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Introduction: Survival rates after out-of-hospital cardiac arrest (OHCA) remain poor with widespread use of conventional (C) CPR. Based on pre-clinical studies showing improved cerebral flow and neurologically-intact survival, a FDA approved automated Head Up Positioning (AHUP) device for CPR was developed for use with an impedance threshold device (ITD), and manual and/or automated suction cup-based CPR. A prospective observational IRB approved registry was created to track use and clinical outcomes with this AHUP device based bundle. Hypothesis: Faster time to use of an AHUP CPR bundle improves survival to hospital discharge after OHCA versus historical controls treated with C-CPR. Methods: Registry patients from sites routinely recording time from 911 call to AHUP device placement (T 911 ) were included. C-CPR controls were from 3 prior randomized prospective CPR trials: 1) Resuscitation Outcomes Consortium Prehospital Resuscitation using an IMpedance valve and Early versus Delayed (ROC PRIMED) Study, 2) Resuscitation Outcomes Consortium Amiodarone, Lidocaine, or Placebo Study (ROC-ALPS), 3) The ResQTrial. Propensity score analysis was performed using logistic regression for baseline characteristics including age, sex, witnessed arrest, bystander CPR, shockable rhythm, and time to first responder CPR. Each AHUP patient was matched with up to 4 C-CPR patients. Results: Of 11 U.S. sites reporting AHUP CPR outcomes, 6 had time from 911 call to AHUP device placement recorded (n = 227). The model yielded a c-statistic of 0.76. Stratified by T 911 , the odds of survival with AHUP CPR were significantly higher than with C-CPR between T 911 < 7 minutes (OR 4.57, 95% CI 1.3-16.0) and T 911 < 15 minutes (OR 2.01, 95% CI 1.1-3.8). There was a time dependent effect of AHUP device placement on survival (See Figure). Conclusions: More rapid initiation of an AHUP CPR bundle resulted in improved survival to hospital discharge versus historical controls treated with C-CPR in OHCA.

Hypothesis: The withholding/delay of positive pressure ventilation can improve out of hospital adult primary cardiac arrest survival. Methods: All adult primary cardiac arrest victims in a single municipal (Sate of Florida) Fire/Rescue service in whom resuscitation attempts were made were initially given chest compressions only. Positive pressure ventilation was withheld until the first of either 10 minutes or return of spontaneous circulation (ROSC). Continuous uninterrupted chest compressions were an integral part of the protocol. Primary cardiac arrest was defined as an arrest not felt to be due to hypoxia. The Florida State EMSTARS (EMS Tracking and Reporting System) database provided the information for statewide average ROSC. Results: Over a two-year period the ROSC and neurologically intact recovery rate was dramatically improved over Florida State average controls. The 2013 total ROSC rate was 40% (18/45) compared to a Florida State average ROSC of 16.7%. The 2014 primary cardiac arrest ROSC rate was 51.5% (17/33) with 29.4% of the ROSC patients or 15.2% of the total achieving neurologically intact survival. This compares to the 2014 Florida State average ROSC of 17.9%. Conclusion: Delayed positive pressure ventilation seems to be associated with both improved ROSC and neurologically intact survival in adult out of hospital primary cardiac arrest. Further study is warranted to determine the extent of this association.