プレホスピタル蘇生におけるプランジャー型およびバンド型機械式胸部圧迫装置の後ろ向き比較

Mechanical CPR (mCPR) device use during the resuscitation of out-of-hospital cardiac arrest (OHCA) patients is increasing in the United States. Multiple device types are commercially available, but limited data exist investigating the association between device type and patient outcomes. We aimed to compare the outcomes of patients treated with band-type and plunger-type mCPR devices.

We used the ESO Data Collaborative 2022-2024 annual datasets for this retrospective cohort study. We included all adult (18-80 years), non-traumatic OHCA patients treated with mCPR following a 9-1-1 call. We excluded patients if they had a resuscitation-limiting advanced directive, experienced OHCA in a nursing home or healthcare facility, or achieved ROSC prior to mCPR device use. We classified patients into treatment groups based on the mCPR device type used during resuscitation, and used patients treated with plunger-type devices as the reference group for all analyses. Our primary outcome was prehospital return of spontaneous circulation (ROSC). To compare these devices, we used a multi-level mixed effects logistic regression model with emergency medical services agency as a random intercept and adjusted for age, sex, race, witnessed status, bystander CPR, etiology, response interval, initial ECG, interval from scene arrival to mCPR device initiation, OHCA location, year, attempted airway management prior to mCPR, initial airway management strategy, initial vascular access strategy, medication administration prior to mCPR, and agency characteristics.

After application of exclusion criteria, 38,561 patients were eligible for analysis (4,010 (10.4%) treated with band-type devices). Our cohort was a median 62 (50-71) years of age, 33.9% female, 45.5% had witnessed OHCA, 34.5% received bystander CPR, 20.9% presented with a shockable rhythm, and the median time from scene arrival to mCPR initiation was 4.8 (3.0-7.7) minutes. The use of a band-type device was associated with lower odds of achieving prehospital ROSC (band-type: 894/4,010 (22.3%) vs. plunger-type: 8,446/34,551 (24.5%); aOR: 0.87 (0.78, 0.96)).

Our study suggested that the use of a band-type mCPR device was associated with a small decrease in odds of achieving prehospital ROSC in comparison to the use of a plunger-type device. Limitations include the potential for residual confounding, unmeasured confounders, and selection bias.