title: Improved neurologically intact survival with the use of an automated, load-distributing band chest compression device for cardiac arrest presenting to the emergency department.
abstract: BACKGROUND
  It has been unclear if mechanical cardiopulmonary resuscitation (CPR) is a viable alternative to manual CPR. We aimed to compare resuscitation outcomes before and after switching from manual CPR to load-distributing band (LDB) CPR in a multi-center emergency department (ED) trial.
  
  
  METHODS
  We conducted a phased, prospective cohort evaluation with intention-to-treat analysis of adults with non-traumatic cardiac arrest. At these two urban EDs, systems were changed from manual CPR to LDB-CPR. Primary outcome was survival to hospital discharge, with secondary outcome measures of return of spontaneous circulation, survival to hospital admission and neurological outcome at discharge.
  
  
  RESULTS
  A total of 1,011 patients were included in the study, with 459 in the manual CPR phase (January 01, 2004, to August 24, 2007) and 552 patients in the LDB-CPR phase (August 16, 2007, to December 31, 2009). In the LDB phase, the LDB device was applied in 454 patients (82.3%). Patients in the manual CPR and LDB-CPR phases were comparable for mean age, gender and ethnicity. The mean duration from collapse to arrival at ED (min) for manual CPR and LDB-CPR phases was 34:03 (SD16:59) and 33:18 (SD14:57) respectively. The rate of survival to hospital discharge tended to be higher in the LDB-CPR phase (LDB 3.3% vs Manual 1.3%; adjusted OR, 1.42; 95% CI, 0.47, 4.29). There were more survivors in LDB group with cerebral performance category 1 (good) (Manual 1 vs LDB 12, P = 0.01). Overall performance category 1 (good) was Manual 1 vs LDB 10, P = 0.06.
  
  
  CONCLUSIONS
  A resuscitation strategy using LDB-CPR in an ED environment was associated with improved neurologically intact survival on discharge in adults with prolonged, non-traumatic cardiac arrest.
authors.forename: Marcus Eng
authors.initials: ME
authors.lastname: Hock Ong
authors.forename: Stephanie
authors.initials: S
authors.lastname: Fook-Chong
authors.forename: Annitha
authors.initials: A
authors.lastname: Annathurai
authors.forename: Shiang Hu
authors.initials: SH
authors.lastname: Ang
authors.forename: Ling
authors.initials: L
authors.lastname: Tiah
authors.forename: Kok Leong
authors.initials: KL
authors.lastname: Yong
authors.forename: Zhi Xiong
authors.initials: ZX
authors.lastname: Koh
authors.forename: Susan
authors.initials: S
authors.lastname: Yap
authors.forename: Papia
authors.initials: P
authors.lastname: Sultana
mesh_terms: D000368:Aged; D016887:Cardiopulmonary Resuscitation / Q000379:methods*; D004636:Emergency Service, Hospital; D005260:Female; D006323:Heart Arrest / Q000401:mortality / Q000628:therapy*; D006801:Humans; D057194:Intention to Treat Analysis; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012846:Singapore; D016019:Survival Analysis