Mechanical CPR in unselected OHCA patients: A real-world Analysis of Selection Patterns and Survival Outcomes

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Background: Out-of-hospital cardiac arrest (OHCA) remains a leading cause of death, with survival rates below 10%.Mechanical chest compression devices (MCD) have been developed to provide consistent, high-quality compressions, but their routine use is not recommended.This study aimed to evaluate the real-world use of MCDs during cardiopulmonary resuscitation (CPR) in non-traumatic OHCA patients admitted to the resuscitation room. Methods:We conducted a single-centre, retrospective study using data from the Innsbruck Resuscitation Room Registry.Adult patients with non-traumatic OHCA admitted between January 2018 and December 2022 were included.Patients receiving CPR with add-on MCD use were compared with those treated with manual compressions only.Kaplan-Meier and multivariable regression were performed to assess survival and to identify independent predictors of outcome.Results: Among 683 OHCA patients admitted to the ED, 188 (27.5%) received MCD and 495 (72.5%) manual CPR.Patients treated with MCDs more frequently had unwitnessed arrests, delayed CPR initiation, and nonshockable rhythms.Patients receiving MCD had lower return of spontaneous circulation (ROSC) rates (51.4% vs. 96.1%,p < 0.001).Thirty-day survival was markedly lower in the MCD group (10.1% vs. 46.9%,p < 0.001).Total CPR time was substantially longer in the MCD group (median 48 vs. 15 minutes, p < 0.001).In multivariable analysis, shockable rhythm and ROSC were the strongest predictors of survival. Conclusion:In this real-world cohort, mechanical CPR devices were primarily used in patients with multiple negative predictive factors and refractory resuscitation situations and were associated with longer CPR duration and lower survival rates.While MCDs may be beneficial in specific circumstances, indiscriminate deployment appears to extend futile efforts and shift the time of death from scene to hospital.Evidence-based selection criteria are needed to guide prehospital MCD use.

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