This observational study included 97,439 adult non-traumatic out-of-hospital cardiac arrest records, comparing ITD alone, ITD with active compression-decompression, and neither device. ITD alone was associated with higher return of spontaneous circulation than neither device (26.7% versus 23.8%; adjusted odds ratio 1.09 [1.04, 1.14]). However, survival to discharge was lower with ITD alone (23.9% versus 32.0%; adjusted odds ratio 0.68 [0.61, 0.76]). Discharge home, used as the favorable neurologic outcome, showed a similar adverse association. Disposition outcomes were available for only 13,026 patients, limiting interpretation of longer-term associations.
ITD use was associated with better early resuscitation outcomes but lower survival to discharge. These observational findings do not establish benefit or harm, particularly given incomplete disposition data.
Study limitation: Incomplete disposition follow-up and potential residual confounding limit causal interpretation; discharge home was the proxy for favorable neurologic outcome.
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