Quantitative effects of mechanical cardiopulmonary resuscitation devices in rural American emergency medical services: a retrospective cohort study.

BACKGROUND

Emergency medical service agencies increasingly utilize medical devices which perform external chest compressions during cardiac arrest. Due to the unique staffing and budget considerations of the rural emergency medical services environment, an investigation of mechanical cardiopulmonary resuscitation in this setting is warranted. Studying the effects of new technologies in the rural environment promotes improvement of the standard of rural prehospital care. This study evaluated the effect of mechanical cardiopulmonary resuscitation use on rural out-of-hospital cardiac arrest performance measures.

METHODS

Five hundred eighty-five rural cardiac arrests were assessed from National Emergency Medical Services Information System 2017-2019 data. Using both linear and logistic multivariate regression analysis, the effect of mechanical cardiopulmonary resuscitation on the incidence of a return of spontaneous circulation, the first defibrillation interval, and the first cardiac epinephrine administration interval was assessed.

RESULTS

In rural cardiac arrest with initial presentation of a shockable rhythm, the use of mechanical cardiopulmonary resuscitation devices delayed initial defibrillation by 21.5% (p < 0.05). A 15.1% (p < 0.05) delay in first administration of epinephrine was also found when mechanical cardiopulmonary resuscitation was used. Incidence of return of spontaneous circulation was unchanged between manual and mechanical cardiopulmonary resuscitation conditions.

CONCLUSIONS

Current rural mechanical cardiopulmonary resuscitation device use can have a negative effect on prompt delivery of vital interventions. Our findings suggest that improvements to equipment training may help remedy improper utilization of mechanical cardiopulmonary resuscitation devices. Delaying application of mechanical cardiopulmonary resuscitation devices until time-sensitive interventions are complete may result in a better standard of care. Proper use of mechanical cardiopulmonary resuscitation devices may help to overcome inherent difficulties faced by rural prehospital clinicians.