Supervivencia, calidad de vida y deterioro cognitivo de la parada cardiorrespiratoria asociada a la aplicación de cardiocompresión externa automática

Resumo

European Research Council (ERC) Guidelines 2105 confirm the importance of performing high-quality chest compressions during Cardiopulmonary Resuscitation (CPR). Following the latest Utstein recommendations, Glasgow-Pittsburgh Outcome Categories (OPC-CPC) is recommended when assessing the neurological status and health-related quality of life. The best values of cerebral perfusion achieved by the LUCAS_2 system in contrast with chest manual compression reported in research carried out in swine and humans, led us to determine the objective of this study: employing LUCAS device during out-of-hospital Cardiopulmonary Resuscitation (OHCPR) would increase the survival of the resuscitated subjects, would improve their perception of their health-related quality of life by employing the SF-12 Health Survey, and would minimise the mental status according to Pfeiffer Short Portable Mental Status Questionnaire (SPMSQ). A multicentre prospective study with consecutive OHCPR cases attended by Emergency Medical Services Andalusia (EMS) was undertaken, both with chest manual compression and LUCAS system. All male and female aged 18 years and older who received OHCPR by the EMS diagnosed with cardiorespiratory arrest of probable cardiac etiology for the period 1 September 2014 to 31 August 2015 were included. The sample consisted of 967 cases, of which 130 were included in LUCAS group and 837 in manual compression group. Both groups were very homogeneous regarding previous factors of comorbidity. The results in this study show an in situ survival rate of 31.54% in LUCAS group in contrast with 33.81% in manual compression group, with no statistical difference. A two-month follow-up survival at hospital discharge reported 24.39% and 36.75% for Lucas and manual compression groups respectively. Whereas such difference proves as not statistically significant in univariate analysis, on applying the Cox model it shows that mechanical compressions become a risk factor with a statistically significant result. Regarding health-related quality of life by employing the SF-12 Health Survey although patients in both groups have showed similar values in their mental summary component (MSC), results have been statistically significant for those patients treated with LUCAS device, since they have shown greater limitations regarding their physical performance. These data differ from the Glasgow-Pittsburgh Outcome Categories gathered at hospital discharge, which reveal that OPC-CPC ≤ 2 correspond with a good overall and neurological result. This minor dysphasia, a non-disabling hemiparesis, the presence of hemiplegia, ataxia, dysarthria, or permanent mental changes, admitted in CPC ≤ 2 and accepted as a “good neurologic outcome”, may not be considered so by the patient. Pfeiffer Short Portable Mental Status Questionnaire revealed that almost 91% of patients resuscitated by EMS did not show a significant alteration of their cognitive functions. Thus, the use of mechanical compression has not necessarily entailed a benefit. In conclusion, the results in this study revealed that mechanical chest compression carried out by LUCAS system to patients with an OHCPR attended by EMS, in contrast with chest manual compression under the guidelines of the European Research Council, does not improve in situ or two-month follow-up patient survival or their health-related quality of life. In addition, it does not minimise either the cognitive impairment of resuscitated patients interviewed in the two-month follow-up at hospital discharge.