitored EMS systems and stratified by T911-CPR, SNI differences with the AHUP resuscitation bundle became increasingly more significant than C-CPR with shorter T911-CPR (eg, SNI was nearly 3-fold higher with T911-CPR < 13 mins [OR 2.68; 95%CI=1.17-6.13] and nearly 5-fold higher [OR 4.74; 95%CI=1.40-16.01] if < 8 mins). CONCLUSIONS: The HTup CPR resuscitation bundle was associated with markedly improved odds of neurologically-favorable OHCA survival versus C-CPR even when comparing well-matched controls with closely-monitored CPR performance. Moreover, shorter times to bundle initiation further augment the odds of neuro-intact survival.