Cardiopulmonary Resuscitation Without Aortic Valve Compression Increases the Chances of Return of Spontaneous Circulation in Out-of-Hospital Cardiac Arrest: A Prospective Observational Cohort Study

Sheng-En Chu; Chun-Yen Huang; Chiao-Yin Cheng; Chun-Hsiang Chan; Hsuan-An Chen; Chin-Ho Chang; Kuang-Chau Tsai; Kuan-Ming Chiu; Matthew Huei-Ming Ma; Wen-Chu Chiang; Jen-Tang Sun

doi:10.1097/CCM.0000000000006336

Cardiopulmonary Resuscitation Without Aortic Valve Compression Increases the Chances of Return of Spontaneous Circulation in Out-of-Hospital Cardiac Arrest: A Prospective Observational Cohort Study

Crit Care Med. 2024 May 23. doi: 10.1097/CCM.0000000000006336. Online ahead of print.

Authors

Sheng-En Chu^{1

2

3}, Chun-Yen Huang¹, Chiao-Yin Cheng^{1

4}, Chun-Hsiang Chan⁵, Hsuan-An Chen¹, Chin-Ho Chang⁶, Kuang-Chau Tsai¹, Kuan-Ming Chiu^{7

8}, Matthew Huei-Ming Ma^{3

9}, Wen-Chu Chiang^{3

9}, Jen-Tang Sun^{1

10}

Affiliations

¹ Department of Emergency Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan.
² Institute of Emergency and Critical Care Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
³ Department of Emergency Medicine, National Taiwan University Hospital Yun-Lin Branch, Douliu City, Taiwan.
⁴ Graduate Institute of Applied Science and Engineering, Fu Jen Catholic University, New Taipei City, Taiwan.
⁵ Department of Geography, National Taiwan Normal University, Taipei, Taiwan.
⁶ Statistical Consulting Unit, National Taiwan University Hospital, Taipei, Taiwan.
⁷ Division of Cardiovascular Surgery, Cardiovascular Center, Far Eastern Memorial Hospital, New Taipei City, Taiwan.
⁸ Department of Electrical Engineering, Yuan Ze University, Taoyuan, Taiwan.
⁹ Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan.
¹⁰ Department of Nursing, Jenten Junior College of Medicine, Nursing and Management, Miaoli County, Taiwan.

PMID: 38780398
DOI: 10.1097/CCM.0000000000006336

Abstract

Objectives: Following current cardiopulmonary resuscitation (CPR) guidelines, which recommend chest compressions at "the center of the chest," ~50% of patients experiencing out-of-hospital cardiac arrest (OHCA) undergo aortic valve (AV) compression, obstructing blood flow. We used resuscitative transesophageal echocardiography (TEE) to elucidate the impact of uncompressed vs. compressed AV on outcomes of adult patients experiencing OHCA.

Design: Prospective observational cohort study.

Setting: Single center.

Patients: This study included adult OHCA patients undergoing resuscitative TEE in the emergency department. Patients were categorized into AV uncompressed or AV compressed groups based on TEE findings.

Interventions: None.

Measurements and main results: The primary outcome was sustained return of spontaneous circulation (ROSC). The secondary outcomes included end-tidal co2 (Etco2) during CPR, any ROSC, survival to ICU and hospital discharge, post-resuscitation withdrawal, and favorable neurologic outcomes at discharge. Additional analyses on intra-arrest arterial blood pressure (ABP) were also conducted. The sample size was pre-estimated at 37 patients/group. From October 2020 to January 2023, 76 patients were enrolled, 39 and 37 in the AV uncompressed and AV compressed groups, respectively. Intergroup baseline characteristics were similar. Compared with the AV compressed group, the AV uncompressed group had a higher probability of sustained ROSC (53.8% vs. 24.3%; adjusted odds ratio [aOR], 4.72; p = 0.010), any ROSC (56.4% vs. 32.4%; aOR, 3.30; p = 0.033), and survival to ICU (33.3% vs. 8.1%; aOR, 6.74; p = 0.010), and recorded higher initial diastolic ABP (33.4 vs. 11.5 mm Hg; p = 0.002) and a larger proportion achieving diastolic ABP greater than 20 mm Hg during CPR (93.8% vs. 33.3%; p < 0.001). The Etco2, post-resuscitation withdrawal, and survival to discharge revealed no significant intergroup differences. No patients were discharged with favorable neurologic outcomes. Uncompressed AV seemed critical for sustained ROSC across all subgroups.

Conclusions: Absence of AV compression during OHCA resuscitation is associated with an increased chance of ROSC and survival to ICU. However, its effect on long-term outcomes remains unclear.