Cardiopulmonary Resuscitation Without Aortic Valve Compression Increases the Chances of Return of Spontaneous Circulation in Out-of-Hospital Cardiac Arrest: A Prospective Observational Cohort Study

Chu, SE; Huang, CY; Cheng, CY; Chan, CH; Chen, HA; Chang, CH; Tsai, KC; Chiu, KM; Ma, MH; Chiang, WC; Sun, JT

doi:10.1097/ccm.0000000000006336

Cardiac arrest & resuscitation

Cardiopulmonary Resuscitation Without Aortic Valve Compression Increases the Chances of Return of Spontaneous Circulation in Out-of-Hospital Cardiac Arrest: A Prospective Observational Cohort Study

Crit Care MedPublished 23 May 2024Prospective observational cohort study

Main finding · Sustained ROSCResultAOR for sustained ROSC 4.72

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Authors' conclusion

Absence of AV compression during OHCA resuscitation is associated with an increased chance of ROSC and survival to ICU.

Study context

Population: Adult out-of-hospital cardiac arrest (OHCA) patients undergoing resuscitative transesophageal echocardiography (TEE) in the EDOctober 2020 to January 2023
Participants: 76 patients

Exposure: Uncompressed vs compressed aortic valve during cardiopulmonary resuscitation (CPR)
Aortic valve (AV) uncompressedn = 39
AV compressedn = 37reference
Outcome: Sustained ROSC

Methodological detailssingle-centre, Sample size pre-estimated at 37 patients/group

Single-centre
Sample size pre-estimated at 37 patients/group

Main finding

As reported in the abstract

AOR for sustained return of spontaneous circulation (ROSC)

4.72

P = 0.010

By group

AV uncompressed53.8%

AV compressed24.3%

Observational data: associations, not effects.

Secondary outcomes

Any ROSC

aOR for any ROSC 3.30 · P = 0.033

AV uncompressed56.4%

AV compressed32.4%

Survival to ICU

aOR for survival to ICU 6.74 · P = 0.010

AV uncompressed33.3%

AV compressed8.1%

Diastolic arterial BP >20 mm Hg during CPR

P < 0.001

AV uncompressed93.8%

AV compressed33.3%

Initial diastolic arterial BP

P = 0.002

AV uncompressed33.4 mm Hg

AV compressed11.5 mm Hg

End-tidal CO2, post-resuscitation withdrawal, survival to discharge

No significant intergroup differences

Favorable neurologic outcome at discharge

No patients discharged with favorable neurologic outcomes

Sustained ROSC by subgroup (subgroup)

Uncompressed AV seemed critical for sustained ROSC across all subgroups

Original publication

Cardiopulmonary Resuscitation Without Aortic Valve Compression Increases the Chances of Return of Spontaneous Circulation in Out-of-Hospital Cardiac Arrest: A Prospective Observational Cohort Study. Crit Care Med. Published 23 May 2024. doi:10.1097/ccm.0000000000006336

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