Abstract 344: Comparing the Efficacy of Real-Time Audiovisual Feedback Devices and Active Compression-Decompression Devices in Out-of-Hospital Cardiac Arrest: A Network Meta-Analysis

Abstract

Introduction: Nearly 350,000 out-of-hospital cardiac arrest (OHCA) cases occur annually in the United States, with a fatality rate nearing 90%. Quality of cardiopulmonary resuscitation (CPR) is known to significantly influence survival. Randomized controlled trials (RCT) on real-time audiovisual feedback (RTAVF) and active compression-decompression (ACD) devices show both provide substantial advantages to standard CPR. We conducted the first network meta-analysis comparing the efficacy of RTAVF and ACD devices in OHCA based on a literature review. Methods: Studies examining the efficacy of RTAVF or ACD devices to standard CPR by emergency medical personnel in OHCA cases were identified in PubMed, SCOPUS, Cochrane, Google Scholar, and Embase. Outcomes of interest were return of spontaneous circulation (ROSC), survival to hospital discharge (SHD), and favorable neurological recovery. Both a frequentist and Bayesian network meta-analysis were conducted. The p-values, P-scores and Surface under the Cumulative Ranking (SUCRA) scores were computed to analyze significance and effect size. Results: The search yielded 31 eligible studies (n = 35,575). RTAVF devices significantly improved ROSC (Risk Ratio (RR) 1.15, 95% CI: 1.09 - 1.22, p < 0.001, P-score > 0.999) and SHD (RR 1.16, 1.07 - 1.26, p < 0.001, P-score > 0.91), but did not significantly improve favorable neurological recovery (RR 1.05, 0.92 - 1.19, p > 0.05). ACD devices did not report significant improvement in either ROSC (RR 1.03, 0.99 - 1.08, p > 0.05) or SHD (RR 1.10, 0.99 - 1.21, p > 0.05), but did report significant benefits in favorable neurological outcome (RR 1.30, 1.07 - 1.58, p < 0.01, P-score > 0.97). Similar findings were also seen in SUCRA scores. Conclusion: We found RTAVF devices increased ROSC and SHD, while ACD devices increased favorable neurological recovery. Our meta-analysis supports the adoption of RTAVF devices, but an RCT directly comparing RTAVF with ACD devices is recommended.

Do cardiopulmonary resuscitation real-time audiovisual feedback devices improve patient outcomes? A systematic review and meta-analysis

“…These devices typically measure one or more of the following CPR metrics: Chest compression rate, depth, hand position, recoil, ventilation volume, ventilation rate, and hands-off time. Multiple types of feedback devices exist, including manikins with integrated sensors, devices that can be added to existing manikins, and hand-held devices that can be easily transferred from patient to patient[ 60 ]. As this meta-analysis examined the effect of using RTAVF devices during CPR on patient outcomes, the only type of RTAVF devices that were analyzed were hand-held devices that can be used during CPR on patients, rather than manikin-based RTAVF devices.…”