Comparison of Sustained Return of Spontaneous Circulation Rate Between Manual and Mechanical Chest Compression in Adult Cardiac Arrest

Figures & data

Figure 1 Patient flow chart.

Table 1 Baseline Characteristics, Initial Management and Causes of Cardiac Arrest

Variables	Manual Chest Compression (N=193)	Mechanical Chest Compression (N=34)	P-value
Age, years, median (IQR)	68 (54,79)	59 (50.8,66.8)	0.010
Male	119 (61.7)	25 (73.5)	0.258
Comorbidity
Diabetic mellitus	44 (22.8)	3 (8.8)	0.104
Hypertension	69 (35.8)	9 (26.5)	0.393
Hyperlipidemia	29 (15)	3 (8.8)	0.431
Respiratory disease	27 (14)	3 (8.8)	0.585
Heart disease	57 (29.5)	13 (38.2)	0.417
Cerebrovascular disease	23 (11.9)	3 (8.8)	0.775
Renal disease	26 (13.5)	2 (5.9)	0.270
Malignancy	18 (9.3)	0 (0)	0.083
Out-of-hospital cardiac arrest	136 (70.5)	32 (94.1)	0.007
Cardiac arrest at the ED	57 (29.5)	2 (5.9)
ED arrival by advanced ambulance service	84 (43.5)	26 (76.5)	0.001
ED arrival by basic ambulance service	47 (24.4)	2 (5.9)
ED arrival time
08:00–16.00 (morning shift)	69 (35.8)	9 (26.5)	0.556
16:01–24:00 (afternoon shift)	71 (36.8)	15 (44.1)
00:01–08:00 (night shift)	53 (27.5)	10 (29.4)
Witness arrest	168 (87)	25 (73.5)	0.076
Bystander CPR	97 (50.3)	8 (23.5)	0.007
Duration from onset of cardiac arrest to ACLS, min, median (IQR)	8 (0,23)	26 (15.2,43.5)	<0.001
Initial shockable rhythm	41 (21.2)	9 (26.5)	0.650
Initial non-shockable rhythm	152 (78.8)	25 (73.5)
Time of cardiac arrest to defibrillation in initial shock rhythm, min, median (IQR)	10 (0,22.5)	12 (4.5,28)	0.564
Time of cardiac arrest to first dose of adrenaline, min, median (IQR)	11 (1,26)	30 (16.5,50.8)	<0.001
Cause of arrest
Myocardial infarction	90 (46.6)	18 (52.9)	0.622
Pulmonary embolism	11 (5.7)	2 (5.9)	1.000
Hypoxia	75 (38.9)	4 (11.8)	0.004
Hypovolemia	19 (9.8)	4 (11.8)	0.758
Acidosis	12 (6.2)	1 (2.9)	0.697
Hypokalemia	1 (0.5)	1 (2.9)	0.278
Hyperkalemia	23 (11.9)	9 (26.5)	0.033
Unknown	25 (13)	6 (17.6)	0.427

Note: Data are presented as n (%) unless indicated otherwise.

Abbreviations: IQR, interquartile range; ED, emergency department; CPR, cardiopulmonary resuscitation; ACLS, advanced cardiac life support.

Table 2 Outcomes of Cardiopulmonary Resuscitation

	Manual Chest Compression (N=193)	Mechanical Chest Compression (N=34)	P-value
Sustained ROSC	83 (43)	3 (8.8)	<0.001
Survive to hospital admission	72 (37.3)	2 (5.9)	0.129
Survival to discharge	29 (15.0)	0 (0)	0.517
Survival to discharge with good neurological outcome	19 (9.8)	0 (0)	NA

Note: Data are presented as n (%) unless indicated otherwise.

Abbreviation: ROSC, return of spontaneous circulation.

Table 3 Application and Complications of Mechanical Chest Compression

	N=34
Mechanical chest compression applied by
First-year resident	9 (26.5)
Second-year resident	11 (32.4)
Third-year resident	14 (41.2)
Duration of time from cardiac arrest to using the mechanical chest compression device, min, median (IQR)	37.5 (5.130)
Complication of mechanical chest compression	6 (17.6)
Circle mark on chest wall	4 (11.8)
Abrasion	1 (2.9)
Chest wall contusion	1 (2.9)

Note: Data are presented as n (%) unless indicated otherwise.

