Mechanical Cardiopulmonary Resuscitation and Hospital Survival Among Adult Patients With Nontraumatic Out‐of‐Hospital Cardiac Arrest Attending the Emergency Department: A Prospective, Multicenter, Observational Study in Japan (SOS‐KANTO [Survey of Survivors after Out‐of‐Hospital Cardiac Arrest in Kanto Area] 2012 Study)
Authors: Hayashida Kei , Tagami Takashi , Fukuda Tatsuma , Suzuki Masaru , Yonemoto Naohiro , Kondo Yutaka , Ogasawara Tomoko , Sakurai Atsushi , Tahara Yoshio , Nagao Ken , Yaguchi Arino , Morimura Naoto , Kitamura Nobuya , Nomura Tomohisa , Shimizu Naoki , Akashi Akiko , Inokuchi Sadaki , Masui Yoshihiro , Miura Kunihisa , Tsutsumi Haruhiko , Takuma Kiyotsugu , Atsushi Ishihara , Nakano  , Tanaka Hiroshi , Ikegami Keiichi , Arai Takao , Kitamura Nobuya , Oda Shigeto , Kobayashi Kenji , Suda Takayuki , Ono Kazuyuki , Furuya Ryosuke , Koido Yuichi , Iwase Fumiaki , Kanesaka Shigeru , Okada Yasusei , Unemoto Kyoko , Sadahiro Tomohito , Iyanaga Masayuki , Muraoka Asaki , Hayashi Munehiro , Miyake Yasufumi , Yokokawa Hideo , Koyama Yasuaki , Tsuchiya Asuka , Kashiyama Tetsuya , Hayashi Munetaka , Oshima Kiyohiro , Kiyota Kazuya , Hamabe Yuichi , Yokota Hiroyuki , Hori Shingo , Inaba Shin , Sakamoto Tetsuya , Harada Naoshige , Kimura Akio , Kanai Masayuki , Otomo Yasuhiro , Sugita Manabu , Kinoshita Kosaku , Sakurai Takatoshi , Kitano Mitsuhide , Matsuda Kiyoshi , Tanaka Kotaro , Yoshihara Katsunori , Yoh Kikuo , Suzuki Junichi , Toyoda Hiroshi , Mashiko Kunihiro , Shimizu Naoki , Muguruma Takashi , Shimada Tadanaga , Kobe Yoshiro , Shoko Tomohisa , Nakanishi Kazuya , Shiga Takashi , Yamamoto Takefumi , Sekine Kazuhiko , Izuka Shinichi 
Published: November 2017

Background

Mechanical cardiopulmonary resuscitation (
mCPR
) for patients with out‐of‐hospital cardiac arrest attending the emergency department has become more widespread in Japan. The objective of this study is to determine the association between the
mCPR
in the emergency department and clinical outcomes.

Methods and Results

In a prospective, multicenter, observational study, adult patients with out‐of‐hospital cardiac arrest with sustained circulatory arrest on hospital arrival were identified. The primary outcome was survival to hospital discharge. The secondary outcomes included a return of spontaneous circulation and successful hospital admission. Multivariate analyses adjusted for potential confounders and within‐institution clustering effects using a generalized estimation equation were used to analyze the association of the
mCPR
with outcomes. Between January 1, 2012 and March 31, 2013, 6537 patients with out‐of‐hospital cardiac arrest were eligible; this included 5619 patients (86.0%) in the manual
CPR
group and 918 patients (14.0%) in the
mCPR
group. Of those patients, 28.1% (1801/6419) showed return of spontaneous circulation in the emergency department, 20.4% (1175/5754) had hospital admission, 2.6% (168/6504) survived to hospital discharge, and 1.2% (75/6419) showed a favorable neurological outcome at 1 month after admission. Multivariate analyses revealed that
mCPR
was associated with a decreased likelihood of survival to hospital discharge (adjusted odds ratio, 0.40; 95% confidence interval, 0.20–0.78;
P
=0.005), return of spontaneous circulation (adjusted odds ratio, 0.71; 95% confidence interval, 0.53–0.94;
P
=0.018), and hospital admission (adjusted odds ratio, 0.57; 95% confidence interval, 0.40–0.80;
P
=0.001).

Conclusions

After accounting for potential confounders, the
mCPR
in the emergency department was associated with decreased likelihoods of good clinical outcomes after adult nontraumatic out‐of‐hospital cardiac arrest. Further studies are needed to clarify circumstances in which
mCPR
may benefit these patients.