Profound Increases in Neurointact Patient Survival for Nonshockable (Asystole/PEA) Cardiac Arrests

Saturday, January 21, 2023

4:00 PM – 4:15 PM PT

Location: 204

First Author(s)

Paul E. Pepe, MD, MPH, FAEMS (he/him/his)

Global Coordinator, Metropolitan EMS Medical Directors Alliance
University of Texas Health Sciences, Houston, Texas, USA
Dallas, Texas

Disclosure information not submitted.

Co-Author(s)

KB

Kerry M. Bachista, MD, FACEP, FAEMS

Assistant Professor
University of Florida College of Medicine, Jacksonville, FL, Florida, United States

Disclosure information not submitted.
Johanna C. Moore

Hennepin Healthcare
Minneapolis, Minnesota

Disclosure information not submitted.
JL

José Labarère, MD, PhD

Quality of Care Unit
University Grenoble Alps/CNRS/CHU de Grenoble Alpes
Grenoble, Rhone-Alpes, France

Disclosure information not submitted.
CL

Charles J. Lick, MD, FACEP, FAEMS

Medical Director
Allina Health Emergency Medical Services, Minneapolis, MN, Minnesota, United States

Disclosure information not submitted.
BS

Bayert J. Salverda, BA

Research Associate
Hennepin Healthcare Research Institute, Minneapolis, MN, Minnesota, United States

Disclosure information not submitted.
LE

Lauren D. Emanuelson, RN, BS, EMT-P

Director of Resuscitation
Advanced Medical Transport of Central Illinois, Peoria, IL
Peoria, Illinois, United States

Disclosure information not submitted.
PN

Paul C. Nystrom, MD, FACEP

Medical Director
Edina Fire Emergency Medical Services, Edina, MN, Minnesota, United States

Disclosure information not submitted.
RQ

Ryan Quinn, EMT-P

EMS Chief
City of Edina, Minnesota
Edina, Minnesota, United States

Disclosure information not submitted.
BP

Brent A. Parquette, NREMT-P

Training Officer
Lucas County Emergency Medical Services, Lucas County, OH
Lucas, Ohio, United States

Disclosure information not submitted.
KL

Keith Lurie, MD (he/him/his)

Professor
n/a
Minneapolis

Disclosure(s): AdvancedCPR Solutions: Major Stockholder (not including mutual funds) (Ongoing), Owner/Co-Owner Founder/Co-Founder (Ongoing)
JH

Joseph E. Holley, MD, FACEP, FAEMS

Medical Director
Memphis Fire Department
Memphis, Tennessee, United States

Disclosure information not submitted.
PA

Peter M. Antevy, MD

Medical Director
City of Coral Springs, Parkland and Davie Fire Rescue Departments
Broward County, Florida, United States

Disclosure information not submitted.
RC

Remle P. Crowe, PhD

National Research Scientist
ESO
Austin, Texas, United States

Disclosure information not submitted.
KS

Kenneth A. Scheppke, MD, FAEMS

State EMS Medical Director
Florida Department of Health
Tallahassee, Florida, United States

Disclosure information not submitted.
GD

Guillaume Debaty, MD, PhD

Professor and Chair of Emergency Medicine,
University Hospital of Grenoble Alps, Grenoble, France, United States

Disclosure information not submitted.

Disclosure(s):

Keith Lurie, MD: AdvancedCPR Solutions: Major Stockholder (not including mutual funds) (Ongoing), Owner/Co-Owner Founder/Co-Founder (Ongoing)

INTRODUCTION: The neuroprotective approach to basic CPR (NPCPR) using adjuncts to lower ICP and enhance cardiac venous return (including gradual head/torso-up positioning [HTup]), has significantly improved overall neuro-intact survival (SURVni) for out-of-hospital cardiac arrest (OHCA) patients (Resuscitation 2022). However, as ~80% of OHCA cases have non-shockable (asystole/PEA) presentations (N-Sh) and attendant grim prognoses, the specific aim was to confirm if (and by how much) NPCPR-improved SURVni applies to N-Sh OHCA cases.

METHODS : Five U.S. EMS agencies using NPCPR prospectively tracked SURVni and all known SURVni related factors: age; sex; witnessed arrest; bystander CPR; T-CPR (time from 9-1-1 call to EMS crews starting CPR); initial ECG; and T-htup (9-1-1 call to HTup start). An automated HTup device (occiput raised to 22cm over several mins) was combined with active compression-decompression and impedance threshold devices (all FDA-cleared). For rigorous comparisons, conventional CPR (C-CPR) controls were derived from 2 large (n=10,053) published NIH trials involving (criteria-compliant) high-performance EMS systems (eg, recorded /monitored /reported CPR quality). Using propensity scoring for the pivotal SURVni factors, 353 N-Sh NPCPR patients were well-matched with 353 N-Sh C-CPR patients and compared for SURVni (mRS < or =3 or CPC 1 or 2).

RESULTS: For both 353 NPCPR patients and 353 controls: 2/3 were in asystole; mean ages 66; 8 min median T-CPR (IQR 6-10). Median T-htup = 11 min (IQR 9-15). Before propensity matching, the overall unadjusted OR [95%CI] for NPCPR SURVni (vs C-CPR) was 3.09 [1.64-5.81] and 3.87 [1.27-11.78] after matching (incl. responses >20 min). Analogous to AEDs in shockable OHCA, the earlier NPCPR was applied, SURVni improved: NPCPR SURVni was >10-fold higher, 6.1% v 0.6% (10/165 v 1/165) when T-htup < 11 mins [OR 10.59;1.34-83.63] or (cumulatively) 4.6% v 0.4% (13/281 v 1/281) if < 16 mins [OR 13.58;1.76-104.54].

CONCLUSIONS: Even compared to top-performing EMS systems, NPCPR, especially applied early, was associated with markedly-improved SURVni odds for asystole/PEA patients, with or without propensity score matching. As most EMS systems can initiate CPR for the majority of patients in < 12 min, NPCPR may potentially salvage many more lives than previously projected.