Abbreviation: IQR, interquartile range.

Table 4 Out-of-Hospital Cardiac Arrest

Variables	Manual Chest Compression (N=136)	Mechanical Chest Compression (N=32)	P-value
Age, years, median (IQR)	65.5 (52,78)	58 (49.3,66.8)	0.027
Male	81 (59.6)	24 (75)	0.155
Comorbidity
Diabetic mellitus	38 (27.9)	3 (9.4)	0.049
Hypertension	51 (37.5)	8 (25.0)	0.260
Hyperlipidemia	23 (16.9)	2 (6.3)	0.170
Respiratory disease	20 (14.7)	3 (9.4)	0.573
Heart disease	39 (28.7)	13 (40.6)	0.270
Cerebrovascular disease	18 (13.2)	3 (9.4)	0.768
Renal disease	18 (13.2)	2 (6.3)	0.372
Malignancy	7 (5.1)	0 (0)	0.349
Cardiac arrest at home	90 (66.2)	26 (81.3)	0.148
Cardiac arrest at public area	46 (33.8)	6 (18.8)
Cardiac arrest to ED arrival time	24 (12,39)	44 (27,58)	<0.001
ED arrival by advanced ambulance	75 (55.1)	25 (78.1)	0.029
ED arrival by basic ambulance	36 (26.5)	2 (6.3)
Witness arrest	111 (81.6)	23 (71.9)	0.322
Bystander CPR	41 (30.1)	6 (18.8)	0.283
Initial shockable rhythm	30 (22.1)	8 (25)	0.902
Initial non-shockable rhythm	106 (77.9)	24 (75)
First defibrillation time in initial shock rhythm minute, median (IQR)	16 (5,26)	19 (9,29)	0.616
Onset of cardiac arrest to BLS	5 (0,11)	10 (8,30)	<0.001
Onset of cardiac arrest to ACLS	16 (7,29)	28 (16,48)	0.002
Time of cardiac arrest to first dose of adrenaline, minute, median (IQR)	18 (7,31)	30 (18,52)	0.001
Cause of arrest
Myocardial infarction	74 (54.4)	17 (53.1)	1.000
Pulmonary embolism	7 (5.1)	2 (6.3)	0.681
Hypoxia	55 (40.4)	4 (12.5)	0.006
Hypovolemia	7 (5.1)	3 (9.4)	0.404
Acidosis	8 (5.9)	1 (3.1)	1.000
Hypokalemia	0 (0)	1 (3.1)	0.190
Hyperkalemia	17 (12.5)	9 (28.1)	0.053
Unknown	24 (17.6)	6 (18.8)	1.000
Outcome of CPR
Sustained ROSC	41 (30.1)	3 (9.4)	0.029
Survival to admission	32 (23.5)	2 (6.3)	0.052
Survival to discharge	11 (8.1)	0 (0)	0.127
Survival to discharge with good  neurological outcome	4 (2.9)	0 (0)	1.000

Note: Data are presented as n (%) unless indicated otherwise.

Abbreviations: IQR, interquartile range; ED, emergency department; CPR, cardiopulmonary resuscitation; BLS, basic life support; ACLS, advanced cardiac life support; ROSC, return of spontaneous circulation.

Table 5 Multivariate Logistic Regression Model for the Associated Factors with the Return of Spontaneous Circulation of Non-Traumatic Cardiac Arrest

Factors	Crude OR (95% CI)	Adjust OR (95% CI)	P-value
Witnessed arrest	7.77 (2.3–26.3)	3.41 (0.94–12.4)	0.038
ED arrival by basic ambulance service	3.3 (1.6–7.11)	1.93 (0.86–4.35)	0.004
Cardiac arrest at the ED	7.99 (4.16–15.37)	3.69 (1.73–7.88)	<0.001
Manual chest compression	7.45 (2.2–25.26)	3.08 (0.82–11.55)	0.067
Cardiac arrest from hypoxia	2.39 (1.35–4.2)	2.01 (1.02–3.97)	0.042

Note: P-values <0.05 are statistically significant.

Abbreviations: OR, odds ratio; CI, confidence interval; ED, emergency department.