Mechanical chest compression devices are associated with poor neurological survival in a statewide registry: A propensity score analysis

Objective: To compare functional survival (discharge cerebral performance category 1 or 2) among victims of out-of-hospital cardiac arrest (OHCA) who had resuscitations performed using mechanical chest compression (mech-CC) devices vs. those using manual chest compressions (man-CC). Methods: Observational cohort of 2600 cases of OHCA from a statewide, prospectively-collected cardiac arrest registry (Utah Cardiac Arrest Registry to Enhance Survival). Comparison of functional survival among those receiving mech-CC vs man-CC was performed using a mixed-effects Poisson model with inverse probability weighted propensity scores to control for selection bias. Results: Overall, mech-CC was utilized in 405/2600 (16%) of the total arrests in Utah during this period. 371/405 (92%) were of the load-distributing band type (AutoPulse) and 22/405 (5%) were mechanical piston devices (LUCASTM), while 12/405 (3%) employed other devices. The relative risk (RR) for functional survival comparing mech-CC to man-CC after propensity score adjustment was 0.41 (95% CI 0.24-0.70, p=0.001). Conclusions: Mechanical chest compression device use was associated with lower rates of functional survival in this propensity score analysis, controlling for Utstein variables and early return of spontaneous circulation. (C) 2016 Elsevier Ireland Ltd. All rights reserved.