We matched cases to controls using important predictors of surviv

We matched cases to controls using important predictors of survival (age, gender, response time, presenting cardiac rhythm, bystander CPR and regional setting), and adjusted for potential confounding through conditional multiple regression techniques and adjusting for propensity score. The matching process appeared effective as there was little change in the

estimate of association when the propensity score was added to the univariable regression model. Our findings are consistent Inhibitors,research,lifescience,medical with a number of other prehospital more information studies comparing A-CPR to conventional resuscitation [10,11,16,17]. Ong et al compared manual compressions (N=499) to A-CPR compressions (N=284) in OHCA patients and found an improved rate of ROSC (34.5% v 20.2%; AOR=1.94, 95% CI 1.38-2.72), survival to hospital admission (20.9%

v 11.1%; AOR=1.88, 95% CI 1.23-2.86) and survival to hospital discharge Inhibitors,research,lifescience,medical (9.7% v 2.9%; OR=2.27, 95% CI 1.11-4.77) [10]. In a case–control study reported by Casner et al, the proportion of patients achieving sustained ROSC was also found to be greater in the A-CPR group than the C-CPR group (39% v 29%; p=0.003) [17]. This study also found that more patients presenting in asystole or agonal rhythms had a sustained ROSC with A-CPR. These findings are consistent with our study. A study by Krep et al found the AutoPulse system to an effective and safe mechanical Inhibitors,research,lifescience,medical CPR device and useful in the management of out-of-hospital cardiac arrest [18]. However, a third study did not find improvement in outcome above C-CPR. Hallstrom et al conducted a large, multicentre randomised controlled trial comparing C-CPR to A-CPR. They reported similar proportions Inhibitors,research,lifescience,medical of patients surviving to ED (C-CPR 41.3% v A-CPR 40.4%) but a lower proportion of A-CPR being discharged from hospital alive (9.9% v 5.8%; OR=0.56; P=0.06) [11]. The current European Resuscitation Council Guidelines [5] identify that clinical trials investigating the role of mechanical devices to date have been conflicting. They conclude that mechanical devices have been used effectively to support patients Inhibitors,research,lifescience,medical in special circumstances (i.e. undergoing primary coronary intervention and CT scans,

and also for prolonged resuscitation attempts) where rescuer fatigue may impair the effectiveness of manual chest compression. Whilst cautioning that the role of mechanical devices still require further evaluation, they acknowledge that mechanical devices may also have a role in the prehospital environment where Brefeldin_A extrication of patients, resuscitation in confined spaces and movement of patients on a trolley often preclude effective manual chest compressions [5]. Several studies have shown that survival from OHCA is much lower in rural areas than urban areas [12,19]. One study showed Urban patients with bystander-witnessed cardiac arrest were more likely to arrive at an emergency department with a cardiac output (odds ratio [OR], 2.92; 95% CI, 1.65–5.17; P<0.

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