Real-time compression feedback for patients with in-hospital cardiac arrest: a multi-center randomized controlled clinical trial

Abstract

ObjectiveTo determine if real-time compression feedback using a non-automated hand-held device improves patient outcomes from in-hospital cardiac arrest (IHCA).MethodsWe conducted a prospective, randomized, controlled, parallel study (no crossover) of patients with IHCA in the mixed medical–surgical intensive care units (ICUs) of eight academic hospitals. Patients received either standard manual chest compressions or compressions performed with real-time feedback using the Cardio First Angel™ (CFA) device. The primary outcome was sustained return of spontaneous circulation (ROSC), and secondary outcomes were survival to ICU and hospital discharge.ResultsOne thousand four hundred fifty-four subjects were randomized; 900 were included. Sustained ROSC was significantly improved in the CFA group (66.7% vs. 42.4%, P < 0.001), as was survival to ICU discharge (59.8% vs. 33.6%) and survival to hospital discharge (54% vs. 28.4%, P < 0.001). Outcomes were not affected by intra-group comparisons based on intubation status. ROSC, survival to ICU, and hospital discharge were noted to be improved in inter-group comparisons of non-intubated patients, but not intubated ones.ConclusionUse of the CFA compression feedback device improved event survival and survival to ICU and hospital discharge.Trial registrationThe study was registered with Clinicaltrials.gov (NCT02845011), registered retrospectively on July 21, 2016.

Real-time audio-visual feedback with handheld nonautomated external defibrillator devices during cardiopulmonary resuscitation for in-hospital cardiac arrest: A meta-analysis

“…One of 4 clinical RCTs assessed the active compression active decompression Ambu CardioPump (Ambu Inc., Columbia, MD, USA),[ 73 ] whereas 3 assessed the active compression passive decompression Cardio First Angel™ [Inotech, Nubberg, Germany; Table 4 ]. [ 3 51 74 ] No clinical RCTs compared AVF devices head-to-head. Three of 4 studies were multi-center,[ 3 51 74 ] whereas 1 was single-center.…”

“…The reliant technology ranges in complexity from a metronome to tensile springs, accelerometers, pressure sensors, and triaxial magnetic sensing [ Table 1 ]. [ 3 42 43 44 45 46 47 48 49 50 51 ] Feedback may be given in audio, visual, or tactile format. Stand-alone AVF devices provide benefits in cost and simplicity, making them potentially useful for applications both in-and outside of hospital settings.…”

“…The bulk of available evidence is from non-randomized or crossover studies of simulated resuscitations. Seven devices [20 studies; Tables 2 and 3 ] have published RCT data from simulated resuscitations, none have published non-randomized clinical studies, and only two have available clinical RCT data [4 studies; Table 4 3 51 73 74 ] The results of the simulation RCTs suggest that free-standing non-AED AVF devices are associated with: (1) no improvement in correct hand position (1 of 1 study); (2) improved compression rate (12 of 15 studies; 3 no change); (3) improved compression depth (12 of 16 studies; 3 no change; 1 worse); (4) possibly improved compression release/chest recoil (4 of 7 studies; 3 no change); (5) unchanged no-flow fraction (1 of 1 study); (6) improved number inefficient compressions (2 of 2 studies); and (7) improved number of correct/error free compressions (7 of 7 studies). Moreover, there are at least five free-standing AVF devices marketed without any published studies, including Beaty (Medical Feedback Technologies Ltd.), CPR-1100 (Nihon Kohden), PrestoPatch™ (Nexus Control Systems LLC.…”

Adult Basic Life Support

“…Task force members did interpret this study to be supportive of the use of feedback devices; however, they also felt that this study represented an outlier. Members felt that replication of this result would be necessary before the task force could make any supportive recommendation for the specific type of device used in the study by Goharani et al 159 …”

“… Outcome Studies No. of Patients Results Survival to hospital discharge 1 RCT, 159 very-low-certainty evidence (downgraded for serious risk of bias) 900 Better outcome with feedback: Relative risk 1.90 (95% CI, 1.60–2.25; P <0.001); Adjusted relative risk 25.56% (95% CI, 19.22%–31.60%), or 91 more patients/1000 survived with the intervention (95% CI, 61 more patients/1000 to 126 more patients/1000 survived with the intervention) ROSC 2 RCTs, 159 , 160 very-low-certainty evidence (downgraded for serious risk of bias) 980 Better outcome with feedback: Relative risk 1.57 (95% CI, 1.38–1.78; P <0.001); Adjusted relative risk 24.22% (95% CI, 17.79%–30.36%), or 58 more patients/1000 survived with the intervention (95% CI, 38 more patients/1000 to 79 more patients/1000) 159 Relative risk 2.07 (95% CI, 1.20–3.29; P <0.001); Adjusted relative risk 37.50% (95% CI, 15.70%–54.68%), or 108 more patients/1000 survived with the intervention (95% CI, 20 more patients/1000 to 232 more patients/1000) 160 CI indicates confidence interval; RCT, randomized controlled trial; and ROSC, return of spontaneous circulation. …”