Real-time audio-visual feedback with handheld nonautomated external defibrillator devices during cardiopulmonary resuscitation for in-hospital cardiac arrest: A meta-analysis
Andrew C Miller1, Kiyoshi Scissum2, Lorena McConnell2, Nathaniel East3, Amir Vahedian-Azimi4, Kerry A Sewell5, Shahriar Zehtabchi6
1 Department of Emergency Medicine, Nazareth Hospital, Philadelphia College of Osteopathic Medicine, Philadelphia, PA, USA
2 Department of Emergency Medicine, East Carolina University, Greenville, NC, USA
3 Department of East Carolina University Brody School of Medicin, East Carolina University, Greenville, NC, USA
4 Trauma Research Center, Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran, Iran
5 William E. Laupus Health Sciences Library, East Carolina University, Greenville, NC, USA
6 Department of Emergency Medicine, State University of New York Downstate Health Sciences University, Brooklyn, NY, USA
Dr. Andrew C Miller
Department of Emergency Medicine, Nazareth Hospital, 2601 Holme Ave, 3rd Floor, Marian Building, Philadelphia 19152, PA
Source of Support: None, Conflict of Interest: None
Objective: Restoring cardiopulmonary circulation with effective chest compression remains the cornerstone of resuscitation, yet real-time compressions may be suboptimal. This project aims to determine whether in patients with in-hospital cardiac arrest (IHCA; population), chest compressions performed with free-standing audiovisual feedback (AVF) device as compared to standard manual chest compression (comparison) results in improved outcomes, including the sustained return of spontaneous circulation (ROSC), and survival to the intensive care unit (ICU) and hospital discharge (outcomes).
Methods: Scholarly databases and relevant bibliographies were searched, as were clinical trial registries and relevant conference proceedings to limit publication bias. Studies were not limited by date, language, or publication status. Clinical randomized controlled trials (RCT) were included that enrolled adults (age ≥ 18 years) with IHCA and assessed real-time chest compressions delivered with either the standard manual technique or with AVF from a freestanding device not linked to an automated external defibrillator (AED) or automated compressor.
Results: Four clinical trials met inclusion criteria and were included. No ongoing trials were identified. One RCT assessed the Ambu CardioPump (Ambu Inc., Columbia, MD, USA), whereas three assessed Cardio First Angel™ (Inotech, Nubberg, Germany). No clinical RCTs compared AVF devices head-to-head. Three RCTs were multi-center. Sustained ROSC (4 studies, n = 1064) was improved with AVF use (Relative risk [RR] 1.68, 95% confidence interval [CI] 1.39–2.04), as was survival to hospital discharge (2 studies, n = 922; RR 1.78, 95% CI 1.54–2.06) and survival to hospital discharge (3 studies, n = 984; RR 1.91, 95% CI 1.62–2.25).
Conclusion: The moderate-quality evidence suggests that chest compressions performed using a non-AED free-standing AVF device during resuscitation for IHCA improves sustained ROSC and survival to ICU and hospital discharge.
Trial Registration: PROSPERO (CRD42020157536).