Manual chest compression versus automated chest compression device during day-time and night-time resuscitation following out-of-hospital cardiac arrest: A retrospective historical control study

Background Although the resuscitation guidelines consider mechanical chest compressions acceptable for cardiopulmonary resuscitation (CPR) in unstable settings, the efficacy of automated chest compression devices for out-of-hospital cardiac arrest (OHCA) patients according to treatment time period remains unclear. We assessed the effectiveness of automated chest compression devices depending on time of admission based on frequency of iatrogenic chest injuries, duration of in-hospital resuscitation efforts, and clinical outcomes among OHCA patients. Methods We conducted a retrospective historical control study of OHCA patients in Japan between April 1, 2015 and March 31, 2022. Patients were divided according to time of admission; wherein day- and night-time were considered as duration between 07:00–22:59 and 23:00–06:59, respectively. These patients were then divided into two categories based on in-hospital cardiopulmonary resuscitation (IHCPR) device used: manual chest compression (mCC) group and automatic chest compression devices (ACCD) group. Univariate and multivariate ordered logistic regression models adjusted for pre-hospital confounders were used to evaluate the impact of ACCD use during IHCPR on outcomes [IHCPR duration, CPR-related chest injuries, and clinical outcomes] in day- and night-time groups. Results A total of 1,101 patients with OHCA (day-time, 809; night-time, 292) formed our study population. Of these, 215 (26.6%) and 104 (35.6%) patients underwent ACCD during IHCPR in day-and night-time groups. Multivariate model showed significant association of ACCD use with outcomes of in-hospital resuscitation, including higher rates of return of spontaneous circulation, lower incidence of CPR-related chest injuries, longer in-hospital resuscitation duration, survival to Emergency Department and hospital discharge, and survival with good neurological outcome to hospital discharge, only in the night-time group. Conclusions Patients who underwent ACCD during in-hospital resuscitation at night had a significantly longer duration of in-hospital resuscitation, lower incidence of CPR-related chest injuries, and better outcomes.