title: Treatment of non-traumatic out-of-hospital cardiac arrest with active compression decompression cardiopulmonary resuscitation plus an impedance threshold device.
abstract: BACKGROUND
  A recent out-of-hospital cardiac arrest (OHCA) clinical trial showed improved survival to hospital discharge (HD) with favorable neurologic function for patients with cardiac arrest of cardiac origin treated with active compression decompression cardiopulmonary resuscitation (CPR) plus an impedance threshold device (ACD+ICD) versus standard (S) CPR. The current analysis examined whether treatment with ACD+ITD is more effective than standard (S-CPR) for all cardiac arrests of non-traumatic origin, regardless of the etiology.
  
  
  METHODS
  This is a secondary analysis of data from a randomized, prospective, multicenter, intention-to-treat, OHCA clinical trial. Adults with presumed non-traumatic cardiac arrest were enrolled and followed for one year post arrest. The primary endpoint was survival to hospital discharge (HD) with favorable neurologic function (Modified Rankin Scale score ≤ 3).
  
  
  RESULTS
  Between October 2005 and July 2009, 2738 patients were enrolled (S-CPR=1335; ACD+ITD=1403). Survival to HD with favorable neurologic function was greater with ACD+ITD compared with S-CPR: 7.9% versus 5.7%, (OR 1.42, 95% CI 1.04, 1.95, p=0.027). One-year survival was also greater: 7.9% versus 5.7%, (OR 1.43, 95% CI 1.04, 1.96, p=0.026). Nearly all survivors in both groups had returned to their baseline neurological function by one year. Major adverse event rates were similar between groups.
  
  
  CONCLUSIONS
  Treatment of out-of-hospital non-traumatic cardiac arrest patients with ACD+ITD resulted in a significant increase in survival to hospital discharge with favorable neurological function when compared with S-CPR. A significant increase survival rates was observed up to one year after arrest in subjects treated with ACD+ITD, regardless of the etiology of the cardiac arrest.
authors.affiliation: Department of Emergency Medicine, Regions Hospital, St. Paul, MN 55101, USA.
authors.forename: Ralph J
authors.initials: RJ
authors.lastname: Frascone
authors.forename: Marvin A
authors.initials: MA
authors.lastname: Wayne
authors.forename: Robert A
authors.initials: RA
authors.lastname: Swor
authors.forename: Brian D
authors.initials: BD
authors.lastname: Mahoney
authors.forename: Robert M
authors.initials: RM
authors.lastname: Domeier
authors.forename: Michael L
authors.initials: ML
authors.lastname: Olinger
authors.forename: David E
authors.initials: DE
authors.lastname: Tupper
authors.forename: Cindy M
authors.initials: CM
authors.lastname: Setum
authors.forename: Nathan
authors.initials: N
authors.lastname: Burkhart
authors.forename: Lucinda
authors.initials: L
authors.lastname: Klann
authors.forename: Joshua G
authors.initials: JG
authors.lastname: Salzman
authors.forename: Sandi S
authors.initials: SS
authors.lastname: Wewerka
authors.forename: Demetris
authors.initials: D
authors.lastname: Yannopoulos
authors.forename: Keith G
authors.initials: KG
authors.lastname: Lurie
authors.forename: Brian J
authors.initials: BJ
authors.lastname: O'Neil
authors.forename: Richard G
authors.initials: RG
authors.lastname: Holcomb
authors.forename: Tom P
authors.initials: TP
authors.lastname: Aufderheide
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002307:Cardiography, Impedance / Q000295:instrumentation*; D016887:Cardiopulmonary Resuscitation / Q000295:instrumentation* / Q000379:methods* / Q000401:mortality; D003131:Combined Modality Therapy; D016001:Confidence Intervals; D005069:Evaluation Studies as Topic; D005260:Female; D006336:Heart Massage / Q000295:instrumentation* / Q000379:methods / Q000401:mortality; D017052:Hospital Mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D058687:Out-of-Hospital Cardiac Arrest / Q000401:mortality* / Q000628:therapy*; D010351:Patient Discharge / Q000706:statistics & numerical data; D011446:Prospective Studies; D012016:Reference Values; D018570:Risk Assessment; D015996:Survival Rate; D016896:Treatment Outcome; D014947:Wounds and Injuries; D055815:Young Adult
keywords: Cardiopulmonary resuscitation; Heart arrest; Mortality; Out-of-hospital cardiac arrest; Outcome; Randomized controlled trial